Sadly, most people do not pay much attention to their bowel health until they experience disorders such as inflammatory bowel disease (IBD). Dr Shanthi Palaniappan, a consultant gastroenterologist and physician based in Kuala Lumpur, sheds light on this disease.

“IBD refers to chronic inflammation in the gastrointestinal tract,” she explained. “It can be divided into Crohn’s disease and ulcerative colitis.”

While both types are marked by inflammation, there are differences: Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the perianal area. Ulcerative colitis, on the other hand, mainly affects the colon or the large bowel.

With Crohn’s disease, deep ulcers may penetrate through the wall of the bowel, while in the case of ulcerative colitis, the inflammation and ulceration are not so severe.

The exact causes of IBD are unknown, Shanthi told FMT, although “what we know is that it is an autoimmune disease”. This means a patient’s immune system, mistaking the bowel cells for being foreign, attacks the lining of the digestive track, leading to inflammation.

Autoimmune diseases usually affect people who have a genetic predisposition, Shanthi said. An environmental trigger, such as a bacterial or viral infection, can lead to a series of inflammation anywhere in the body – in the case of IBD, in the gastrointestinal tract.

When it comes to Crohn’s disease, smoking has been known to exacerbate it but is not a causative factor.

“Some patients have been found to have ulcerative colitis after they stop smoking,” she pointed out, adding, however, that this does not mean they should continue to do it.

How common is it?

According to Shanthi, the prevalence of IBD is nine per 100,000 people. “So we have approximately 3,000 cases in Malaysia, though there is definitely a rise in the number of new cases diagnosed every year.”

She said although IBD is more common in western countries, it is an emergent disease in the Asia-Pacific region and “not so rare in Malaysia anymore”.

Among the possible reasons for this is the “‘westernisation’ of our diet and an increase in consumption of processed foods”, she added.

IBD generally affects the younger population – those in their mid-teens to 30 years old – even though those beyond this age bracket could also develop it. There are more males than females with IBD.

“Younger children are also getting IBD, some below the age of five. This is very sad as this is a chronic disease with no cure.”

Signs and symptoms

Common symptoms for both Crohn’s disease and ulcerative colitis are diarrhoea, abdominal pain, and bleeding. Other symptoms for Crohn’s disease include arthritis, mouth sores, and anal problems.

“With Crohn’s disease, it can be difficult to recognise blood in the stool,” Shanthi pointed out. “This is because the ulcer can happen at any part of the gastrointestinal tract and, by the time it comes out, it can be black in colour.

“Sometimes the blood loss can be minimal, and the stool may appear normal to the patient.”

She explained that with ulcerative colitis, blood is visible because the inflammation usually happens in the lower colon.

There are three classifications of ulcerative colitis: mild, moderate, and severe. Someone with a mild case may have up to four episodes of diarrhoea per day, while those with a severe case may have more than six episodes.

This, of course, results in great difficulty for someone with IBD. “If they go to a shopping mall, they would have to look for the nearest bathroom. It may affect their performance at work or in school.

“This could lead to psychological issues and stress, on top of potential side effects from medication.”

How is it diagnosed?

Methods for diagnosing IBD include:

• a blood test;
• a stool test;
• endoscopy or colonoscopy with biopsies;
• capsule endoscopy, where a patient swallows a capsule with a tiny camera that takes photos of the gastrointestinal tract;
• magnetic resonance enterography, which is an imaging test that produces detailed pictures of the small intestine.

Shanthi further advises those who experience recurrent abscesses in the anal region to get a scope done as it could be the starting point of IBD.

“It is very important for the disease to be detected early to ward off more serious health issues,” she said, citing fistula – an abnormal connection between the bowel and other organs such as the bladder – and stenosis, a narrowing of the bowel opening, as potential complications.

Are IBD and IBS the same?

It’s important to differentiate between IBD and irritable bowel syndrome (IBS), Shanthi said. “A lot of people think it’s the same and use the terms interchangeably.”

Both can have similar symptoms such as abdominal pain, bloating, diarrhoea, or constipation. However, when an endoscopy is performed on someone suffering from IBS, it shows no abnormality. In the case of IBD, inflammation and ulceration can be seen.

Similarly, blood or stool tests conducted on someone with IBS will show normal results, but this will not be the case for someone with IBD.

How is it treated?

As there is no cure for IBD at this time, the condition is treated with various medications and surgery, if required.

Medications include the short-term use of steroids to treat acute diarrhoea; anti-inflammatory oral medicine; enemas or suppositories; or oral immunosuppressants such as azathioprine or methotrexate.

A group of medications known as biologics may be prescribed for those with severe IBD that does not respond to oral immunosuppressants, Shanthi added.

“With proper diagnosis and effective treatment, this disease can be controlled, and a patient can lead a normal life,” she concluded.