Inflammatory Bowel Disease (IBD) is a chronic condition affecting the digestive tract, with common forms including Crohn’s disease and ulcerative colitis. Diagnosis often involves a combination of blood tests, imaging, and endoscopic procedures. Treatments typically focus on reducing inflammation and may include medications like anti-inflammatories, immunosuppressants, and biologics, along with dietary changes and, in severe cases, surgery.

The diagnosis of chronic inflammatory bowel diseases

When diagnosing IBD, other intestinal diseases must first be ruled out, such as bacterial or viral intestinal inflammation, food intolerances, food allergies, or irritable bowel syndrome.

There is no single examination method for diagnosing chronic inflammatory bowel disease. Instead, in IBD, the clinical symptoms, laboratory diagnostics, and endoscopic, histological (tissue samples), and radiological findings from imaging procedures are evaluated and interpreted (15).

• Anamnesis: A thorough anamnesis (including family history) and physical exam are crucial.
• Allergy and Intolerance Tests: Tests can rule out food intolerances (lactose, fructose, histamine, celiac disease) and food allergies, which can worsen chronic inflammatory bowel disease symptoms.
• Blood Test: Blood tests check for inflammation (CRP, ESR, white blood cells), nutrient deficiencies (folic acid, vitamins B12, D), anemia, and elevated autoantibodies in ulcerative colitis.
• Stool Examination: A stool test can identify infections (e.g., Clostridium difficile), foreign parasites, and inflammation markers like calprotectin, predicting flare-ups.
• Ultrasound: Detects intestinal wall thickening and affected sections.
• Endoscopy: Gastroscopy and colonoscopy examine the intestinal lining, detect bleeding/ulcers, and allow biopsy for inflammation or malignancy.
• Capsule Endoscopy: Examines the small intestine, useful when colonoscopy is limited.
• MRI/CT: MRI is used for diagnosis; CT is avoided to limit radiation.
• X-ray: Only for suspected toxic megacolon.

Life-threatening IBD complication: toxic megacolon

Toxic megacolon is a (fortunately very rare) complication of IBD, particularly ulcerative colitis (since the colon is affected), which results in a type of intestinal paralysis. The abdomen is distended (acute abdomen) with defensive tension and pain, and there is high fever, chills, rapid heartbeat, and even intestinal obstruction.

The bloated colon can damage the intestinal wall so much that intestinal contents can enter the blood, which can lead to sepsis (commonly known as blood poisoning). In the worst case, megacolon can lead to shock with life-threatening organ failure.

However, if you go to the hospital immediately or call an emergency doctor when you experience the corresponding symptoms, you can be treated.

Chronic Inflammatory Bowel Diseases in Conventional Medicine

From a conventional medical perspective, chronic inflammatory bowel disease (IBD) was initially considered an autoimmune disease. It was believed that parts of the immune system attack the body’s own tissue in the intestine, in this case the intestinal mucosa/intestinal wall. As mentioned above, IBD is now thought to be a barrier disorder in which the immune system does not attack the body’s own structures, but rather bacteria in the intestinal flora. Anti-inflammatory and immune-suppressant drugs are used in particular, i.e., cortisone preparations (e.g. budesonide) and immunosuppressants (e.g., azathioprine), often in long-term therapy.

Cortisone-containing medications—budesonide—for IBD

Budesonide, a cortisone-containing medication, is often used for IBD. It has fewer side effects than other glucocorticoids because it primarily affects the large intestine and breaks down quickly in the liver. In Crohn’s disease, it’s effective for inflammation in the ascending colon, but less so for the upper digestive tract. For ulcerative colitis, it’s applied rectally (e.g. Entocort) for mild to moderate inflammation in the lower colon or rectum, often alongside other treatments like mesalazine. Only 10% enters the bloodstream, reducing side effects, but caution is needed for liver disease or drug interactions. Prolonged use may still cause side effects like Cushing’s syndrome, digestive issues, infections, osteoporosis, and psychological effects.

Mesalazine inhibits intestinal inflammation in IBD

The standard therapy for chronic inflammatory bowel disease (IBD) in mild to moderate cases also includes mesalazine, a drug from the group of aminosalicylates, which both inhibits inflammatory processes and suppresses the immune system.

Mesalazine can be used for intestinal inflammation orally in capsule form or locally, for example as an enema, foam, or suppository. The most common possible side effects of mesalazine include diarrhea, nausea, abdominal pain, headache, vomiting, skin rash, hypersensitivity reactions, and fever.

Sometimes sulfasalazine is also prescribed, a mixture of mesalazine and another active ingredient (sulfonamide).

Monoclonal antibodies in IBD

In severe cases of IBD, mesalazine alone is often too weak and is therefore usually combined with other medications or replaced with stronger medications such as adalimumab. Adalimumab is a so-called monoclonal antibody, a drug from the group of biologics, and is very expensive. A single injection, which is due every two weeks, costs around 1500 AUD .

Adalimumab blocks tumor necrosis factor ( TNF-α ), a messenger substance of the immune system and an important mediator of immune and inflammatory reactions. TNF-α blockers are therefore among the drugs that suppress the immune system. They are also called immunosuppressants.

Common side effects include increased blood lipid levels, dizziness, drowsiness, frequent respiratory infections, an overall increased susceptibility to infections, pancreatitis and pneumonia, diarrhea, skin rashes, inflammatory changes in the skin with itching, new onset of psoriasis and worsening of existing psoriasis, etc.

Drug therapy for IBD: No guaranteed effect

Overall, the success of drug treatments for intestinal inflammatory bowel disease varies greatly. For some, the treatment works and repeatedly leads to longer breaks (remissions) between the individual attacks of the disease, while for others, there is hardly any noticeable effect.

If the above-mentioned medications fail to treat IBD, surgical measures are also considered, during which the inflamed parts of the intestine are removed.

The disease often ends in what is known as short bowel syndrome. In this case, more than 100 cm of the small intestine had to be removed, which means that the intestine is eventually so shortened by the surgical intervention that it can no longer absorb nutrients properly and various deficiency symptoms can occur, not to mention the often extreme weight loss.

Ultimately, conventional medicine offers little hope for IBD. Attempts are made to alleviate symptoms and prolong remissions, but the possibility of a cure for chronic intestinal inflammation is dismissed. It is no wonder that more and more people with chronic inflammatory bowel disease are turning to naturopathy, nutritional therapy and other complementary medical procedures.

Learn about natural approaches to IBD.