Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.
The digestive tract comprises the:
- small intestine
- large intestine
It’s responsible for:
- breaking down food
- extracting nutrients
- removing any unusable material and waste products
Inflammation anywhere along the digestive tract interferes with this normal process. IBD can be very painful and disruptive. In rare cases, it may even be life threatening.
Learn all about IBD, including:
- the different types
- what causes it
- its complications
The Crohn’s & Colitis Foundation of America (CCFA) estimates that
Many diseases are included under the umbrella term IBD. The two most common ones are:
- Ulcerative colitis (UC). This involves inflammation of the large intestine — but only in the digestive tract. It can lead to other non-digestive issues.
- Crohn’s disease. This can cause inflammation in any part of the digestive tract. However, it mostly affects the tail end of the small intestine.
Symptoms of IBD vary depending on the location and severity of inflammation, but they may include:
- diarrhea, which occurs when affected parts of the bowel cannot reabsorb water
- bleeding ulcers, which may cause blood to show up in the stool (a condition known as hematochezia)
- stomach pain, cramping, and bloating due to bowel obstruction
- weight loss and anemia, which can cause delayed physical growth or development in children
IBD can also be associated with problems outside of the digestive system, such as:
The exact cause of IBD is unknown.
Family history and genetics
People who have a parent, sibling, or child with IBD are at a much higher risk of developing it themselves. This is why scientists believe IBD
The immune system
The immune system may also play a role in IBD.
The immune system normally defends the body from pathogens, which are organisms that cause diseases and infections.
A bacterial or viral infection of the digestive tract can trigger an immune response. The digestive tract becomes inflamed as the body tries to create an immune response against the invaders.
In a healthy immune response, the inflammation goes away when the infection is gone.
In people with IBD, however, digestive tract inflammation can occur even when there’s no infection. The immune system attacks the body’s own cells instead. This is known as an autoimmune response.
IBD can also occur when the inflammation doesn’t go away after the infection is cured. The inflammation may continue for months or even years.
Smoking is one of the main risk factors for developing Crohn’s disease. Smoking also aggravates the pain and other symptoms associated with Crohn’s disease. It increases the risk for complications too.
However, UC primarily affects nonsmokers and former smokers.
IBD rates are also rising among Black people in the United Kingdom, especially young people, according to a 2011 study conducted by Crohn’s and Colitis UK. The research involved young people between the ages of 16 and 24 years, since IBD symptoms tend to present at a younger age in 20 to 25 percent of people.
IBD can happen at any age, but in most cases, it starts before age 35.
People who live in urban areas and industrialized countries have a higher risk of developing IBD, according to
Residents of industrialized countries also tend to eat more fat and processed food, which has been shown to be connected to the development of IBD, according to a
IBD is also
On the other hand, some studies, including a
IBD tends to affect men and women equally.
According to a 2018 study, UC is generally more common among men over 45 years old than it is among women of the same age range.
On the other hand, Crohn’s disease is more common among girls and women over the age 14.
Possible complications of IBD include:
- malnutrition with resulting weight loss
- colorectal cancer
- fistulas, or tunnels that go through the bowel wall, creating a hole between different parts of the digestive tract
- intestinal rupture, which is also known as perforation
- bowel obstruction
To diagnose IBD, your doctor will first ask you questions about your family’s medical history and your bowel movements.
A physical exam may then be followed by one or more diagnostic tests.
Stool sample and blood test
Stool samples and blood tests can be used to look for infections and other diseases.
Blood tests can also sometimes be used to distinguish between UC and Crohn’s disease. However, blood tests alone cannot be used to diagnose IBD.
A barium enema is an X-ray exam of the colon and small intestine. In the past, this type of test was often used, but now, other tests have largely replaced it.
Flexible sigmoidoscopy and colonoscopy
These procedures use a camera on the end of a thin, flexible probe to look at the colon.
The camera is inserted through the anus. It allows your doctor to look for ulcers, fistulas, and other damage or abnormalities in the rectum and colon.
During these procedures, a small sample of the tissue inside the intestine will sometimes be taken. This is called a biopsy. This sample can be examined under a microscope and used to diagnose IBD.
This test inspects the small intestine, which is much harder to examine than the large intestine. For the test, you swallow a small capsule containing a camera.
The camera takes pictures as it moves through your small intestine. Once you’ve passed the camera in your stool, the pictures can be seen on a computer.
This test is only used when other tests have failed to find the cause of Crohn’s disease symptoms.
Plain film or X-ray
A plain abdominal X-ray is used in emergency situations where intestinal rupture is suspected.
CT and MRI scans
CT scans are basically computerized X-rays. They create a more detailed image than a standard X-ray. This makes them useful for examining the small intestine. They can also detect complications of IBD.
MRIs use magnetic fields to form images of the body. Since they don’t require radiation, they’re safer than X-rays. MRIs are especially helpful in examining soft tissues and detecting fistulas.
