How serious is IBD (inflammatory bowel disease)?

Inflammatory bowel disease (IBD) can be highly unpleasant and in some cases debilitating, taking its toll on the patient’s quality of life. But can it be life-threatening? Or can it be cured? Leading London gastroenterologist Dr Stuart Bloom provided the answers in an interview with Top Doctors:

What is inflammatory bowel disease?

We usually use it as a term to cover two diseases, firstly, ulcerative colitis, and secondly, Crohn’s disease.

Ulcerative colitis is an inflammatory disorder of the large bowel affecting the colon, which produces blood and diarrhoea. That’s what patients experience when they have flares of ulcerative colitis and it tends to proceed in a relapsing and remitting way – patients can have long periods of remission, but then from time to time, they can have active flares.

Crohn’s disease is a different illness discovered by a New York physician called Burrill B. Crohn in the 1930s, which is characterized by inflammation anywhere in the gut from mouth to anus. It classically tends to present with abdominal pain and diarrhoea rather than bleeding (although in a small proportion of cases, it can present with bleeding as well as with pain around the bottom or higher up in the digestive tract, such as the oesophagus or the stomach). 

Can inflammatory bowel disease be fatal?

Patients often ask if inflammatory bowel diseases can be fatal. This is really very unusual. It’s true that the diseases can be serious – ulcerative colitis can affect the whole of the colon, doesn't always respond to medical treatment, and can need surgery. However, it’s extremely uncommon for it to be fatal, unless the disease is missed or not treated, or results in complications such as a perforation of the bowel. In this situation, an unpleasant and rather debilitating disease can turn into a dangerous and life-threatening one with peritonitis. This would then be a surgical emergency.

Crohn’s disease can affect any part of the digestive tract and can affect absorption of food and nutrients. In some unfortunate patients who have had Crohn’s in a very severe way affecting their small bowel, they can become nutritionally compromised and require intravenous feeding. There is a certain amount of mortality associated with this type of Crohn’s (although once again, with modern management, it’s extremely unlikely and uncommon for Crohn’s disease to directly be associated with fatality).

Can inflammatory bowel disease be cured?

Patients often ask me whether inflammatory bowel disease can be cured and the short answer is no. Interestingly, the cause of inflammatory bowel disease, while it’s not known, is a very active area of study and we’re finding out a lot about this quite quickly.

In brief, people have thought that Crohn’s disease is an autoimmune condition for very many years, but current research into genetics is giving us a lot of information that Crohn’s disease may, in fact, result from a failure of dealing with intestinal antigens and bacteria. We know that the bacteria in the gut are very relevant to the cause of Crohn’s. However, while this may lead to some more effective therapeutic innovations in the future, at the moment, we can't say that we can cure Crohn’s disease.

Similarly, we can’t cure colitis, although the mechanism of this is likely to be different. One day we may be able to cure these diseases, but at the moment, there is no definite cure for ulcerative colitis. However, we can induce prolonged periods of remission for years at a time, and help patients to manage their condition to improve their quality of life.