We don’t know the number of cases in the UAE, but IBD is believed to affect between 2 and 4 per cent of the population. Globally, the incidence of IBD is thought to be around 364 cases per 100,000 people*. Both Crohn’s disease and ulcerative colitis are more common in white, Europeans and in countries in Northern Europe and North America.
*Centers for Disease Control and Prevention: What is inﬂammatory bowel disease? Available at: Data and Statistics (cdc.gov) (last accessed Nov 2020).
Most Crohn’s disease and ulcerative colitis are diagnosed in adolescents or between the ages of 20 and 30*, but a diagnosis can occur at any age. Ulcerative colitis affects men and women equally, but Crohn’s disease appears to be slightly more common in women. The reason for this is not known.
*Centres for Disease Control and Prevention: Data and Statistics, Inflammatory Bowel Disease at https: Data and Statistics (cdc.gov) (last accessed Nov 2020).
There are different types of Crohn’s disease and they each have a different name, usually in relation to the different part of the gut that is most affected.
- Terminal ileal and ileocecal – affecting the ileum, the last part of the small intestine. This is one of the most common forms of Crohn’s. Symptoms usually include pain in the lower right side of the abdomen, diarrhoea and weight loss.
- Large bowel – affects the colon and is sometime call Crohn’s colitis. Symptoms usually include diarrhoea with blood and mucus, and frequent bowel movements.
- Gastroduodenal – affecting the upper gut (the oesophagus and stomach) and symptoms include an indigestion-like pain, nausea, appetite loss and weight loss. This is a less common condition.
- Perianal – affects the area around the anus and symptoms involve the development of skin tags, haemorrhoids (piles), abscesses and fistulas.
- Oral Crohn’s – affects the mouth but is a rare condition. IT causes swollen lips and mouth fissures and ulcers.
There are three main type of ulcerative colitis and they are categorised according to which part of the large intestine is affected:
- Proctitis – affects only the rectum. As the rest of the colon is unaffected, the main system is usually passing blood in stools, or an increased urge to go to the toilet.
- Left-sided (or distal) colitis – affects the rectum and the left-side of the colon. Symptoms include diarrhoea with blood and mucus, pain on the left side of the abdomen and an urge to go to the bathroom.
- Total colitis or Pancolitis – affects the whole colon. As inflammation is extensive, symptoms include very frequent diarrhoea with blood and mucus, severe abdominal cramps, pain, fever and weight loss.
Although the symptoms of IBD and IBS can be similar, they are not the same. Both affect the digestive tract, but the main characteristic of IBD is inflammation. In IBS, changes to bowel function or the way the brain senses what is happening in the bowel causes the issues, but inflammation does not play a part. It is possible to have IBS if you already have IBD, or you can have just one of the conditions.
Living with IBD
Everyone is different and everyone’s experience of living with IBD will vary. The impact it has on your life will also depend on the severity of your symptoms. Medication you are taking may enable you to manage the disease and control symptoms so they remain mild, and you can live a normal and active life.
Most patients go through stages of feeling well, known as remission, where symptoms are mild, and periods of relapse, also known as a flare-up or active stage, when symptoms are more severe and difficult to manage. During a flare-up, treatment with medication may not be as effective and the disease will cause a bigger impact on day to day life.
Many people living with IBD can control their symptoms with medication, enabling them to have a good quality of life. Changes to diet may help manage your condition, so always talk to a dietician to see how this could help you. IBD is a chronic, life-long condition, so some patients may experience depression, particularly during an active phase where symptoms are harder to manage. Finding a doctor and IBD team who can support you is key to improving any mental health issues you may face.
IBD is a chronic condition, which means it is life-long. Currently, there is no cure, but people living with IBD experience active phases of the disease, when symptoms are more severe and harder to manage, followed by periods of remission, when symptoms are milder and easier to manage. Periods of remission can last many years and treatment with drugs can help to successfully prolong them.
The exact cause is not known, but it is known that stress alone does not cause Crohn’s and Colitis. Stress can, however, aggravate symptoms and be the cause of a flare up, but this is usually in conjunction with other symptoms.
There is no cure for IBD. People with IBD go through periods of remission when the disease is not active and periods when the disease is active (also called flare-ups), when symptoms are more severe and difficult to manage. Medication can help to reduce inflammation and increase the periods of remission, but there is no cure.
