Inflammatory bowel disease

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a term for conditions that cause your digestive system to become inflamed, leading to severe tummy pain and diarrhoea. The two main types are Crohn's disease and ulcerative colitis, and while IBD is long-term, treatments can help control your symptoms.

Symptoms of inflammatory bowel disease

Symptoms of IBD range from mild to severe and tend to come and go. You may have flare-ups when symptoms are active, followed by periods of remission when they ease or disappear. Symptoms can include:

• diarrhoea that lasts longer than 4 weeks, sometimes with blood or mucus
• severe or chronic cramping pain in your tummy
• bleeding from your bottom
• feeling tired all the time
• losing weight without trying
• fever, particularly during a flare-up
• a frequent, urgent need to go to the toilet, even when your bowel is empty.

IBD can also affect other parts of your body, causing joint pain, skin rashes, or eye inflammation.

Causes of inflammatory bowel disease and who is at risk

It's not clear exactly what causes IBD. It happens when your immune system attacks your bowel, causing it to become inflamed, though why this happens isn't fully understood.

You may be more likely to develop IBD if you:

• have a close relative with IBD, such as a parent, grandparent or sibling, since genetics seem to play a role
• smoke, which is linked to a higher risk of Crohn's disease
• are of Jewish (Ashkenazi) or Hispanic and non-Hispanic white heritage, which some studies link to higher rates
• are over 45, though IBD can develop at any age.

IBD is common. Around 1 in 123 people in the UK have Crohn's disease or ulcerative colitis.

Are there different types of inflammatory bowel disease?

Yes, the two main types of IBD are:

• Ulcerative colitis: This affects the large intestine and rectum, causing continuous inflammation and small ulcers along the lining
• Crohn's disease: This can affect any part of the digestive system from the mouth to the anus, usually in patches with normal tissue in between – it most often affects the small intestine.

Both cause similar symptoms, and your doctor will use tests to work out which type you have.

How inflammatory bowel disease is diagnosed

Your doctor will ask about your symptoms and medical history, and examine you. You'll usually have blood tests and a stool sample to check for inflammation, bleeding or anaemia.

You may also need a colonoscopy or sigmoidoscopy, where a thin, lighted camera is passed into your bowel under sedation to look at the lining and take a small tissue sample. Other tests can include an upper endoscopy, a capsule endoscopy using a tiny camera you swallow, or scans such as a CT or MRI.

How inflammatory bowel disease is treated

Non-surgical treatment

Treatment depends on your symptoms and which type of IBD you have, and usually starts with medicines to reduce inflammation and control flare-ups:

• Aminosalicylates: These are taken by mouth or inserted into the rectum, most often used for ulcerative colitis
• Corticosteroids: These are strong anti-inflammatory drugs used for short periods to bring flare-ups under control
• Immunomodulators: These calm an overactive immune system and can be taken long-term
• Biologics: These are newer medicines that target specific proteins involved in inflammation.

Your doctor may also suggest changes at home, such as adjusting your diet, managing stress, stopping smoking, and taking vitamin or mineral supplements if you're not getting enough nutrients from food. Talking therapies can also help you cope with the emotional impact of living with IBD.

Surgical treatment

Surgery may be an option if medicines aren't controlling your symptoms well enough.

For Crohn's disease, this might involve removing the damaged section of bowel and rejoining the healthy ends, or removing the large intestine and rectum and creating an opening in your tummy, called a stoma, for waste to leave the body.

Surgery doesn't cure Crohn's disease, and more than half of people with the condition need surgery within 20 years of diagnosis.

For ulcerative colitis, removing the entire large intestine and rectum can cure the condition. Afterwards, waste either leaves through a stoma, or your surgeon creates an internal pouch so you can pass stool in the usual way.

Almost 1 in 3 people with ulcerative colitis need surgery at some point.

When to see a doctor

See a GP if you have:

• diarrhoea that lasts more than 7 days
• tummy pain or bloating that won't go away or keeps coming back
• blood or mucus in your poo
• weight loss that you can't explain.

Call 999 or go to A&E immediately if you have severe tummy pain, non-stop bleeding from your bottom, a lot of blood in the toilet or large blood clots, or you're vomiting blood or your sick looks like coffee grounds.