Inflammatory Bowel Disease

Question 1

What are the things I need to learn about IBS?

Answer 1

• To review basic bowel anatomy and physiology
• To explore dietary and other factors which may contribute to IBD
• To consider the conditions Crohn’s disease and ulcerative colitis, the similarities and differences between the two

Question 2

What does the bowel do when its healthy?

Answer 2

Small intestine (duodenum, jejunum, ileum):
* Duodenum – further breakdown of stomach contents, neutralisation of stomach acid, breakdown and absorption of fats
* Jejunum – absorption of sugars, amino acids and fatty acids
* Ileum – absorption of remaining nutrients (vitamin B12 especially), absorption of residual bile acids

Large intestine:
* Absorption of vitamins
* Absorption of water and electrolytes
* Formation and propulsion of faeces

Question 3

What causes IBD?

Answer 3

No precise cause discovered for IBD
* Diet and stress initially considered to be causative but this is not the case
* Diet can still be a risk factor, an exacerbating factor and a preventative factor however, along with some lifestyle factors

Question 4

What are dietary risk and excerbating factors for IBD?

Answer 4

Additional risk comes when people eat a lot of
- Sugar
- Animal fats and proteins
- They have a high linoleic acid intake

Potentially exacerbating factors include
- Eating sulphur containing items (red meat, cheese, eggs, cruciferous vegetables)
- Alcohol

Question 5

How can we prevent the development of IBD through diet?

Answer 5

Preventative factors include:
* Ensuring good levels of dietary fibre
* Eating unsaturated omega 3 fatty acids
* Magnesium
* Vitamin C

Question 6

What non-dietary factors increase risk of developing IBD? What herbal considerations might help?

Answer 6

• Smoking – risk for Crohn’s and UC (if historic), risk for Crohn’s and protective against UC (if current)
• Non-steroidal antiinflammatories
• Exposure to pathogens triggering disordered immune response

Herbal considerations for risk factors:
* Support to stop smoking (Avena, Lobelia…)
* Replace NSAIDS (Filipendula, Calendula, Chamomilla, Curcuma…)
* Support overall immune function (Echinacea, Sambucus, Astragalus…)

Question 7

What are the signs and symptoms of Crohn’s Disease?

Answer 7

• Diarrhoea (prolonged, intermittent)
• Cramping abdominal pain
• Low grade fever
• General fatigue
• Weight loss
• Possible blood in stool if the colon is involved
• Loss of appetite and nausea if small intestine involved
• Image showing some different patterns of bowel involvement

Question 8

What is Crohn’s Disease’s pathophysiology?

Answer 8

Pathophysiology
1. Exposure to Antigen
2. Unregulated T-cell response (influenced by Genetic susceptibility)
3. Inflammatory cytokines
4. Inflammtory substances (e.g. free radicals, platelet activating factor) - influenced by Direct tissue injury in the GIT

Question 8

What likely causes Crohn’s Disease?

Answer 8

The disease is chronic, inflammatory, and may affect any part of the GIT from mouth to anus

Risk factors include
* genetic
* microbial
* immunologic,
* environmental
* dietary,
* vascular
* smoking
* use of
* oral contraceptives
* use of nonsteroidal antiinflammatory agents (NSAIDs)

Question 9

What Key diagnostic tests are recommended for Crohn’s Disease?

Answer 9

• Colonoscopy
• Biopsy
• MRI/CT scan

Question 10

What are convential treatments for Crohn’s Disease? What herbs can help?

Answer 10

Conventional treatment
* Steroids
* Immunosuppressants
* Enteral nutrition (liquid diet)
* Biologic medicines
* Surgery

Herbs to help”
* Immunomodulators to prevent (Echinacea, Withania)
* Demulcents to sooth the GIT (Althaea)
* Antiinflammatories (Filipendula, Matricaria)

Question 11

What are the signs and symptoms of Ulcerative colitis? What are the potential complications?

Answer 11

Signs and Symptoms
* Frequent bloody diarrhoea with excess mucous
* Tenesmus
* Constipation if rectal involvement only

Potential complications
* Bowel cancer
* Primary sclerosing cholangitis
* Musculoskeletal, skin and eye inflammation
* Dehydration if diarrhoea severe

Question 12

What likely causes Ulcerative colitis?

Answer 12

• Only affects large intestine
• Genetic predisposition to abnormal immune response
• Low levels of anti-oxidants, psychological stress, potentially dairy consumption, NSAID use
• Conflicting evidence around
• smoking

Question 13

What is the pathophysiology of Ulcerative colitis?

Answer 13

• Accumulation of cytotoxic T cells and presence of anticolonic antibodies
• Inflammatory infiltration beneath colonic epithelium
• Mucous discharge from goblet cells

Question 14

What are the key diagnostic tests for Ulcerative colitis?

Answer 14

Blood test
X-ray/CT scan
Sigmoidoscopy
Colonoscopy
Biopsy

Question 15

What are the convential treatments for Ulcerative colitis

Answer 15

Conventional treatment
* Aminosalicylates
* Corticosteroids
* Immunosuppressants
* Biologic medicines
* Potential surgery

Consider the role of immunomodulatory
herbs in diseases where an abnormal immune response is part of the pathophysiology. Herbal actions to consider are the same as for Crohn’s disease – think about capacity for absorption of active constituents in an inflamed GIT

Question 16

What are the differences between Crohn’s Disease and Ulcerative colitis?

Answer 16

Although grouped together under the umbrella term Inflammatory Bowel Disease, and both tending to onset from teenage to young adulthood, Crohn’s and ulcerative colitis are distinct conditions – it is important to understand the differences in order to appropriately guide diagnosis and treatment.

**Crohn’s disease : **
* May affect any part of GIT
* Inflammation is patchy and there may be healthy areas of tissue
* Inflammation may penetrate through the whole bowel wall
* Pain tends to be localised to right lower quadrant between inflamed areas.

**Ulcerative colitis: **
* Affects large intestine only
* Inflammation is continuous along affected areas
* Inflammation is restricted to the epithelial layer of the colon
* Pain tends to be localised to left lower quadrant

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