IBD: Commonplace symptoms belie more serious health threat
Abdominal cramps or diarrhea don’t often point to something serious. But for millions of sufferers around the world, these routine-like symptoms turn out to be a more serious digestive disorder known as Inflammatory Bowel Disease (IBD).
Most people shrug off the occasional bout of diarrhea or abdominal cramps. After a few unpleasant days, the symptoms will clear up on their own and life will return to normal. But not always.
When symptoms clear up briefly but then return, or whenthey persist without relief, this may actually indicate something more serious – a chronic condition affecting millions of people worldwide known as inflammatory bowel disease, or IBD.
To learn more about IBD, we sought the expertise of Dr. Sinn Anuras, Bumrungrad’s Group Medical Director and a US-board certified gastroenterologist and hepatologist. Dr. Sinn has treated many IBD patients during his 30-year medical career.
What is IBD?
“We don’t have a specific word in Thai for inflammatory bowel disease,” says Dr. Sinn. “Several conditions that have similar symptom profiles are grouped together under a category called chronic inflammatory bowel ailments. The category doesn’t include acute bowel inflammation, a condition which is caused by a virus, bacteria or parasite and can be treated successfully with antibiotics.”
The exact cause of IBD isn’t known, but it’s marked by inflammation in either or both the small intestine and the large intestine. IBD is comprised of two main disorders: Crohn’s disease (CD) and ulcerative colitis (UC). “Both conditions are more prevalent in western countries and the Middle East,” notes Dr. Sinn. “They’re both prevalent in Asia, but the rate of incidence across the region is lower. As a consequence of this, the general public doesn’t hear much about IBD. Doctors generally won’t have much experience diagnosing and treating IBD, and many may not have been trained to recognize the role that ethnic differences can have in causing symptom variations.”
Here’s a more detailed look at the two main IBD conditions:
Crohn’s disease (CD)
Crohn’s disease is a chronic inflammatory bowel disorder affecting the gastrointestinal tract. While the GI tract extends all the way from the mouth to the anus, CD typically affects the area from the lower smaller intestine to the upper part of the colon (large intestine).
The inflammation resulting from Crohn’s disease leads to several painful conditions, including:
• Bowel wall abscess: An abscess is a collection of liquefied tissue called pus that forms while the bowel undergoes self-repair. During this process, inflammation triggers the formation of abscesses which may cause a blockage of the intestinal tunnel;
• Fistulas: Fistulas are abnormal openings or passageways that connect two organs or body cavities (e.g. bladder and vagina) that are not supposed to be connected;
• Intestinal inflammation: Inflammation can lead to the formation of tissue masses in areas inside the smalland large intestines.
Ulcerative colitis (UC)
Ulcerative colitis can be a serious, potentially-fatal disease that causes inflammation in the wall of the colon. Symptoms range from bloody defecation and high fever to fatigue and unexplained weight loss; some patients experience inflammation of the liver, eyes and joints.
Ulcerative colitis usually responds to treatment. “Once the inflammation is brought under control, patients can live a normal life,” notes Dr. Sinn.
Correctly diagnosing IBD is quite difficult thanks to Crohn’s disease and ulcerative colitis producing many of the same symptoms. “It can be difficult to spot the difference between the two conditions based on symptoms alone,” Dr. Sinn explains. “In their early stages, both CD and UC cause abdominal pain and diarrhea. In severe cases, patients may have to defecate more than 10 times a day around the clock, and sometimes interrupting a good night’s sleep. Both diseases can lead to blood in stools, bouts of high fever and loss of weight resulting from the body’s inability to absorb nutrients.”
Dr. Sinn describes the complex process that may be necessary to yield an accurate diagnosis: “A patient’s condition is termed chronic when symptoms continue for more than two weeks and prove unresponsive to medication. Laboratory stool testing may be used to detect the presence of an infection or inflammation. If no infection is found, a colonoscopy and a CT scan may be needed to determine the patient’s condition and the location of the affected area. Laboratory testing of tissue samples from the patient’s intestines may be needed to confirm the diagnosis and determine the specific disease type.”
Living with IBD means dealing with daily challenges that can greatly affect a patient’s quality of life, especially considering the frequent need to defecate and the resulting loss of blood and important nutrients. It can certainly affect a patient’s quality of life with complications including anemia.
In the case of both CD and UC, when chronic inflammation goes undiagnosed and untreated, patients are at a higher risk for developing colorectal cancer.
Treatments for IBD
Medication is the primary first-line treatment for the two IBD conditions.
“After confirming the diagnosis, a doctor will usually prescribe anti-inflammatory medication,” Dr. Sinn explains.
“As the inflammation subsides, symptoms will dissipate and the illness enters a state of remission. Patients will need to be examined by their doctor at regular intervals. Patient compliance – especially adhering to instructions for taking medication – is the best way to prevent a recurrence of IBD, just as it is for managing other chronic conditions.”
Not all patients are good candidates for medication – notably those with other, co-existing health problems. For these patients, and for those who haven’t responded to treatment with medication, surgery may be the next best option.
“Surgery may be recommended for treating ulcerative colitis, since the disease is confined within the colon,” Dr. Sinn explains. “But Crohn’s disease affects both intestines; surgery is generally not recommended except where connective tissues have narrowed a patient’s bowel tunnels, which makes it harder for food to pass through the narrower lumen.”
Dedicated IBD Clinic
Specialized knowledge and training are all the more important in light of IBD’s nondescript symptom profile and variability related to patient ethnicity and disease genotype. “More attention is being paid to IBD in Thailand in recent years,” notes Dr. Sinn. “At Bumrungrad, we’ve treated more than 300new cases of IBD patients, including Thais and patients coming from Asia, Europe, North America and the Middle East. We reached a point where our significant expertise and the growing volume of patients justified having a dedicated IBD Clinic. Patients certainly appreciate the greater convenience, and it has helped raise awareness about IBD.
“Our medical team has extensive IBD training and experience using advanced procedures and technologies, so patients know they’ll enjoy an international standard of care. The specialty clinic is also an important source for data that can be studied and added to the knowledge base among medical professionals in Thailand and overseas.”
While IBD and other chronic diseases can last a lifetime, patients don’t have to give up their hope of enjoying a good quality of life. If you know IBD’s symptoms and take appropriate action when faced with those symptoms, you will be in a much better position to bring the condition under control.