How do I know if I have IBD (Irritable Bowel Syndrome)?

Screening tests and investigations to confirm or rule out IBD

Diagnosis of IBD is made through tests and ruling out of other conditions like infection, ischemic colitis, irritable bowel syndrome (IBS), diverticulitis and colon cancer. Tests include:

1. Blood tests - To check for infection or anaemia.
2. Stool sample - The presence of white blood cells indicates IBD and antibodies in the stool will rule out infection.
3. Colonoscopy - The inside of the colon is viewed through a lighted tube with a camera.
4. Flexible sigmoidoscopy - A flexible, lighted tube examines the end portion of the colon.
5. Barium enema - The entire large intestine is viewed through an x-ray, by placing a contrast solution (barium) into the bowel. Barium coats the bowel lining, creating images rectum, colon and small intestine.
6. X-ray - X-ray of the abdominal area rules out toxic megacolon or colon perforation.
7. Computerized tomography (CT) scan - This is performed in case of complications in IBD and to see the extent of inflammation.
8. Magnetic resonance imaging (MRI) - MRI creates detailed images of the affected region. It is especially useful in diagnosing and managing Crohn's disease.
9. Capsule endoscopy - The patient swallows a tiny capsule with a camera in it, which takes images as it moves along the digestive tract, transmitting the images to a computer. It is performed when diagnostic tests do not support the symptoms of Crohn's disease.
10. Double-balloon endoscopy - A long scope is used to look into the small bowel.
11. Small bowel imaging - Patient is made to drink a solution containing barium before an X-ray, CT scan or MRI is performed. The test looks for inflammation or narrowing in the small bowel.

Treatment Options For IBD

The goal of IBD treatment is reducing inflammation that triggers symptoms for symptom relief and longer remission. Treatment usually involves drugs or surgery.

Drug therapy for IBD:

1. Anti-inflammatory drugs - These are the first line of drugs used to treat IBD and include sulfasalazine, mesalamine, balsalazide and olsalazine.
2. Corticosteroids - These help in reducing inflammation.
3. Immune system suppressors - These also reduce inflammation but target the immune system rather than the inflammation itself.
4. Antibiotics - These help in reducing the amount of drainage and also prove useful in healing abscesses and fistulas in those with Crohn's disease. Antibiotics can also counter harmful intestinal bacteria and suppress the body's immune system.
5. Other medications - Other medications that help reduce the signs and symptoms of IBD include laxatives, anti-diarrhoeal, pain relievers, iron supplements, B-12 shots and calcium and vitamin supplements.

Surgery:

Surgery is recommended if diet, lifestyle changes and drug therapy do not relieve symptoms of IBD.

1. Surgery for ulcerative colitis - Surgery involves the removal of the entire colon and rectum (protocolectomy). The patient is then required to wear a small bag over an abdominal opening (ileostomy) to collect stool. However, another procedure known as ileoanal anastomosis is now preferred as it eliminates the need to wear a bag.
2. Surgery for Crohn's disease - Surgery can provide long-term remission or temporary relief from signs and symptoms. It involves the removal of a damaged portion of the digestive tract and the reconnection of the healthy sections. It can also include closure of fistulas and drainage of abscesses.

What are the dietary and physical activity requirements during the treatment?

Dietary changes can help control the symptoms and increase the time gap between the next severe episodes. Though there is no evidence that foods cause IBD, certain foods can aggravate symptoms.

1. Limiting dairy products in lactose intolerant patients.
2. Trying foods rich in fibre - Though fibre forms part of a normal healthy diet, patients with IBD may experience diarrhoea, gas and pain with fibre intake. Alternative methods of cooking like steaming or baking may be tried.
3. Avoiding certain foods - These include 'gassy' foods like beans, cabbage, raw fruit juices, popcorn, caffeine and carbonated beverages.
4. Drinking plenty of fluids.
5. Eating small meals - Five to six small meals may work better than two or three large ones.
6. Adding multivitamins to diet - These supplements may be needed as IBD interferes with the body's ability to absorb nutrients.

Exercise - Even mild exercise can reduce stress and depression and promote normal bowel movements.

Smoking - Smoking increases a person's risk of developing Crohn's disease, and increases episodes of relapses in patients. Quitting smoking can improve the overall health of the digestive tract.