Living with inflammatory bowel disease: how to manage chronic bowel conditons

A change in bowel movements can indicate the presence of an inflammatory bowel disease, such as ulcerative colitis. Professor Ailsa Hart, a highly experienced London-based gastroenterologist, explains that early diagnosis and careful monitoring are essential to maximise quality of life for sufferers.

What is inflammatory bowel disease?

Inflammatory bowel diseases, which include ulcerative colitis and Crohn’s disease, are chronic lifelong and life-limiting diseases which affect the gastrointestinal tract. They may be diagnosed in childhood, in young people or indeed at any age.  The diseases are increasing in prevalence across the world, particularly in newly industrialised countries whose societies have become more 'westernised'.

What are the symptoms of inflammatory bowel disease?

The symptoms include altered bowel habits or diarrhoea, sometimes with faecal urgency or incontinence which can impact in a major way on quality of life. Other symptoms include abdominal pain, weight loss and often fatigue, which again impacts upon a person’s ability to pursue their day to day activities and achieve their goals. Not only is the intestine affected, but patients may also experience joint pains, skin issues or painful eyes. In some patients fistulas, or communications, develop from the intestinal lumen to the skin surface or to other organs. The ability to enjoy food can be compromised.

How is inflammatory bowel disease diagnosed?

Prompt diagnosis is important to optimise outcomes and ensure good education about the disease and plan a strategy for management.

Investigations to diagnose inflammatory bowel disease include blood tests, stool tests, endoscopy examinations (often colonoscopy to assess the large bowel or colon) and radiological tests (often magnetic resonance imaging to assess the small bowel or ileum).

How is inflammatory bowel disease treated?

A key principle of managing inflammatory bowel disease is careful monitoring of the disease to assess how active and extensive the disease is, as this guides the ongoing strategy of therapy. Goals of therapy are to ameliorate symptoms, improve quality of life and achieve mucosal healing (and probably histologic healing as well in the case of ulcerative colitis).

Therapies involve drugs called induction agents to gain control of the disease and maintenance therapy to ensure the disease is kept under control.

Joint decision making, with patients actively participating in the plan for their management and allowing them to make fully informed decisions at particular times when changes in therapy are necessary, are key to management.