Both CT scans and MRIs can be used to determine how IBD affects much of the intestine.
There are a number of different treatments for IBD.
Anti-inflammatory drugs are the first step in IBD treatment. These drugs help decrease inflammation of the digestive tract. However, they have many side effects.
- budesonide (Uceris)
- prednisone (Prednisone Intensol, Rayos)
- prednisolone (Millipred, Prelone)
- methylprednisolone (Medrol, Depo-Medrol)
These drugs are available in a variety of forms, including:
- oral tablets
- rectal foams
They’re usually given at the lowest dose possible for the shortest amount of time.
5-ASA drugs (aminosalicylates)
5-ASA drugs (aminosalicylates) also decrease inflammation, mainly in the last part of the small intestine and in the colon. They include:
- balsalazide (Colazal)
- mesalamine (Apriso, Asacol HD, Canasa, Pentasa)
- olsalazine (Dipentum), which is only available as a brand-name drug
- sulfasalazine (Azulfidine)
In 2019, the American Gastroenterological Association (AGA) released treatment guidelines for adults with extensive mild to moderate UC. For this group, they strongly recommended:
- standard-dose oral mesalamine
- diazo-bonded 5-ASA drugs, such as balsalazide and olsalazine
The AGA prefers these over low-dose mesalamine, sulfasalazine, or no treatment at all. However, the AGA also says it’s fine to take sulfasalazine, as long as you’re aware that it comes with the risk of more severe side effects.
People who do not respond to standard-dose mesalamine or diazo-bonded 5-ASA drugs should try a combination of rectal mesalamine and high-dose oral mesalamine.
Immunomodulators may be an effective option if corticosteroids and 5-ASA drugs aren’t enough. They prevent the immune system from attacking the bowel and causing inflammation.
The Food and Drug Administration (FDA) has not approved these drugs for the treatment of IBD. However, your doctor may prescribe them anyway. They refer to this as off-label drug use.
OFF-LABEL DRUG USE
Off-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat medical conditions in their patients.
So your doctor can prescribe a drug however they think is best for your care.
Biologics are genetically designed drugs that may be a choice for people with moderate to severe IBD.
Some biologics block tumor necrosis factor (TNF). TNF is an inflammation-triggering chemical that the immune system produces. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation.
TNF-alpha inhibitors include:
Other biologics include:
Biologics are not available as generic drugs. Biosimilars, which are cheaper and have been reverse-engineered to produce the same results as biologics, are available for some of these drugs, though.
In 2020, the AGA released treatment guidelines for people with moderate to severe UC. The guidelines recommend that people who’ve never tried a biologic before opt for infliximab or vedolizumab over adalimumab. Adalimumab is less effective.
You can self-administer adalimumab, which may make it more convenient than the other drugs. If convenience is a concern, it’s fine to choose adalimumab instead.
Other drugs block separate pathways causing inflammation and include:
- The UC drug tofacitinib (Xeljanz). The AGA recommends taking this oral drug only if you’ve tried taking tumor necrosis factor α (TNF-α) inhibitors and they aren’t successful for resolving symptoms. However, the FDA has ruled that manufacturers of this drug class, Janus kinase (JAK) inhibitors, must inform JAK inhibitor users of the severe side effects including cardiac events, cancers, and blood clots.
- Antibiotics. These kill bacteria in the small intestine that may trigger or aggravate the symptoms of Crohn’s.
- Antidiarrheal medications and laxatives. These can help keep your bowel movements regular.
Lifestyle choices are important when you have IBD.
- Drinking plenty of fluids. This helps you make up for fluids lost in your stool.
- Avoiding triggers, like dairy products and stressful situations. This can help improve symptoms and reduce flare-ups.
- Exercising and if you smoke, quitting smoking. These actions can help preserve your health if you have IBD.
Vitamin and mineral supplements can help with nutritional deficiencies. For example, iron supplements can help treat anemia.
Talk with your doctor before adding any new supplements to your diet.
Surgery can sometimes be necessary for people with IBD. Some IBD surgeries include:
- strictureplasty to widen a narrowed bowel
- closure or removal of fistulas
- removal of affected portions of the intestines — for people with Crohn’s disease
- removal of the entire colon and rectum — for severe cases of UC)
Your doctor will likely recommend a routine colonoscopy to monitor for colorectal cancer, since those with IBD have a higher risk of developing it.
You cannot prevent the hereditary causes of IBD. But you may be able to reduce your risk of developing IBD or prevent a relapse of symptoms by:
IBD can cause some discomfort, but actively following your doctor-advised treatment plan, you can manage the disease and live a healthy, active lifestyle.
Bezzy IBD is a free community that connects you with others living with IBD through 1:1 messaging and live group chats while also providing access to expert-approved information on managing IBD.
Download the app for iPhone or Android.
You can also visit the Crohn’s & Colitis Foundation for resources and more information on IBD, including UC and Crohn’s disease.
It can also be helpful to talk with others who understand what you’re going through.