Inflammatory bowel disease, or IBD, the collective term for a group of debilitating conditions in which the gastrointestinal tract becomes inflamed, swollen or ulcerated is increasing in the western world.
“IBD has been steadily increasing in incidence and prevalence in industrialised societies over the last century, with rapid changes in our lifestyle, diet and environment contributing to this — especially among those who are genetically susceptible,” says Prof Barbara Ryan, consultant gastroenterologist at Tallaght University Hospital.
In Ireland, it is estimated that about 40,000 people suffer from IBD, which is almost three times the number of people deemed to have the condition 10 years ago. The most common forms of IBD are ulcerative colitis (which is limited to the large bowel and rectum) and Crohn’s cisease which can occur anywhere from the mouth to the anus, but most commonly in the small or large intestine.
[ What is IBS and how do you deal with this complex condition?Opens in new window ]
However, as well as the increased incidence of the disease, experts are also concerned that many people are ignoring symptoms either due to embarrassment or a mistaken belief that they have the less severe and unrelated condition known as irritable bowel syndrome, or IBS.
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“IBS is much more common and while it can be debilitating and unpleasant, it is never life-threatening and never requires surgery,” explains Prof Ryan.
“Teenagers and those in their early 20s are the group in which these conditions are the most common and many of them don’t pay attention to symptoms,” says Prof Colm O’Morain, consultant gastroenterologist at Tallaght University Hospital and HSE national clinical lead for gastroenterology.
He estimates that about 25 per cent of people with IBD are being diagnosed through A&E departments. This happens, he says, because many people either ignore or misunderstand symptoms and only seek help when they become very severe. Long waiting lists for patients referred by their GPs to see gastroenterologists in outpatient clinics also cause delays in diagnosis at earlier stages of the condition.
Symptoms of the disease vary from person to person which also contributes to confusion between IBS with IBD. “Some patients have symptoms of IBD for years and think that they have IBS, trying out various dietary measures first which don’t work as well for IBD,” explains Ryan.
The most common symptoms of Crohn’s disease that are confused with IBS are abdominal bloating or excessive gas, cramps, constipation or diarrhoea. However, people with IBS rarely suffer from weight loss, mouth ulcers and nocturnal diarrhoea (the need to get up in the night to pass a bowel movement); these symptoms are most likely due to IBD. Ulcerative colitis is more easily identified through the persistent presence of blood in the stools.
O’Morain would like to see more GPs carrying out initial diagnostic tests to identify IBD in patients, which he believes would result in faster routes to specialists once patients with inflammatory conditions are identified. Such tests could also prevent unnecessary colonoscopies, which would in turn help to reduce waiting lists for such procedures.
There are two specific tests that GPs could use with their patients which would put patients on a faster track to having endoscopic investigations to help specialists clarify which condition they have. The faecal calprotectin test monitors levels of the enzyme calprotectin whose levels increase in white blood cells when inflammation occurs. The concentration of calprotectin relates directly to the severity of the inflammation.
The faecal immunochemical test, which is already used in colon cancer screening programmes, picks up on blood in the stools at levels unseen by the human eye. “These tests have to be sent to laboratories but their use for identifying IBD would fast track patients for colonoscopies,” explains O’Morain. The risk of colon cancer is also higher in people with IBD, and the faecal immunochemical test would also detect such cancers at an early stage for those who aren’t part of the current colon cancer screening programme.
Ahead of World IBD Day on May 19th, the patient support group, Crohn’s and Colitis Ireland has launched a symptom checker to encourage people to check for common symptoms such as recurrent episodes of blood in their stools, waking up to have a bowel movement at nighttime, unexplained weight loss, abdominal pain, unexplained fatigue and mouth ulcers.
“We want people to stop ignoring the key signs of what can be a serious disease. We want people to overcome any embarrassment that they may have and to seek medical advice,” says Ryan.
She also wants to reassure patients that there is an ever-expanding array of treatments available which will improve symptoms for most patients. “Medication is extremely important in these conditions. Some people can go into a deep remission. Others will get off their medication in time but many people will remain on medication for life,” she says.
The principal treatments for IBD are medications which dampen down the inflammatory response in the gut and reduce symptoms. “We have mild to strong medications delivered in tablet form, sub-cutaneously and through infusions. The view now is to start with the stronger medications and while these biological agents are expensive, some of them have run out of their patents and are available as best-value biologics,” says O’Morain.
The cost of IBD medication can be an issue for some patients who don’t qualify for medical cards as IBD isn’t classified as a chronic illness in Ireland. While there is no known single cause for the disease, genetics and environment each plays a part. There is also some evidence to suggest that the prolonged use of antibiotics can increase the risk of IBD as antibiotics interfere with the gut flora. And there is ongoing research into the use of targeted probiotics as a potential future treatment for these conditions.
People with IBD can also go through long periods of remission and stress is deemed to be a significant factor in flare-ups. There are now a number of advanced nurse practitioners specialising in IBD who work closely with patients to monitor their condition. Members of the patient group, Crohn’s and Colitis Ireland, also offer support to patients recently diagnosed with the condition as well as those living with the disease in the long term.
