Overview of IBD: Characteristics, symptoms, and complications

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of idiopathic conditions characterized by chronic gastrointestinal (GI) tract inflammation.1 The most common subtypes are Crohn’s disease (CD) and ulcerative colitis (UC).2

Crohn’s disease
Silhouette of person with GI tract highlighted Characteristics
  • Can affect any portion of the GI tract, predominantly the ileum3,4
  • Potential transmural involvement of all tissue layers (full-thickness inflammation)3 
Symptoms
Symptoms may include diarrhea, abdominal pain, weight loss, fever, rectal bleeding, perianal disease, signs of malnutrition, abdominal mass, and growth failure in children and adolescents.4,6 

Complications
  • Complications may include bowel obstruction, stricture, perforation, fistula, abscess, and cancer3,4,6
  • Increased risk of colorectal cancer3
    - Related to length of disease (more than 8 to 10 years)
    - Related to length of colon involved
Ulcerative colitisSilhouette of person with ulcerative colitis highlighted
Characteristics
  • Limited to the colon and rectum3,5
  • Inflammation is limited to mucosal layer of colonic tissue3,5 
Symptoms
Symptoms may include bloody diarrhea, abdominal pain, weight loss, fever, anemia, rectal bleeding, and signs of malnutrition.5,6 

Complications
  • Complications may include perforated bowel and toxic megacolon3
  • Increased risk of colorectal cancer3
    - Related to length of disease (more than 8 to 10 years)
    - Related to length of colon involved

Prevalence and costs: The burden of IBD

Prevalence of IBD

IBD affects millions of people worldwide.

Map showing IBD cases per country

Economic burden

  • Annual indirect costs are estimated at an additional $5.5 billion in the United States, between €8 billion and €28 billion in Europe, and more than $1 billion in Canada7-10
  • In addition, productivity losses due to absenteeism and short-term disability also contribute to the indirect costs of IBD11

Managing IBD: Multiple therapeutic options

IBD can be managed through several options, including therapeutic, dietary, and surgical.

Therapeutic agents for IBD

Aminosalicylates

Target

  • MOA undetermined12

Corticosteriods

Target

  • Glucocorticoid receptors13

Immunomodulators

Target

  • Purine biosynthesis14
  • Cell proliferation14

Biologics

Target

  • TNF-α14

Antibiotics

Target

  • Luminal bacteria16

Antidiarrheals

Target

  • Gut motility14


                                                     
Surgery
  • When therapeutic agents are not enough to maintain the patient in remission, surgery may be needed. For patients with UC, the risk of abdominal surgery within their lifetime is 25-30 %. For Crohn’s disease, 50–70 % of the patients will require surgery.20
  1. Knigge KL. Inflammatory bowel disease. Clin Cornerstone. 2002;4(4):49-60.

  2. Eksteen B, Liaskou E, Adams DH. Lymphocyte homing and its role in the pathogenesis of IBD. Inflamm Bowel Dis. 2008;14(9):1298-1312.

  3. Crohn’s and Colitis Foundation of America. The Facts About Inflammatory Bowel Diseases. 2011.http://www.ccfa.org/assets/pdfs/ibdfactbook.pdf. Accessed July 15, 2013.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Crohn’s disease. 2011.http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/. Accessed March 28, 2012.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Ulcerative colitis. 2011.http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/. Accessed March 28, 2012.

  6. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347(6):417-429.

  7. Park KT, Bass D. Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis. 2011;17(7):1603-1609.

  8. Yu AP, Cabanilla LA, Wu EQ, Mulani PM, Chao J. The costs of Crohn’s disease in the United States and other Western countries: a systematic review. Curr Med Res Opin. 2008;24(2):319-328.

  9. Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010;31(7):693-707.

  10. Canadian Digestive Health Foundation. Statistics. http://www.cdhf.ca/digestive-disorders/statistics.shtml. Accessed February 22, 2012.

  11. Gibson TB, Ng E, Ozminkowski RJ, et al. The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J Occup Environ Med. 2008;50(11):1261-1272.

  12. Hanauer SB. Review article: aminosalicylates in inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20(Suppl 4):60-65.

  13. Nicolaides NC, Galata Z, Kino T, Chrousos GP, Charmandari E. The human glucocorticoid receptor: molecular basis of biologic function. Steroids. 2010;75(1):1-12.

  14. Pithadia AB, Jain S. Treatment of inflammatory bowel disease (IBD). Pharmacol Rep. 2011;63(3):629-642

  15. Kaser A, Tilg H. Novel therapeutic targets in the treatment of IBD. Expert Opin Ther Targets. 2008;12(5):553-563

  16. Perencevich M, Burakoff R. Use of antibiotics in the treatment of inflammatory bowel disease. Inflamm Bowel Dis. 2006;12(7):651-664.

  17. Ginsburg PM, Bayless TM. Managing functional disturbances in patients with inflammatory bowel disease. Curr Treat Options Gastroenterol. 2005;8(3):211-221.

  18. Crohn’s and Colitis Foundation of America. Diet and Nutrition. http://www.ccfa.org/info/diet. Accessed April 23, 2012.

  19. Eiden KA. Nutritional considerations in inflammatory bowel disease. Pract Gastroenterol. 2003;27(5):33-54.

  20. Läkartidningen: Kirurgi – omistligt komplement till medicinsk behandling. 2009 nr 45 vol 106.

  21. Stedman’s Medical Dictionary. 27th ed. New York, NY: Lippincott Williams & Wilkins; 2000.

  • Idiopathic: denoting a disease of unknown cause22

  • Ileum: the third and longest portion of the small intestine, about 12 feet in length in humans22

  • Transmural: through any wall, as of the body or of a cyst or of any hollow structure22

  • Perianal: surrounding the anus22

  • Stricture: a circumscribed narrowing or stenosis of a hollow structure22

  • Perforation: abnormal opening in a hollow organ or viscus22

  • Fistula: an abnormal passage from one epithelial surface to another epithelial surface22

  • Abscess: a circumscribed collection of purulent exudate frequently associated with swelling and other signs of inflammation22

  • Colorectal: relating to the colon and rectum, or to the entire large bowel22

  • Colon: the division of the large intestine extending from the cecum to the rectum22

  • Rectum: the terminal portion of the digestive tube, extending from the rectosigmoid junction to the anal canal22

  • Toxic megacolon: acute, nonobstructive dilation of the colon, seen in fulminating ulcerative colitis and Crohn’s disease22

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