Inflammatory Bowel Disease (IBD)

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    Last Updated: October 27, 2022

    Inflammatory bowel disease (IBD) describes a group of gastrointestinal conditions characterized by chronic inflammation that damages the intestinal lining. Common symptoms include diarrhea, unexplained weight loss, abdominal pain, bloating, and fatigue. The cause of IBD is unknown, but researchers believe it is likely an autoimmune disease that develops due to interactions between the immune system, genes, gut microbiome, and certain lifestyle factors. There is no cure, but IBD can be managed with lifestyle modifications, medications, intermittent bowel rest, and surgery.

    Inflammatory Bowel Disease (IBD) falls under the Gut Health and Autoimmune Disease categories.

    What is IBD?

    IBD is a term used to describe multiple gastrointestinal diseases characterized by chronic inflammation that damages different parts of the intestinal lining. Crohn’s disease, ulcerative colitis (UC), and microscopic colitis are the most common types of IBD.

    Crohn’s disease can cause inflammation anywhere along the digestive tract (from mouth to anus), but usually involves the small intestine and the first part of the large intestine. Microscopic colitis and UC cause inflammation solely in the large intestine. UC also leads to the formation of ulcers (small sores) in the large intestine.[1] [2] [3] [4]

    What are the main signs and symptoms of IBD?

    The most common signs of IBD are diarrhea, abdominal pain, and unexplained weight loss. UC may also cause blood, mucus, or pus in the stool, and urgent or persistent feelings of needing to have a bowel movement (tenesmus). Crohn’s disease may cause additional symptoms, including joint or eye pain, nausea, or anemia. Severe cases of UC or Crohn’s may also lead to fever or lasting fatigue.

    The symptoms of IBD naturally go through phases of greater severity during flares, and spontaneous resolution during periods of remission.[2] [3] [4]

    How is IBD diagnosed?

    Multiple tests are required to diagnose IBD and rule out other potential diseases. A physical exam is performed to check for bloating and abdominal tenderness, and blood and stool samples are collected to detect signs of IBD such as anemia and intestinal inflammatory markers.

    An endoscopy (e.g., colonoscopy or flexible sigmoidoscopy) allows the doctor to view the intestinal lining with a small camera and collect biopsies (tissue samples) for examination, which can confirm diagnosis. Imaging procedures like CT scans can also be used to observe the gastrointestinal tract.[5] [6] [7]

    What are some of the main medical treatments for IBD?

    There is no cure for IBD, but it can be managed with long-term care from a gastroenterologist and anti-inflammatory medications that suppress the immune system or interrupt certain aspects of the immune response that cause damage to the intestinal lining. Symptoms like diarrhea and mild pain can also be treated short-term with anti-diarrheal medications and acetaminophen. Unfortunately, IBD can also lead to infections, which need to be treated with antibiotics.

    Exclusive enteral nutrition — which uses specific liquid formulas to meet a patient’s dietary needs — can induce remission, especially in pediatric IBD. Emerging evidence suggests that partial enteral nutrition can prevent flares when a patient is in remission, especially when fed through a nasogastric tube that delivers the formula directly into the stomach through the nose.[8]

    In some cases, surgery is required to remove sections of the intestine that have become severely damaged. If the entire large intestine is removed, the end of the small intestine will be attached to an internal reservoir or external pouch (called an ostomy bag) to collect stool, or can be rerouted via ileoanal anastomosis (a surgery that enables an individual whose large intestine has been removed to defecate normally).[9] [10] [11]

    Have any supplements been studied for IBD?

    Most evidence indicates that probiotics, prebiotics (including resistant starch), and synbiotics are all equally, modestly effective for inducing remission and reducing some symptoms of IBD, especially in UC.[12][13][14][15][16][17]

    Though high-quality evidence is limited to just a few trials, cannabis and cannabinoids may improve quality of life and reduce abdominal pain and IBD symptoms.[18]

    Emerging evidence suggests that resveratrol and curcumin might improve gastrointestinal symptoms and quality of life, while vitamin D supplementation could reduce inflammation and encourage cell turnover for repair of the intestinal lining. In patients under 40, curcumin also improved remission rates.[19][20][21]

    Polyunsaturated fatty acids (PUFAs), such as omega-3 fatty acids and omega-6 fatty acids, have also been studied for IBD. However, when taken in the form of supplements, PUFAs are ineffective for improving IBD remission rates or inflammatory markers.[22]

    How could diet affect IBD?

