World Inflammatory Bowel Disease Day 2023: Causes, symptoms and treatment for this condition

Inflammatory Bowel Disease is a chronic condition resulting from interactions between intestinal microorganisms and the immune system in susceptible individuals (Image: Canva)

Today is World Inflammatory Bowel Disease Day, also called World IBD Day. IBD is a group of chronic conditions that result in inflammation and sometimes causes damage to the gastrointestinal tract. Abdominal pain, cramps, and diarrhea that persist for several days and may even subside after months can be an indication of inflammation of the bowel.

Inflammatory Bowel Disease is a chronic condition resulting from interactions between intestinal microorganisms and the immune system in susceptible individuals. It can be classified into Crohn's Disease and Ulcerative Colitis. While both cause bowel inflammation, a distinction is made based on the site and morphological expression.

The large intestine, also known as the colon, is responsible for absorbing water and electrolytes from undigested food, forming solid waste (stool), and eliminating it from the body. The colon is divided into four parts: the ascending, transverse, descending, and the sigmoid colon, which further connects to the rectum.

Also referred to as regional enteritis, Crohn's disease may involve any area of the gastrointestinal tract, frequently targeting the ascending colon. It can lead to several symptoms and complications that may vary from person to person. It affects the entire bowel wall thickness and causes fistula formation (abnormal connections between different parts of the intestine or other organs) but may rarely affect the stomach or the oesophagus. Its clinical presentation includes diarrhea, fever, and abdominal pain.

Additionally, some people may present a history of intermittent reactivation of the disease between asymptomatic phases. Non-steroidal anti-inflammatory drugs, emotional stress, and smoking may aggravate the symptoms. Complaints of migrating joint pain are common. Further, it can result in complications such as ulcers, strictures (narrowing of the intestine), and nutritional deficiencies.

Microscopically, Crohn's disease shows characteristic 'skip lesions' - separate and delineated affected areas. Cobblestone appearance can help in differentiating it from Ulcerative Colitis.

It is commonly seen in the rectum and the sigmoid colon. Here, the superficial layers of the bowel wall get affected with fistulae formation being rare. Pseudo-polyps are small, bulging elevations of the mucosal layer that are seen on the lumen (bowel cavity). Prolonged conditions may lead to malignant changes, like cancer. It is a relapsing disorder characterised by bloody diarrhea and abdominal cramps. The attack may occasionally be so intense as to be considered a medical emergency. The absence of skip lesions helps in diagnosis.

There is approximately a 30 percent chance of suffering from inflammatory bowel disease in first-degree relatives (like parents and siblings). About a 50 percent chance of developing IBD is seen in monozygotic (identical) twins. A mutation of the CARD15 (caspase-associated recruitment domain-containing protein 15) hampers the functioning of the mucosal layer of the intestine, thus making it prone to inflammation.

Our body's immunity, by default, does not attack the "good gut microorganisms" that protect the gastrointestinal tract and help in digestion. This mechanism is lost in IBD, and the immune cells begin invading the microbiota leading to malabsorption.

People who have recently experienced transforming life events like the death of a loved one, separation, family conflict, or teetering interpersonal relationships, may become sensitive to inflammatory conditions. Such circumstances can worsen existing symptoms.

Long-term use of oral contraceptives can increase the risk of development of Crohn's disease. Cigarette smoking has also been reported to be related to regional enteritis.