Fortunately, inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis are not acutely life-threatening diseases. However, they do bring with them distressing symptoms: chronic diarrhea, pain, weight loss, and much more. Naturopathic measures can provide relief from intestinal inflammation.

IBD: Chronic inflammatory bowel disease

When we talk about chronic inflammatory bowel disease (IBD), we are talking about two diseases in particular: Crohn’s disease (terminal ileitis) and ulcerative colitis. Both diseases were initially classified as autoimmune diseases, but it is now assumed that they are barrier disorders in which the intestinal mucosa is so damaged that bacteria from the intestinal flora can penetrate into the deeper layers of the mucosa and trigger immune reactions there. They are therefore not infectious diseases, nor are they acutely life-threatening illnesses.

In most cases, medications with many side effects (as long-term therapy) or even operations are used, so that those affected usually look for natural therapies on their own and want to treat their intestinal inflammation with naturopathic medicine.

Intestinal inflammation: Not always Crohn’s disease and ulcerative colitis

The long term “chronic inflammatory bowel disease” is often abbreviated to IBD. In English-language literature, however, you will find the abbreviation IBD for “inflammatory bowel disease,” not to be confused with IBS for “irritable bowel syndrome“.

The term intestinal inflammation is also often used, although there can also be intestinal inflammations that cannot be attributed to Crohn’s disease or ulcerative colitis. For example, inflammation of the appendix (appendicitis) is also an intestinal inflammation.

Diverticulitis and antibiotic-associated colitis are also considered intestinal inflammations. The latter occurs when antibiotics damage the intestinal flora so severely that pathogenic germs, such as Clostridioides difficile, take over.

Crohn’s disease and ulcerative colitis: The differences

While Crohn’s disease can affect the entire digestive tract from the mouth to the anus, ulcerative colitis is limited to the large intestine. In ulcerative colitis, the intestinal inflammation begins in the rectum (the 20-cm-long section of intestine in front of the anus) and spreads continuously throughout the rest of the large intestine as the disease progresses—a pattern of spread that can be easily identified with a colonoscopy.

The preferred location of Crohn’s disease is in the area where the small intestine and large intestine meet. Another term for Crohn’s disease is therefore terminal ileitis. The lowest section of the small intestine is called the ileum, and the very last section of the ileum before the transition to the large intestine is called the terminal ileum. The ending -itis in the term ileitis indicates inflammation. (Examples: arthritis (joint inflammation), bronchitis (inflamed bronchi), gastritis (inflammation of the stomach lining), etc.).

In Crohn’s disease, intestinal inflammation can also occur simultaneously in several parts of the digestive tract. Usually, the terminal ileum and the rectum are inflamed at the same time.

Crohn’s disease affects all layers of the intestinal wall. In ulcerative colitis, only the inner mucous membrane layer (the colon wall) is affected. Both diseases can sometimes reach serious proportions and can significantly impair the lives of those affected.

The symptoms of IBD

The most common symptoms in inflammatory bowel disease (IBD) are:

• stomach pain
• Diarrhea
• blood in the stool
• weight loss
• chronic fatigue

Diarrhea in IBD can be bloody, mucous, or both. A typical course of the disease is recurrent, i.e. intermittent, with tolerable periods (remissions) alternating with dramatic phases (relapses), the latter often requiring treatment in a clinic.

During IBD flare-ups (relapses) or afterwards, other illnesses can occur. One in five Crohn’s disease patients and one in seven ulcerative colitis patients develop reactive arthritis. Exactly the same number of IBD sufferers develop sacroiliitis (inflammatory, degenerative changes in the sacroiliac joint (lower back)). Reactive arthritis is arthritis that occurs as a result of (usually bacterial) inflammation of the urinary tract or intestines.

Bile duct inflammation, anemia , skin diseases (e.g., rosacea), or eye inflammation (uveitis) can also occur after IBD attacks.

Diarrhea and stomach pain mean that you can no longer eat everything and eat less overall, especially during flare-ups. In addition, the damage to the inflamed mucous membrane can lead to absorption disorders. Both – eating little and absorption disorders lead to nutrient and vital substance deficiencies, which in turn can lead to further symptoms and illnesses.

In the course of intestinal inflammation, stenosis (narrowing) can occur in the inflamed intestine, which increases the risk of intestinal obstruction.

Special features of Crohn’s disease

In Crohn’s disease, fistulas (ducts filled with pus) and abscesses can also develop in the intestine. The body actually forms fistulas for a good reason. It tries to drain pus outwards through these ducts. However, this often does not work in the desired way.

The fistulas can connect different parts of the intestine or even lead from the intestine to other organs or to the surface of the body. These passages can also end “blindly” and form abscesses, which are very painful and often accompanied by fever and generalized (affecting the whole body) inflammation.