    A Western dietary pattern — characterized by a high intake of refined grains, animal protein (particularly red or processed meat), and animal fat (from meat or dairy), along with a low intake of fruit and vegetables — may increase the risk of developing IBD.[23] Higher fruit, vegetable, and fiber consumption are associated with a reduced risk of developing IBD.[24]

    Despite these findings, exclusion diets — like those that remove milk, carrageenan, or animal products — have little to no effect on IBD disease activity or remission rates.[25] A Low-FODMAP diet improves some GI symptoms without changing markers of disease activity.[26]

    People with IBD tend to consume less fiber than healthy people, and often fail to eat enough calories (which is why they may need enteral nutrition support).[27][8] They also have lower levels of vitamins A and K in their blood, and over time, low vitamin A status is associated with greater disease activity.[28]

    Are there any other treatments for IBD?

    There’s some evidence that mindfulness can reduce stress in people living with IBD, while cognitive behavioral therapy could improve both quality of life and fatigue.[29][30][31]

    Fecal microbiota transplants are more effective than placebo for inducing remission in ulcerative colitis, but their efficacy in other forms of IBD is still unclear, and most of the available trials for Crohn’s disease lack control groups.[32][33]

    Most of the studies assessing hyperbaric oxygen therapy and acupuncture had serious design flaws (like a lack of randomization or control groups), so although these treatments are associated with remission and clinical improvements, it’s unclear whether those occurred as a result of the treatment or as a normal part of the disease process.[34][35]

    What causes IBD?

    The exact causes of IBD are unknown, but researchers suspect that these diseases result from interactions between the immune system, genes, gut microbiome, and certain lifestyle factors. IBD is thought to be an autoimmune reaction, and genetics likely play a role since it tends to run in families.

    Smoking, certain medications, female hormones, infections, and the presence of other autoimmune diseases may slightly increase the chances of developing IBD.[2] [3] [4]

    Examine Database: Inflammatory Bowel Disease (IBD)

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    Frequently asked questions

    What is IBD?

    IBD is a term used to describe multiple gastrointestinal diseases characterized by chronic inflammation that damages different parts of the intestinal lining. Crohn’s disease, ulcerative colitis (UC), and microscopic colitis are the most common types of IBD.

    Crohn’s disease can cause inflammation anywhere along the digestive tract (from mouth to anus), but usually involves the small intestine and the first part of the large intestine. Microscopic colitis and UC cause inflammation solely in the large intestine. UC also leads to the formation of ulcers (small sores) in the large intestine.[1] [2] [3] [4]

    What is the difference between IBD and IBS?

    IBD is considered an organic disorder because the disease affects both the tissues and the function of the intestinal tract. Irritable bowel syndrome (IBS), on the other hand, is considered a functional disorder because the intestines aren’t damaged, but they don’t function normally. Whereas IBD is likely an autoimmune disease, IBS is thought to involve the gut-brain axis and the enteric nervous system (nerves that control the GI tract independent of the brain.) Abdominal pain and bloating can occur in both disorders, but more serious symptoms — like bloody stool — would only be present in IBD.[36]

    Is IBD linked to other GI or autoimmune diseases?

    Patients with IBD are at increased risk of developing intestinal cancer and celiac disease, and small intestinal bacterial overgrowth (SIBO) is more common in people with IBD than in healthy people.[37][38][39]

    Eczema is more common in people with IBD than in those without, and IBD is also associated with higher rates of multiple sclerosis.[40][41]

    What are the main signs and symptoms of IBD?

    The most common signs of IBD are diarrhea, abdominal pain, and unexplained weight loss. UC may also cause blood, mucus, or pus in the stool, and urgent or persistent feelings of needing to have a bowel movement (tenesmus). Crohn’s disease may cause additional symptoms, including joint or eye pain, nausea, or anemia. Severe cases of UC or Crohn’s may also lead to fever or lasting fatigue.

    The symptoms of IBD naturally go through phases of greater severity during flares, and spontaneous resolution during periods of remission.[2] [3] [4]

    How is IBD diagnosed?

