Two out of three patients with chronic inflammatory bowel disease have ulcerative colitis and one out of three have Crohn's disease. Approximately 10% of IBD patients have an indeterminate colitis that includes the features of both ulcerative colitis and Crohn’s disease. The onset of the disease typically occurs at the age of 20–35, but it can occur at any age.
Approximately 42,000 people in Finland suffer from chronic inflammatory bowel disease (IBD), and nearly 2,000 more are diagnosed with the disease every year.
What are the causes of IBD?
Genetic predisposition, an inflammation caused by an external or internal factor and the exceptionally intense and prolonged reaction of the intestinal immune system are the most likely explanations.
The cause of IBD is unknown. The general perception is that IBD is caused by
- a genetic predisposition
- intestinal bacteria
- environmental, nutritional and psychosocial factors
- inflammatory disorders and disorders of the anti-inflammatory system.
Symptoms of IBD
The most common symptom of IBD is diarrhoea. If the diarrhoea persists, blood may be present in the stool.
Symptoms of ulcerative colitis
Ulcerative colitis is associated with
- frequent bowel movements
- bloody and mucinous stool
- abdominal pain (a less common symptom)
Learn more: Ulcerative colitis (in Finnish)
Symptoms of Crohn’s disease
Abdominal pain is often present in the case of Crohn’s disease. Crohn’s disease is often present in the section of the intestinal system between the large and small intestine, so the abdominal pain may be present in the lower right abdomen.
Crohn’s disease is also associated with
- loss of weight
- occasional fever
- ulcers in the mouth and
- abscesses, ulcers or fistulae in the anal region
Symptoms of IBD
IBD can also cause anaemia and impair the overall condition of the patient. Symptoms may also be present in other organs than the gastrointestinal tract, for example, in joints or the eyes or on the skin.
IBD is associated with
- arthritis
- rheumatic diseases
- hepatitis, cholangitis and pancreatitis
- erythema nodosum
- various infections of the eye.
Examination and diagnosis of IBD
The diagnosis of IBD requires laboratory tests and endoscopic examinations. The most commonly performed laboratory tests include basic blood count, inflammation markers (sedimentation rate and CRP), kidney and liver enzyme markers and fluid and sodium balance tests. A stool sample analysis is performed to study the level of calprotectin, which is a protein occurring in inflammatory cells.
Ileocolonoscopy is a procedure in which the ileum and the colon are examined endoscopically, and it is the most important diagnostic procedure whenever the presence of IBD is suspected. In the case of Crohn’s disease, the endoscopic examination of the oesophagus and the upper part of the stomach (gastroscopy), small bowel MRI or a capsule endoscopy might also be required. Biopsies of the mucous membrane are taken in these endoscopic examinations to verify the diagnosis.
The endoscopic examinations are commonly performed by our experienced specialists when the patients are awake, but it is also possible to perform these procedures under general anaesthesia.
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Treatment of IBD
Chronic IBD is treated according to a medication plan prescribed by a doctor. In very rare cases, surgical treatment is required, but it can become a viable option if pharmacological treatment is not enough to calm the inflammation in the intestines.
In addition to appropriate pharmacological therapy, regular check-ups and endoscopic examinations performed by a doctor are essential in the treatment of IBD.
The expert interviewed for the article is gastroenterologist Satu Väkeväinen.
Mehiläinen's gastroenterologists