Special features of ulcerative colitis

Visible blood in the stool can occur more frequently in the case of ulcerative colitis than in Crohn’s disease. Bleeding in the colon caused by ulcerative colitis leads to bright blood in the stool. However, if Crohn’s disease affects the upper digestive tract (esophagus/stomach) and bleeding occurs there, contact with stomach acid causes the blood (or the red blood pigment (=hemoglobin)) to turn into black hematin chloride. The stool then appears black due to the older blood.

Of course, there can also be a mixture of fresh and older blood in the stool, namely when both the upper and lower digestive systems are affected and bleeding occurs in both areas, which can only occur in Crohn’s disease.

The History of Chronic Inflammatory Bowel Disease IBD

The typical symptoms of intestinal inflammation (IBD) have been known in medicine for a long time. Of course, it is no longer possible to determine whether it was actually IBD as we know it today. Chronic diarrhea, for example, has been described in the history of medicine since ancient Greece. Hippocrates of Kos, the most famous doctor of antiquity (460–370 BC), also spoke of the possible causes of chronic non-infectious diarrhea.

Sir Samuel Wilks (1824–1911), a British physician and lecturer at the University of London , explained a case report in 1859 in which the term “ulcerative colitis” was used for the first time to describe exactly what is still understood by this disease today. However, it is now suspected that it was more likely a case of Crohn’s disease.

The year 1909 is considered an important year in terms of ulcerative colitis. At that time, the Royal Society of Medicine in London held a symposium to discuss more than 300 cases of ulcerative colitis, their risk factors, symptoms, and possible treatment methods. In the same year, the proctologist and surgeon John Percy Lockhart-Mummery (1875–1957) introduced the small colonoscopy (sigmoidoscopy) as a reliable diagnostic method for colon diseases (2).

Sigmoidoscopy is still used today to examine part of the colon (in a modernized form, of course), which is usually sufficient, especially in the case of ulcerative colitis, and is over in just a few minutes without anesthetics. If the entire colon is to be examined, a normal colonoscopy is used, which takes about half an hour and is done under anesthetics.

In 1955, the first blind clinical study appeared, which showed that cortisone was effective in treating ulcerative colitis. At the same time, the two drugs mesalazine and sulfasalazine came onto the market. The following decades were used to research the disease, and monoclonal antibodies (e.g., infliximab and adalimumab) were soon introduced.

These so-called biologics are intended to inhibit the activities of TNF-α. Certain immune cells release a substance known as TNF-, which causes inflammatory responses. If TNF-α is inhibited, the inflammation caused by IBD subsides.

IBD affects so many people

People with chronic inflammatory bowel disease (IBD) are no longer a rarity. The number of people affected by this intestinal inflammation has been increasing slowly but steadily for decades. In the 1980s, there was a sudden, massive increase in the number of people affected—at least in industrialized nations.

According to official sources, there are now well over 170000 people in Australia who suffer from chronic inflammatory bowel disease (IBD) (more common from Crohn’s disease than ulcerative colitis). However, it can be assumed that the number of unreported cases is much higher, as many people deny the disease out of shame or fear of consequences (e.g., at work or in their relationship), especially when it is mild to moderate and can still be concealed.

Life expectancy in intestinal inflammation IBD

Depending on the study, the life expectancy of patients with IBD is either not reduced or only slightly reduced. In 2003, for example, data from 16,550 people with chronic inflammatory bowel disease showed a slightly increased mortality compared to 82,917 healthy controls (20), with mortality being higher in Crohn’s disease than in ulcerative colitis.

In 2010, an analysis of nine studies on Crohn’s disease found that mortality was slightly increased, while the risk of colorectal cancer was no higher than in people without Crohn’s disease (19).

Four years later, a study was published in the journal Gut, in which almost 240 Crohn’s disease patients were scientifically monitored over a period of 20 years. There was no increase in mortality and no increased risk of cancer or cardiovascular disease (6).

A 2020 study found that life expectancy in IBD patients was reduced by 2.3 years (21).

At this age, intestinal inflammation occurs most frequently

Crohn’s disease and ulcerative colitis usually occur between the ages of 15 and 35. People of all genders are equally affected. Around 25 percent of all IBD patients are diagnosed before the age of 18. The disease therefore occurs not only in adults, but also in children and teenagers.

A quarter of all affected children and adolescents are younger than 10 years old when diagnosed. The course of IBD is even faster and more aggressive in children and adolescents than later in adulthood.

Smokers are twice as likely to suffer from Crohn’s disease

Smokers are twice as likely to suffer from Crohn’s disease as non-smokers, so smoking is considered an important risk factor . Experiments have discovered that cells damaged and inflamed by smoking can break off from the lungs, then travel to the intestines and fuel inflammatory processes there. If you are suffering from Crohn’s disease and are also smokers, now would be a good time to quit smoking .

Read more about Diagnosis and common Treatments for IBD