A period of remission is a time when your IBD is not active, and symptoms can become mild and manageable. These periods can last a long time and can be extended if you are responding well to medication, but they do not mean the disease has gone away. Unfortunately, there is no cure for IBD.
People living with Crohn’s disease and ulcerative colitis are at a higher risk of developing colorectal cancer. The risk correlates to the amount of time that someone has been living with the disease. Colorectal cancer is one of the most common forms of cancer in the UAE, but with early detection and early treatment, survival rates are as high as 90%*. Regular screening is vitally important, especially for IBD patients, as the early symptoms of colorectal cancer can be very similar to the symptoms of IBD.
*Cancer.Net: Colorectal Cancer Statistics. Available at: Colorectal Cancer: Statistics | Cancer.Net (last accessed Dec 2020)
The medication that someone with Crohn’s or colitis may be taking can prevent them from giving blood. Always check with your local blood donation centre.
IBD is a chronic condition, which means it will last a lifetime. Patients experience periods of remission when symptoms are a lot milder and easier to manage. Medication can be effective at extending periods of remission.
If you are diagnosed with IBD, it does not necessarily mean you will pass the condition down to your children.
If an immediate family member, such as a parent or sibling, has IBD then your risk of being diagnosed is significantly higher. If another family member, such as an uncle, cousin, grandparent, has it, then there is a slightly increased risk. However, more than 80% of patients with IBD have no family history, so developing IBD isn’t just down to genetics.
*Centers for Disease Control and Prevention: What causes inﬂammatory bowel disease? Available at: CDC -What is inflammatory bowel disease (IBD)? – Inflammatory Bowel Disease – Division of Population Health (last accessed Nov 2020).
Your child may need to take medication long-term and will probably have to attend more doctor’s appointments. They may need to stay in hospital at some point. IBD is a life-long condition, but with the proper treatment and management of symptoms, you can help to minimise its impact and help them live as normal a life as possible.
IBD does not affect your chances of becoming pregnant. There is some evidence to suggest that it may be more difficult to conceive during an active phase. If you are taking medication to control your IBD, or you have had surgery, always talk to your doctor before becoming pregnant.
Diagnosis and treatment
Your doctor may need you to take tests from time to time to see how your condition is progressing or how you are responding to treatment. Certain medication may require blood testing to check for any side effects. Always talk to your doctor and ask them to explain why you are taking any tests that they suggest.
Following an IBD diagnosis, you are likely to see a team of IBD specialists on a regular basis. Talk to your family doctor about specialists in your area. Try and build a good relationship with a supportive doctor, as you will see them fairly regularly, and they will become a key part of your support network and this will help make managing your condition a lot easier.
Thanks to advancements in medicine, surgery is a lot less common nowadays. If, however, you are unable to control your symptoms with medication and you are experiencing repeated flare-ups which are seriously affecting day to day life, surgery is an option that can be life changing.
during certain types of surgery for IBD, a section of intestine is brought to the surface and through the abdomen wall. The part of the intestine that is brought to the surface is called the ileum, so the procedure is known as an ileostomy, or a stoma. A bag is then fitted which collects the waste that would normally go through the anus.
An IBD diagnosis does not mean you will need a stoma. Stomas are only necessary after certain types of surgery and many people with IBD control their condition with medication. Surgery, which involves removing part of the bowel, may be necessary if medication is not working or is not well tolerated. Some people choose to have a stoma as it can improve quality of life.
Talk to your general practitioner or family physician and they will help refer you to a specialist in your area.
There may be programmes in your area available to offer support with payment for medication, if it is not covered by your insurance. Talk to your doctor to find out about any programmes that may be able to support you and whether you may be eligible.
Some viruses which stay in the body after an initial infection, can return in people taking immunosuppressants. Some bacterial infections of the skin and soft tissue are also more likely to occur in people taking immunosuppressants. However, these risks are outweighed but the risks of complications from IBD if you don’t take the immunosuppressants. Always talk to your doctor about the benefits versus the risks.
There is no specific diet that can fully control IBD, but by managing what you eat, you may be able to manage symptoms. Talk to a dietitian about ways you can identify ‘trigger’ foods. These are foods that cause your symptoms to become worse. By eliminating these foods, you may be able to ease some of your symptoms.
There are alternative treatment options being investigated by researchers that are showing promising results for the treatment of IBD. These include ‘Faecal or stool transplantation’. These treatments are still very much in the experimental stage but talk to your doctor if you want to know more, or to enquire about any medical trials that might be happening locally.
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