Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)

Inflammatory bowel disease refers to two related chronic conditions — Crohn’s disease and ulcerative colitis — in which the immune system causes ongoing inflammation of the digestive tract. Both cause recurring symptoms with periods of flare and remission and require long-term management.

• Persistent or recurrent diarrhoea, often with blood or mucus, particularly in ulcerative colitis
• Abdominal pain and cramping
• Urgency to have a bowel movement
• Unintentional weight loss and fatigue
• Fever during flares
• Crohn's disease can affect any part of the digestive tract and cause additional complications such as strictures or fistulas; ulcerative colitis is confined to the colon and rectum

• Results from an abnormal immune response causing chronic inflammation of the digestive tract, with genetic and environmental factors both contributing.
• Family history of inflammatory bowel disease increases risk.
• The exact trigger for the abnormal immune response is not fully understood, though it is not caused by diet alone, contrary to some common assumptions.

• Diagnosed through a combination of history, blood and stool tests showing markers of inflammation, and colonoscopy with biopsy, which confirms the diagnosis and distinguishes between Crohn's disease and ulcerative colitis based on the pattern and location of inflammation.
• Imaging may be used, particularly for Crohn's disease, to assess the extent of bowel involvement and check for complications.

Treatment aims to reduce inflammation, control symptoms during flares, and maintain remission, and is guided by disease severity and extent.

Anti-inflammatory medicines are used for mild to moderate disease, with corticosteroids used for short-term control of flares.

More significant or persistent disease often requires medicines that modify the immune system, used under specialist supervision, aiming to maintain long-term remission and reduce the risk of complications.

Nutritional support is important, particularly during flares or with significant weight loss.

Surgery may be needed for complications such as strictures, fistulas, or disease not responding to medical treatment, particularly in Crohn's disease, or for severe ulcerative colitis not controlled by medicine.

• Attend regular follow-up with a specialist for ongoing monitoring and treatment adjustment.
• Take maintenance medicine consistently, even during periods of remission, to reduce the risk of flares.
• Avoid smoking, which worsens Crohn's disease specifically.
• Seek prompt medical assessment for any new or worsening symptoms during a known diagnosis, since flares can sometimes need treatment adjustment.