Inflammatory Bowel Disease (IBD) encompasses Crohn’s disease and ulcerative colitis, affecting over 500,000 people in the UK, according to Crohn’s & Colitis UK. These chronic, relapsing conditions cause gastrointestinal inflammation, leading to abdominal pain, diarrhoea, weight loss, and systemic complications. The NHS emphasises a multidisciplinary approach combining medication, diet, and surgery to manage symptoms and maintain remission.
Disease Overview
Crohn’s Disease (CD):
- Can affect any part of the gastrointestinal tract from mouth to anus
- Transmural inflammation with skip lesions
- Fistulae, strictures, and abscesses common
Ulcerative Colitis (UC):
- Limited to colon and rectum
- Continuous mucosal inflammation
- Risks of toxic megacolon and colorectal cancer
Pathogenesis:
- Genetic predisposition (NOD2, IL23R mutations)
- Dysregulated immune responses to gut microbiota
- Environmental triggers: smoking (worsens CD, protective in UC), NSAIDs, diet
- Barrier function defects and microbiome alterations
Clinical Presentation
Common Symptoms:
- Abdominal pain and cramping
- Diarrhoea, often bloody in UC
- Weight loss and malnutrition
- Fatigue and systemic symptoms
- Extra-intestinal manifestations: arthritis, uveitis, skin lesions
Disease Activity Indices:
- Crohn’s Disease Activity Index (CDAI)
- Mayo Score for UC
- Biomarkers: C-reactive protein, faecal calprotectin
Diagnosis and Assessment
Endoscopy and Imaging:
- Ileocolonoscopy with biopsies
- Upper GI endoscopy if indicated
- MR enterography or CT enterography for small bowel CD
- Capsule endoscopy for isolated small bowel disease
Laboratory Tests:
- Anaemia, inflammation markers, electrolytes
- Nutritional deficiencies: vitamin B12, vitamin D, iron
Histology:
- Granulomas in CD
- Crypt abscesses and continuous mucosal injury in UC
Management Strategies
Medication
Aminosalicylates (5-ASAs):
- First-line in mild UC
- Less effective in CD
Corticosteroids:
- Induce remission in moderate-to-severe flares
- Not for maintenance due to side effects
Immunomodulators:
- Azathioprine, 6-mercaptopurine, methotrexate
- Steroid-sparing agents
Biologics:
- Anti-TNF agents: infliximab, adalimumab
- Anti-integrin: vedolizumab
- Anti-IL-12/23: ustekinumab
- Indicated for moderate-to-severe disease
JAK inhibitors:
- Tofacitinib for refractory UC
Surgical Management
Crohn’s Disease:
- Resection of strictured segments
- Drainage of abscesses
- Fistula repair
Ulcerative Colitis:
- Colectomy with ileoanal pouch formation
- Definitive cure but surgical risks
Nutritional Support
Dietary Management:
- Exclusive enteral nutrition for paediatric CD
- Low-residue diet during flares
- Address malabsorption and deficiencies
Micronutrient Supplementation:
- Iron, vitamin B12, vitamin D, calcium
Monitoring and Follow-Up
- Regular colonoscopic surveillance for UC
- Monitoring therapeutic drug levels for biologics
- Imaging to assess small bowel disease activity
Impact on Quality of Life
- Employment and social participation affected
- Psychological comorbidities: anxiety, depression
- Multidisciplinary support: gastroenterology, dietetics, psychology
Future Directions
- Personalized medicine using pharmacogenomics
- Microbiome-targeted therapies
- Novel small molecules and biologics
Conclusion
IBD requires lifelong, multidisciplinary care. Early diagnosis, tailored therapy, and close monitoring optimize outcomes. Patients benefit from comprehensive support addressing medical, nutritional, and psychosocial needs.
