Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a chronic condition characterized by inflammation of the intestinal tissue, primarily manifesting as two main forms: Crohn's disease and ulcerative colitis. The exact cause of IBD remains unclear, though it is believed to involve an abnormal immune response in genetically predisposed individuals, leading to prolonged inflammation and tissue damage. Millions of Americans are affected by IBD, with a prevalence that appears to vary by race and socioeconomic status; notably, American Jews of European descent and those of African descent exhibit higher rates. Common symptoms include diarrhea—often bloody in ulcerative colitis—along with weight loss, nausea, and fever.
Diagnosis typically requires a colonoscopy, as symptoms can overlap with other gastrointestinal disorders. Treatment strategies depend on disease severity and may include anti-inflammatory medications, steroids, and newer biological therapies designed to target inflammation. While IBD can significantly impact patients' quality of life and poses an increased risk for colon cancer, it is rarely fatal and advancements in treatment continue to evolve. Understanding IBD is essential for those affected, as well as for their families and healthcare providers, to navigate this complex and often challenging health issue.
Inflammatory bowel disease
ALSO KNOWN AS: IBD, Crohn's disease, ulcerative colitis
RELATED CONDITIONS: Colon cancer, irritable bowel syndrome (IBS)
DEFINITION: Inflammatory bowel disease is a chronic inflammation of the intestinal tissue. The two main conditions are Crohn's disease and ulcerative colitis.
Risk factors: Inflammatory bowel disease may be at least partially inherited, as studies have shown that between 20 and 33 percent of IBD patients have a close relative with the disease. Race and ethnicity may also be important determinants in the formation of inflammatory bowel disease, and American Jews of European descent are particularly prone to developing Crohn's disease. Americans of African descent were also more likely to develop IBD. For unknown reasons, higher socioeconomic status seems to predispose to IBD.
Etiology and the disease process: The development of inflammatory bowel disease is still undetermined, but it is thought to be the result of an abnormal immune response to an unknown antigen. In genetically susceptible individuals, this immune activation is prolonged, resulting in an inflammatory response that leads to intestinal tissue damage.
Incidence: Millions of Americans are estimated to be affected by inflammatory bowel disease, with an equal prevalence of ulcerative colitis and Crohn's disease. Women are more affected than men. While between 5 and 15 percent of the US population is believed to have some form of IBD, only between 5 and 7 percent have been formally diagnosed. Still, between 25 and 45 million Americans are afflicted.
Symptoms: The symptoms of inflammatory bowel disease depend on the severity of the disease. Ulcerative colitis and Crohn's disease patients may both complain of diarrhea, although bloody diarrhea is more characteristic of ulcerative colitis. Weight loss, nausea, vomiting, and fever are also common symptoms.
Screening and diagnosis: Because the symptoms associated with inflammatory bowel disease are common to many other gastrointestinal disorders, a colonoscopy is used both to confirm a diagnosis of inflammatory bowel disease and to differentiate between ulcerative colitis and Crohn's disease.
Treatment and therapy: Treatment of inflammatory bowel disease depends entirely on the severity of the disease. The chronic nature of inflammatory bowel disease causes patients to experience extended periods of symptom-free living, interrupted by inflammatory “flares.” These flares are treated with a variety of agents, including anti-inflammatory drugs, steroids, and immunosuppressants. Some biological therapies have proven effective in inflammatory bowel disease. Most of these biological therapies are antibodies that inhibit proinflammatory molecules within the intestine. The goal of therapy is to induce and maintain remission.
As the twenty-first century progressed, new treatments for patients with IBD were investigated and brought to market. In 2023, the US Food and Drug Administration approved mirikizumab for use in patients not seeing success with traditional IBD medications. Medical researchers at Johns Hopkins and the Cleveland Clinic studied a new class of oral therapies that targeted the enzyme glutamate carboxypeptidase II (GCPII) and reduced inflammation. In February 2024, researchers identified BECLIN1 as a protein that is integral to gut health. This discovery could lead to new treatments for IBD. These discoveries are just a few of the medical advances in treating IBD, and many other medications and therapies were being studied in the mid-2020s.
Prognosis, prevention, and outcomes: The of patients with inflammatory bowel disease depends on the severity of their disease. Severe gastrointestinal symptoms can cause patients to restrict their lifestyles. Patients with inflammatory bowel disease are at an increased risk for developing colon cancer, although most inflammatory bowel disease patients never develop intestinal cancers. Inflammatory bowel disease is rarely fatal, but death can occur if serious complications are not properly treated.
“FDA Approves Mirikizumab, a Promising Induction and Maintenance Therapy for Ulcerative Colitis.” Mount Sinai, 27 Oct. 2023, www.mountsinai.org/about/newsroom/2023/fda-approves-mirikizumab-a-promising-induction-and-maintenance-therapy-for-ulcerative-colitis. Accessed 16 June 2024.
“New Discovery May Lead to Potential IBD Treatments.” Technology Networks, 23 Feb. 2024, www.technologynetworks.com/proteomics/news/new-discovery-may-lead-to-potential-ibd-treatments-384160. Accessed 16 June 2024.
O'Mary, Lisa. “Genetic Research Points Toward Possible New IBD Treatments.” WebMD, 6 June 2024, www.webmd.com/ibd-crohns-disease/news/20240606/genetic-research-points-toward-possible-new-ibd-treatments. Accessed 16 June 2024.
“Researchers Identify Promising Compound for IBD Treatment.” Consult QD, 12 Oct. 2023, consultqd.clevelandclinic.org/researchers-identify-promising-compound-for-ibd-treatment. Accessed 16 June 2024.