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Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) affect approximately 250,000 people in Italy (7 million worldwide), with an estimated incidence of 5 to 10 new cases per 100,000 inhabitants.

They include:

  • Crohn's disease.
  • Ulcerative colitis.
  • Indeterminate Colitis.
  • Microscopic Colitis (Lymphocytic Colitis, Collagenous Colitis, Eosinophilic Colitis).

They manifest themselves with episodes of aggravation alternating with periods of mitigation. Their etiology is still obscure; however, the most recent scientific evidence points to a decisive role of altered immune system and multifactorial elements.

Chronic inflammatory bowel disease may present periodic manifestations and evolve over time. Although modifying diet and lifestyle can help reduce the symptoms of the disease, people with IBD often manage them through drug therapies. The therapeutic approach is highly individualized, and treatment varies according to the severity of the condition. In some cases, surgery may be necessary to remove severely compromised parts of the digestive tract.

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What Is Inflammatory Bowel Disease (IBD)?

Chronic Inflammatory Bowel Diseases (IBD) are chronic and recurring conditions that cause inflammation of the gastrointestinal tract. The two main types of IBD are Crohn’s disease and ulcerative colitis.

In the case of ulcerative colitis, the inflammation is confined to the colon and rectum. Crohn’s disease, on the other hand, can affect the small intestine and colon, but the inflammation can extend to any part of the digestive tract.

If you suffer from ulcerative colitis, the inflammation will be limited to the colon and rectum. Crohn’s disease typically affects the small intestine and colon, but inflammation can also occur in other parts of the digestive tract.

If left untreated, IBD can lead to serious complications, including:

  • Intestinal ulcers
  • Tears and infections in the intestinal lining
  • Malnutrition
  • Intestinal obstruction

Additionally, an increased risk of colorectal cancer has been observed in patients with IBD.

How to prevent chronic inflammatory bowel disease

Just as the causes of IBDs are not known for sure, there is no guaranteed way to prevent them. However, certain tricks can help reduce risk factors, especially if there is a family history of these or other autoimmune diseases:

  • Reduce exposure to environmental toxins such as cigarette smoke, pesticides or other harmful chemicals.
  • Take antibiotics or painkillers only if recommended by your doctor.
  • Adopting a healthy diet, reducing stress and getting enough sleep help protect the immune system.
  • Favour fibre-rich foods such as fruit, vegetables, legumes and whole grains, which help healthy gut bacteria. Fermented foods such as yoghurt, kefir or naturally fermented vegetables are also good for the gut.
  • Evaluate with your doctor whether to take a probiotic supplement.

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What Are the Symptoms of Inflammatory Bowel Disease?

Chronic Inflammatory Bowel Diseases (IBD) can present with different symptoms depending on the type of disease and the location of inflammation in the gastrointestinal tract.

Symptoms of Crohn’s Disease

Crohn's disease can affect any part of the gastrointestinal tract. Symptoms may vary depending on location, but usually include:

  • Persistent abdominal pain.
  • Diarrhoea, sometimes accompanied by blood.
  • Fever (usually below 38°C, especially in the afternoon or evening).
  • Significant weight loss.
  • Anaemia.

Approximately 30% of patients may be asymptomatic. If undiagnosed and untreated, the disease can progress and lead to complications such as:

  • Stenosis.
  • Fistulas (including perianal fistulas).
  • Abscesses.

Symptoms of Ulcerative Colitis

Ulcerative colitis can also involve the entire colon. Symptoms may vary depending on the site of inflammation, but commonly include:

  • Presence of blood in the stool.
  • Diarrhoea.
  • Fever.
  • Abdominal pain.
  • Anaemia.

Persistently active ulcerative colitis is a risk factor for the development of colon cancer.

Risk factors for chronic inflammatory bowel disease

The prevalence of chronic inflammatory bowel disease varies significantly depending on the country of origin and cultural habits, especially related to diet, indicating a significant role of environmental factors in the development of these diseases.

