What Is Inflammatory Bowel Disease (IBD)?

More than 2.4 million people in the U.S. have inflammatory bowel disease (IBD), and cases are on the rise. Some people defer help because they’re uncomfortable talking about symptoms, but IBD is a chronic condition that needs to be managed long-term.

IBD is an autoimmune disorder that causes the immune system to attack the gastrointestinal tract. Crohn’s disease and ulcerative colitis fall under the umbrella of IBD, both leading to inflammation in the intestines. It’s often confused with irritable bowel syndrome or IBS, because symptoms can be similar. However, IBS does not result in inflammation of the GI tract.

“With IBS, patients will have bloating, diarrhea, constipation, abdominal pain, but there’s no inflammation present when we do an evaluation such as imaging or endoscopy,” said Jill Gaidos, MD, Gastroenterologist, Associate Professor of Medicine in the section of Digestive Diseases and the Medical Director of the Yale Inflammatory Bowel Diseases Program.

Symptoms of inflammatory bowel disease

Crohn’s disease can have symptoms that overlap with IBS, including:

• Abdominal pain
• Bloating
• Diarrhea
• Fevers
• Loss of appetite
• Weight loss
• Malnutrition

Ulcerative colitis may also involve blood in bowel movements, which should prompt a visit to the doctor. Other red flags include weight loss, having to restrict your diet or lab abnormalities such as anemia or B12 deficiencies which may signal the body isn’t absorbing nutrients.

Family history is the biggest risk factor and over 200 genes have been identified as having an association with IBD. Dr. Gaidos says it’s believed IBD is then triggered when patients are exposed to something that turns on the immune system, leading to inflammation.

“It’s important that patients understand that there is a genetic predisposition already there, and so there was nothing they could do to prevent IBD. Essentially, it’s not anything they did to cause this,” she said.

How to treat IBD

Left untreated, Crohn’s disease can lead to the development of strictures (or a narrowing) in the GI tract or fistulas due to persistent inflammation. In patients with ulcerative colitis, there is a risk of dilation of the colon, which can lead to a perforation or hole in the colon. Untreated inflammation can also lead to cancer with both.

Diet can trigger symptoms for some patients, and there is benefit in patients eating a balanced plant-forward diet, with less reliance on processed foods. However, diet changes alone won’t treat the inflammation caused by IBD.

Sometimes surgery for ulcerative colitis, which involves removal of the colon, is an option for patients. However, Dr. Gaidos says typically there are several other options that patients can try first, which may include injections, IV therapies or oral medications.

“There’s been a big boom in treatment options for inflammatory bowel disease. It’s been very exciting, particularly for patients who’ve already been on everything and need something else,” said Dr. Gaidos.

However, once inflammation is under control, patients don’t stop taking their medication. Treating IBD is like treating other chronic conditions such as diabetes or high blood pressure.

“When we talk about starting therapy, people think, ‘OK how long do I need to be on this?’ And really the answer is as long as it’s working for you,” said Dr. Gaidos. “We keep you on it because in most patients, when you stop taking therapy, their inflammation will eventually come back.”