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Charlie Lees

3y ago

I write about Crohn's disease and ulcerative colitis (IBD), digital health, diet, genetics and the microbiome. I am a passionate educator and innovator. I am a gastroenterologist and I run a busy IBD clinic. I am a Professor of Gastroenterology running a research team improving outcomes for people living with IBD. For more content please see charlielees.com and search Charlie Lees at YouTube.

What is inflammatory bowel disease?
Charlie Lees

Let's clear this up, because there appears still to be a lot of confusion.

Inflammatory bowel disease (IBD) is not the same as irritable bowel syndrome |IBS).

IBD consists of Crohn's disease and ulcerative colitis (UC).

Together Crohn's and UC affect about 1 in 125 people across Europe and N America. IBD can occur at any age of life but typically starts in young people. It is characterised by inflammation in the digestive tract that can be clearly seen down an endoscope (e.g. colonoscopy), under a microscope (a biopsy) or on a scan (CT or MRI). This inflammation requires treatment and we have a range of effective anti-inflammation therapies available.

IBD is lifelong and incurable. For the majority two phases of therapy are needed:

  • induction therapy: short-term (4-12 weeks) to get a person well

  • maintenance therapy: long-term to keep a person well (and prevent flares)

Untreated inflammation leads to irreversible bowel damage

This is particularly true in Crohn's disease, but also in UC.

Most of the time inflammation and symptoms are in sync - a person with active colitis will often have bloody diarrhoea. Treat the colitis and the bloody diarrhoea will stop.

All too often however there is a disconnect between inflammation and symptoms. This is important - treat the symptoms but not the inflammation and there is a high chance of complications. These include build up of scar tissue (fibrosis), blockages (obstructions), abscesses and fistulas, pre-cancer (dysplasia) and cancer in the colon, hospital admission, surgery to remove portions of the intestine and stoma formation.

The good news is that we know how to manage IBD

And for the majority of newly diagnosed patients today we are successful. Prompt referral and diagnosis, investigations and induction therapy. Monitor and adjust therapy (using a treat-to-target approach) and then maintain long-term remission.

No symptoms and no inflammation = no long-term bowel damage.

Many patients with IBD will also have IBS

But they are not the same conditions. IBS is very common (10-15% of the population), requires identification of triggers (eg foods / stress) and symptom control. There are no long-term consequences to the digestive system.

Where both IBD and IBS co-exist (perhaps 25% of people with IBD with have IBS) we will be treat both.

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