    Multiple tests are required to diagnose IBD and rule out other potential diseases. A physical exam is performed to check for bloating and abdominal tenderness, and blood and stool samples are collected to detect signs of IBD such as anemia and intestinal inflammatory markers.

    An endoscopy (e.g., colonoscopy or flexible sigmoidoscopy) allows the doctor to view the intestinal lining with a small camera and collect biopsies (tissue samples) for examination, which can confirm diagnosis. Imaging procedures like CT scans can also be used to observe the gastrointestinal tract.[5] [6] [7]

    What are some of the main medical treatments for IBD?

    There is no cure for IBD, but it can be managed with long-term care from a gastroenterologist and anti-inflammatory medications that suppress the immune system or interrupt certain aspects of the immune response that cause damage to the intestinal lining. Symptoms like diarrhea and mild pain can also be treated short-term with anti-diarrheal medications and acetaminophen. Unfortunately, IBD can also lead to infections, which need to be treated with antibiotics.

    Exclusive enteral nutrition — which uses specific liquid formulas to meet a patient’s dietary needs — can induce remission, especially in pediatric IBD. Emerging evidence suggests that partial enteral nutrition can prevent flares when a patient is in remission, especially when fed through a nasogastric tube that delivers the formula directly into the stomach through the nose.[8]

    In some cases, surgery is required to remove sections of the intestine that have become severely damaged. If the entire large intestine is removed, the end of the small intestine will be attached to an internal reservoir or external pouch (called an ostomy bag) to collect stool, or can be rerouted via ileoanal anastomosis (a surgery that enables an individual whose large intestine has been removed to defecate normally).[9] [10] [11]

    Have any supplements been studied for IBD?

    Most evidence indicates that probiotics, prebiotics (including resistant starch), and synbiotics are all equally, modestly effective for inducing remission and reducing some symptoms of IBD, especially in UC.[12][13][14][15][16][17]

    Though high-quality evidence is limited to just a few trials, cannabis and cannabinoids may improve quality of life and reduce abdominal pain and IBD symptoms.[18]

    Emerging evidence suggests that resveratrol and curcumin might improve gastrointestinal symptoms and quality of life, while vitamin D supplementation could reduce inflammation and encourage cell turnover for repair of the intestinal lining. In patients under 40, curcumin also improved remission rates.[19][20][21]

    Polyunsaturated fatty acids (PUFAs), such as omega-3 fatty acids and omega-6 fatty acids, have also been studied for IBD. However, when taken in the form of supplements, PUFAs are ineffective for improving IBD remission rates or inflammatory markers.[22]

    How could diet affect IBD?

    A Western dietary pattern — characterized by a high intake of refined grains, animal protein (particularly red or processed meat), and animal fat (from meat or dairy), along with a low intake of fruit and vegetables — may increase the risk of developing IBD.[23] Higher fruit, vegetable, and fiber consumption are associated with a reduced risk of developing IBD.[24]

    Despite these findings, exclusion diets — like those that remove milk, carrageenan, or animal products — have little to no effect on IBD disease activity or remission rates.[25] A Low-FODMAP diet improves some GI symptoms without changing markers of disease activity.[26]

    People with IBD tend to consume less fiber than healthy people, and often fail to eat enough calories (which is why they may need enteral nutrition support).[27][8] They also have lower levels of vitamins A and K in their blood, and over time, low vitamin A status is associated with greater disease activity.[28]

    Are there any other treatments for IBD?

    There’s some evidence that mindfulness can reduce stress in people living with IBD, while cognitive behavioral therapy could improve both quality of life and fatigue.[29][30][31]

    Fecal microbiota transplants are more effective than placebo for inducing remission in ulcerative colitis, but their efficacy in other forms of IBD is still unclear, and most of the available trials for Crohn’s disease lack control groups.[32][33]

    Most of the studies assessing hyperbaric oxygen therapy and acupuncture had serious design flaws (like a lack of randomization or control groups), so although these treatments are associated with remission and clinical improvements, it’s unclear whether those occurred as a result of the treatment or as a normal part of the disease process.[34][35]

    What causes IBD?

    The exact causes of IBD are unknown, but researchers suspect that these diseases result from interactions between the immune system, genes, gut microbiome, and certain lifestyle factors. IBD is thought to be an autoimmune reaction, and genetics likely play a role since it tends to run in families.