IBDs are complex conditions with multiple causes, including:

  • Abnormal immunological reaction of the gut towards intestinal bacteria.
  • Interaction between genetic and environmental factors.
  • Familial tendency, but not direct inheritance.
  • Mutations in more than 240 gene loci associated with the risk of developing IBD.
  • Cigarette smoking.
  • Psychological distress, such as anxiety and depression.
  • Abuse of antibiotics or NSAID drugs, such as aspirin or ibuprofen.
  • Infections in childhood.
  • Changes in the intestinal microbiota.
  • The pre-existence of other autoimmune diseases, such as psoriasis or rheumatoid arthritis.

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How Do You Diagnose Inflammatory Bowel Disease?

The diagnosis of IBD is based on a thorough clinical evaluation by a specialist, starting with a detailed medical history and followed by specific instrumental tests to detect intestinal inflammation.

Among the main diagnostic tests for inflammatory bowel disease are:

  • Endoscopy – e.g. colonoscopy, which allows direct examination of the inside of the colon and small intestine for signs of inflammation, ulcers or other abnormalities.
  • X-ray with contrast – especially useful for the diagnosis of Crohn's disease, this technique involves the use of a contrast medium to highlight any areas of inflammation or stenosis in the gastrointestinal tract.
  • Scintigraphy – an imaging technique that uses small amounts of radioactive material to detect inflammation or other abnormalities in the intestinal tract.
  • Nuclear magnetic resonance imaging (NMR) – this imaging technique provides detailed images of the gastrointestinal tract without the use of ionizing radiation and is particularly useful for assessing the extent and severity of inflammation in patients with inflammatory bowel disease.

These instrumental examinations can be used individually or in combination, depending on the patient's specific diagnostic needs.

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How Do You Treat Inflammatory Bowel Disease?

It is crucial to adopt a multidisciplinary approach in the treatment of chronic inflammatory bowel disease in order to effectively manage both physical and emotional symptoms, which can have a significant impact on patients' personal and relational lives.

This approach begins with the clinical gastroenterological diagnosis and treatment and is complemented with customized nutritional treatment plans and appropriate psychological support.

Nonsurgical treatment for IBD

  • Dietary planning.
    Your doctor may recommend following a special diet to help manage your condition. In addition to providing you with information about your dietary plan, your doctor may refer you to a registered dietitian for nutritional support.
  • Medications.
    Your doctor will work closely with your gastroenterologist or family doctor to develop and coordinate your treatment plan, which may include medications to control inflammation, reduce symptoms, and prevent infection.

Surgical procedures for IBD

Our board-certified colon and rectal surgeons are skilled in open, laparoscopic, and robotic surgical techniques. Whenever possible, we use sphincter-preserving techniques and other approaches that preserve natural bowel function. Our surgeons will use minimally invasive techniques whenever possible to shorten your recovery time, decrease pain, and improve outcomes.

Surgical procedures to treat inflammatory bowel disease include:

  • Colectomy – Complete or partial removal of the colon, with the possibility of ileostomy or ileo-anal anastomosis ("ileal pouch").
  • Intestinal strictureplasty – Indicated for Crohn’s disease, this procedure allows the widening of narrowed areas of the intestine caused by scar tissue.
  • Proctocolectomy – Removal of the colon and rectum, often combined with ileostomy or surgery with an ileal pouch.
  • Small bowel resection – A procedure to remove damaged portions of the small intestine, such as in cases of fistulas, abscesses, or obstructions.

Behavioral health treatment options

It is important to address the emotional aspects related to IBD as well. A personalised approach may include:

  • Psychotherapy and pharmacological therapies
  • Mindfulness practices and relaxation techniques
  • Physical activity programs and nutritional counselling

These interventions help manage stress, anxiety, and depressive symptoms, improving the overall well-being of the individual.

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Reviewed March 2025.