Anjali (name changed), a healthy woman in her late 30s, presented with sudden onset of chronic abdominal pain. She was also experiencing diarrhoea with blood and mucus in her stool, along with fatigue and notable weight loss. These symptoms, combined with feelings of loneliness, had begun to affect her mental wellbeing. As her evaluation progressed, it was confirmed that she had an inflammatory bowel disease (IBD)―a group of diseases that includes both Crohn’s disease (CD) and ulcerative colitis (UC).
Understanding IBD and its symptoms
Inflammatory bowel disease (IBD) refers to chronic or recurring inflammation of the gastrointestinal tract caused by immune system dysregulation. These conditions are multifactorial and can be attributed to genetic susceptibility, microbial dysbiosis, diet, and lifestyle transitions. Once considered a disease predominantly affecting developed nations, IBD is now on the rise in countries like India due to increasing urbanisation and dietary changes.
The two major types of IBD―Crohn’s disease and ulcerative colitis―present with overlapping but distinct symptoms. Crohn’s disease can affect any part of the GI tract and is often marked by abdominal pain, diarrhoea, fever, weight loss, and in some cases, perianal complications such as abscesses or fistulas.
In the case of Anjali, her symptoms were more consistent with ulcerative colitis, prompting further diagnostic evaluation. Initial blood and stool tests revealed elevated inflammatory markers, including fecal calprotectin―an important marker of intestinal inflammation. A colonoscopy showed ulcerations in the colon, and a biopsy confirmed the diagnosis of ulcerative colitis.
The management of IBD should be targeted, as the disease progresses differently in each patient. For Anjali, we initiated treatment with aminosalicylates (5-ASA), which are effective in reducing inflammation and inducing remission. As she had severe symptoms right from the onset, we also gave her corticosteroids for the short-term management of the condition. These drugs are potent and can reduce inflammation within hours or days but cannot be used long-term because they have side-effects such as weight gain, mood swings, and osteoporosis.
Role of microbiota and prevention
Prevention of IBD involves changes in the patient’s way of life and dieting regime during the process of treatment. The consumption of processed food affects the composition of the gut microbiota, causing dysbiosis (imbalance in bacterial composition or changes in bacterial distribution within the gut), which plays a significant role in the development of IBD.
Research show that breastfeeding, through the promotion of healthy immune system and gut microbiota, contributes to the reduction of IBD. However, because antibiotics affect gut bacteria, using them more frequently or inappropriately as a child has been linked to an increased risk of having IBD as an adult.
The use of fecal microbiota transplantation (FMT) and probiotics in IBD is another intriguing area of study. The use of probiotics, which help to introduce friendly bacteria into the colon, has some success in treating UC though its effectiveness in treating Crohn’s disease is not as effective. FMT is a process that involves introducing stool from a healthy individual into an IBD patient with the aim of rebalancing the microbial flora. Although this approach is still in its infancy, it may be considered for those patients who do not respond to conventional therapies.
The writer is medical gastroenterologist at Kasturba Medical College Hospital in Mangaluru.