Inflammatory Bowel Disease (IBD)
About the disease & condition
Aetiology & Pathophysiology
Aetiology:** Complex interplay of genetic predisposition (e.g., NOD2 gene mutations), dysregulated immune response to gut microbiota, and environmental triggers (e.g., diet, smoking, antibiotics).
Pathophysiology:**
- Crohn’s disease: Transmural inflammation that can affect any part of the GI tract (mouth to anus), often discontinuously (“skip lesions”).
- Ulcerative colitis: Continuous mucosal inflammation limited to the colon, starting at the rectum.
Symptoms & Signs
Common symptoms:**
- Diarrhoea (often bloody in UC, watery in CD).
Abdominal pain/cramping (more focal in CD, left-sided in UC).
Urgency, tenesmus (especially in UC). - Weight loss, fatigue, and fever.
Extra-intestinal manifestations:**
- Joints (arthralgia/arthritis), skin (erythema nodosum, pyoderma gangrenosum), eyes (uveitis, episcleritis).
Red-flag symptoms:**
- Severe abdominal pain, persistent vomiting (suggesting obstruction or toxic megacolon).
- Profuse bleeding, unexplained weight loss, and signs of sepsis.
Diagnosis
Clinical assessment:** Detailed history (symptom pattern, family history), physical exam (abdominal tenderness, perianal disease in CD).
Laboratory tests:**
Fecal calprotectin (to distinguish from IBS).
- CBC (anemia, leukocytosis), CRP/ESR (inflammation), albumin (nutritional status).
- Serology (e.g., ASCA, pANCA; supportive but not diagnostic).
Endoscopy with biopsy (gold standard):**
- Colonoscopy: For visual assessment and histologic confirmation (crypt abscesses in UC, granulomas in CD).
- Cross-sectional imaging: MRI enterography/CT enterography (for small bowel involvement in CD).
- Capsule endoscopy: For suspected small bowel CD.
Management
Induction of remission:**
- Mild-moderate: Aminosalicylates (e.g., mesalamine; primarily UC), corticosteroids (budessonide/systemic).
- Moderate-severe: Biologics (anti-TNF agents like infliximab/adalimumab, anti-integrins, anti-IL-12/23), immunomodulators (thiopurines, methotrexate).
Maintenance therapy:**
- Immunosuppressives/biologics to prevent relapse.
- Dietitian support (e.g., exclusive enteral nutrition in CD).
Surgical options:**
- UC: Colectomy (curative).
- CD: Stricturoplasty, resection for complications (obstruction, fistulae).
Potential Complications
- Local:**
- Strictures, fistulae, abscesses (CD).
- Toxic megacolon, perforation (UC).
- Malnutrition, growth failure (in pediatric IBD).**
- Increased risk of colorectal cancer (long-standing UC/extensive CD).**
- Bone loss (osteoporosis/osteopenia).**
Prevention & Follow-up
Prevention:** No known prevention; smoking cessation reduces CD risk/flares.
Follow-up:**
- Regular monitoring of disease activity (symptoms, biomarkers, endoscopy).
- Vaccinations (avoid live vaccines on immunosuppressants).
- Bone density screening, dermatologic/ophthalmic exams for extra-intestinal manifestations.
- Colonoscopic surveillance for dysplasia in long-standing colitis.
Relevant Specialities
Gastroenterology
Our Gastrosciences service diagnoses and treats conditions of the digestive system such as the oesophagus, stomach, small intestine, colon, liver, pancreas and bile ducts. Our team of gastroenterologists, hepatologists and specialist nurses use advanced, minimally invasive techniques to give precise care. POEM (Peroral Endoscopic Myotomy) treats oesophageal motility disorders, ESD to remove early tumours without open surgery, ERCP and SpyGlass for bile-duct problems, EndoVAC for closing leaks, STER for subepithelial tumours, and capsule endoscopy to image the small intestine. We also perform diagnostics and therapeutic endoscopy (OGD, colonoscopy, EUS, manometry, pH studies) and offer stenting, polypectomy, dilation, variceal therapy and biliary drainage as needed. In addition, age appropriate diagnostics and transplant-linked care are provided with dietitians and psychological support built into long-term plans.