    Smoking, certain medications, female hormones, infections, and the presence of other autoimmune diseases may slightly increase the chances of developing IBD.[2] [3] [4]

    What role might the gut microbiome play in IBD?

    Rarely, a fecal microbiota transplant worsens IBD, which suggests that gut microbes could play a role in the development or progression of the disease.[42] Though the gut microbiomes of people with IBD tend to differ from those of healthy individuals, a consistent, disease-specific pattern hasn’t been identified.[43]

    One study found that several groups of bacteria — most of which are salivary — were elevated uniquely in IBD compared to other diseases. However, this doesn’t suggest that they play any role in IBD. It could simply have been a reflection of their higher relative abundance compared to abnormally low levels of other bacteria.[43]

    What role might the gut-brain axis play in IBD?

    IBD significantly reduces quality of life, and is associated with higher levels of anxiety, depression, stress, cognitive impairment, and fatigue. Some evidence suggests a relationship between psychological factors (such as stress or anxiety) and IBD symptoms, but it’s still unclear whether these psychological factors cause symptoms to worsen, or vice versa.[44]

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    3. ^Symptoms & Causes of Ulcerative Colitis
    4. ^Symptoms & Causes of Microscopic Colitis
    5. ^Diagnosis of Crohn’s Disease
    6. ^Diagnosis of Ulcerative Colitis
    7. ^Diagnosis of Microscopic Colitis
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    13. ^Marcos Natal Rufino, Airan Lobo da Costa, Eloisa Nascimento Jorge, Viviane Ferreira Paiano, Marjori Leiva Camparoto, Rogéria Keller, Hermann Bremer-NetoSynbiotics improve clinical indicators of ulcerative colitis: systematic review with meta-analysisNutr Rev.(2021 May 19)
    14. ^Astó E, Méndez I, Audivert S, Farran-Codina A, Espadaler JThe Efficacy of Probiotics, Prebiotic Inulin-Type Fructans, and Synbiotics in Human Ulcerative Colitis: A Systematic Review and Meta-Analysis.Nutrients.(2019-Jan-30)
    15. ^Xiao-Feng Zhang, Xiao-Xian Guan, Yu-Jun Tang, Jin-Feng Sun, Xiao-Kai Wang, Wei-Dong Wang, Jian-Ming FanClinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysisEur J Nutr.(2021 Feb 8)
    16. ^Chen M, Feng Y, Liu WEfficacy and safety of probiotics in the induction and maintenance of inflammatory bowel disease remission: a systematic review and meta-analysis.Ann Palliat Med.(2021-Nov)
    17. ^Montroy J, Berjawi R, Lalu MM, Podolsky E, Peixoto C, Sahin L, Stintzi A, Mack D, Fergusson DAThe effects of resistant starches on inflammatory bowel disease in preclinical and clinical settings: a systematic review and meta-analysis.BMC Gastroenterol.(2020-Nov-10)
    18. ^Benthe H Doeve, Maartje M van de Meeberg, Fiona D M van Schaik, Herma H FidderA Systematic Review With Meta-Analysis of the Efficacy of Cannabis and Cannabinoids for Inflammatory Bowel Disease: What Can We Learn From Randomized and Nonrandomized Studies?J Clin Gastroenterol.(2020 Jul 14)
    19. ^Joanna Giang, Xiao Lan, Megan Crichton, Wolfgang Marx, Skye MarshallEfficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysisNutr Diet.(2021 May 7)
    20. ^Guo X, Liu C, Huang YEfficacy and Safety of Vitamin D Adjuvant Therapy for Ulcerative Colitis: A Meta-Analysis.Comput Math Methods Med.(2022)
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    22. ^Sarah M Ajabnoor, Gabrielle Thorpe, Asmaa Abdelhamid, Lee HooperLong-term effects of increasing omega-3, omega-6 and total polyunsaturated fats on inflammatory bowel disease and markers of inflammation: a systematic review and meta-analysis of randomized controlled trialsEur J Nutr.(2020 Oct 21)
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    24. ^Milajerdi A, Ebrahimi-Daryani N, Dieleman LA, Larijani B, Esmaillzadeh AAssociation of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.Adv Nutr.(2021-06-01)
    25. ^Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T, Parian A, Matarese LE, Bracewell K, MacDonald JK, Gordon M, Mullin GEDietary interventions for induction and maintenance of remission in inflammatory bowel disease.Cochrane Database Syst Rev.(2019-Feb-08)
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    28. ^Fabisiak N, Fabisiak A, Watala C, Fichna JFat-soluble Vitamin Deficiencies and Inflammatory Bowel Disease: Systematic Review and Meta-Analysis.J Clin Gastroenterol.(2017)
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    37. ^Wan Q, Zhao R, Xia L, Wu Y, Zhou Y, Wang Y, Cui Y, Shen X, Wu XTInflammatory bowel disease and risk of gastric, small bowel and colorectal cancer: a meta-analysis of 26 observational studies.J Cancer Res Clin Oncol.(2021-Apr)
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    Examine Database References

