Inflammatory Bowel Disease (IBD): Causes, Symptoms, and Treatment

Inflammatory Bowel Disease (IBD): Causes, Symptoms, and Treatment

Inflammatory Bowel Disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease, is a chronic, relapsing condition caused by the immune system mistakenly attacking the intestinal lining. It significantly affects quality of life, especially in young adults, and requires a multidisciplinary approach for both medical and surgical management.

What is IBD?

IBD occurs due to immune system dysregulation that leads to persistent inflammation in the intestinal mucosa. The condition is linked to genetic predisposition, environmental triggers, and gut microbiota imbalances.

What are the types of IBD?

There are two main forms of IBD:

  • Ulcerative Colitis: Inflammation is limited to the mucosal layer of the colon; commonly presents with bloody stools.
  • Crohn’s Disease: Can affect any part of the gastrointestinal tract from mouth to anus; typically presents with abdominal pain, diarrhea, and weight loss.

Prevalence and Risk Factors

Globally, IBD affects an estimated 7 million people, and its prevalence is increasing in both developed and developing countries. Major risk factors include genetic predisposition, smoking, antibiotic use, Western-style diet, and chronic stress.

What are the symptoms?

Common symptoms of IBD include:

  • Chronic diarrhea
  • Cramping abdominal pain
  • Sudden weight loss, loss of appetite
  • Fever and fatigue attacks
  • Perianal fistulas and abscesses (more common in Crohn’s)

How is IBD diagnosed?

Standard diagnostic tools include advanced endoscopy, colonoscopy, MR enterography, and stool calprotectin testing. 2025 treatment guidelines emphasize the importance of histopathological confirmation via biopsy and screening for complications.

How is IBD treated?

5-ASA / Mesalazine

First-line therapy for mild to moderate cases; available in oral tablets, enemas, or suppositories.

Immunomodulators

Azathioprine, mercaptopurine, or methotrexate help reduce steroid dependence; treatment response is assessed after 3–6 months.

Biologic and Targeted Therapies

  • Anti-TNF agents: Infliximab, adalimumab
  • Anti-IL-12/23 & Anti-IL-23: Ustekinumab, risankizumab
  • JAK inhibitors: Tofacitinib and upadacitinib

These drugs reduce steroid dependence and improve mucosal healing rates.

Surgical Approaches

In emergencies like toxic megacolon (UC) or fistulas/strictures (Crohn’s), surgical options such as segmental resection or proctocolectomy may be necessary. Advanced laparoscopic techniques shorten recovery times.

Supportive and Lifestyle Approaches

Combinations of prebiotics, probiotics, and postbiotics can be taken orally or delivered via endoscopy for additional gut support.

Follow-Up and Complication Management

Routine colonoscopy, dysplasia screening, and bone density monitoring (especially in steroid-treated patients) are recommended. Immunization schedules (Influenza, HBV, HPV) should be kept up-to-date for immunosuppressed individuals.

Preventive Recommendations

The following measures may help prevent IBD flare-ups:

  • Quitting smoking (improves prognosis in Crohn’s disease)
  • Limiting dietary fiber during flare-ups
  • Avoiding over-the-counter NSAIDs
  • Iron and B12 supplementation under medical supervision

Frequently Asked Questions About Inflammatory Bowel Disease (IBD)

  1. Is IBD hereditary? Genetic predisposition is important, but environmental factors also play a role in disease development.
  2. Which age group is most commonly affected? It most often begins between the ages of 15 and 40, but it can also be diagnosed later in life.
  3. Can stress trigger the disease? Stress alone does not cause IBD, but it can aggravate existing inflammation.
  4. Can IBD lead to cancer? Long-standing active ulcerative colitis can increase the risk of colorectal cancer. Regular screenings are essential.
  5. Is treatment safe during pregnancy? In planned pregnancies, most 5-ASA drugs and some biologics can be used safely—always consult your physician.
  6. What dietary changes are recommended? Fermented foods, omega-3 fatty acids, and gluten-free whole grains are encouraged. Personal intolerances should be considered.
  7. Do probiotics really help? Pre-/probiotic combinations, especially those containing B. infantis, may help prolong remission periods.
  8. When should biologic therapy be started? In moderate-to-severe disease, biologics are considered when conventional therapy fails or corticosteroid dependence occurs.
  9. Can the disease recur after surgery? Yes, in Crohn’s disease there is a risk of recurrence. Prophylactic medication may be planned postoperatively.

Sources:

  • Mayo Clinic
  • Cleveland Clinic
  • Johns Hopkins Medicine
  • NHS
  • World Health Organization
  • American College of Gastroenterology
  • European Crohn’s and Colitis Organisation (ECCO)
  • UpToDate
  • Medscape
  • PubMed Central
  • Nature
  • FDA
  • Harvard Health
  • Stanford Health
  • Verywell Health
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