    1. Subjective Well-Being - İlkay Yılmaz, M Enver Dolar, Haydar ÖzpınarEffect of administering kefir on the changes in fecal microbiota and symptoms of inflammatory bowel disease: A randomized controlled trialTurk J Gastroenterol.(2019 Mar)
    2. Fecal Microbial Load - Selina R Cox, James O Lindsay, Sébastien Fromentin, Andrew J Stagg, Neil E McCarthy, Nathalie Galleron, Samar B Ibraim, Hugo Roume, Florence Levenez, Nicolas Pons, Nicolas Maziers, Miranda C Lomer, S Dusko Ehrlich, Peter M Irving, Kevin WhelanEffects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized TrialGastroenterology.(2020 Jan)
    3. Quality of Life - Giorgia Bodini, Claudia Zanella, Mattia Crespi, Sara Lo Pumo, Maria Giulia Demarzo, Edoardo Savarino, Vincenzo Savarino, Edoardo G GianniniA randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel diseaseNutrition.(Nov-Dec 2019)
    4. C-Reactive Protein (CRP) - Gauree G Konijeti, NaMee Kim, James D Lewis, Shauna Groven, Anita Chandrasekaran, Sirisha Grandhe, Caroline Diamant, Emily Singh, Glenn Oliveira, Xiaoyun Wang, Bhuvan Molparia, Ali TorkamaniEfficacy of the Autoimmune Protocol Diet for Inflammatory Bowel DiseaseInflamm Bowel Dis.(2017 Nov)
    5. Quality of Life - Anita Chandrasekaran, Shauna Groven, James D Lewis, Susan S Levy, Caroline Diamant, Emily Singh, Gauree Gupta KonijetiAn Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel DiseaseCrohns Colitis 360.(2019 Oct)
    6. Inflammatory Bowel Disease Symptoms - Anita Chandrasekaran, MD, MPH, Bhuvan Molparia, PhD, Ehsaan Akhtar, MD, Xiaoyun Wang, MS, James D. Lewis, MD, MSCE, John T. Chang, MD, PhD, Glenn Oliveira, BS, Ali Torkamani, PhD, and Gauree Gupta Konijeti, MD, MPHThe Autoimmune Protocol Diet Modifies Intestinal RNA Expression in Inflammatory Bowel DiseaseCrohn's & Colitis 360.()
    7. C-Reactive Protein (CRP) - Armita Mahdavi Gorabi, Saeed Aslani, Danyal Imani, Bahman Razi, Thozhukat Sathyapalan, Amirhossein SahebkarEffect of resveratrol on C-reactive protein: An updated meta-analysis of randomized controlled trialsPhytother Res.(2021 Dec)
    8. Quality of Life - Joanna Giang, Xiao Lan, Megan Crichton, Wolfgang Marx, Skye MarshallEfficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysisNutr Diet.(2021 May 7)
    9. Ulcerative Colitis Symptoms - Peter R Holt, Seymour Katz, Robert KirshoffCurcumin therapy in inflammatory bowel disease: a pilot studyDig Dis Sci.(2005 Nov)
    10. Bone Mineral Density - Melek J, Sakuraba AEfficacy and safety of medical therapy for low bone mineral density in patients with inflammatory bowel disease: a meta-analysis and systematic review.Clin Gastroenterol Hepatol.(2014-Jan)