May marks Crohn’s and Colitis Awareness month. IBD (inflammatory bowel disease) is commonly confused with IBS (irritable bowel syndrome), and in this blog we aim to discuss the difference between the two.
What is IBS?
Irritable bowel syndrome (IBS) is a functional bowel disorder. This is diagnosed using a symptom criteria and after excluding other gastrointestinal diseases such as coeliac disease and inflammatory bowel disease.
IBS is estimated to affect up to 15% of the population worldwide, and is more common in women than men. The cause of IBS is unknown, and it often goes undiagnosed. It can significantly impact quality of life, and can leave sufferers feeling frustrated and anxious.
Some proposed factors of cause include:
- Altered movement of the gut
- Visceral hypersensitivity
- Low grade inflammation
- Alterations in the gut microbiota
- Impaired perception and processing of information by the brain
There are no definitive tests to diagnose, or rule out an IBS diagnosis. Symptoms are the main diagnostic feature, and they play an important role in guiding physicians to a diagnosis. IBS is diagnosed by a medical doctor or gastroenterologist, using a criteria called the Rome IV criteria. This is based on the predominant symptom that bothers the individual, these are:
• IBS-C (constipation predominant)
• IBS-D (diarrhoea predominant)
• IBS-M (mixed bowel habits)
• IBS-U (unclassified)
IBS, whilst inconvenient, does not cause damage to the gastrointestinal lining.
Common symptoms of IBS include:
• lower abdominal pain
• altered bowel habits (diarrhoea, constipation, or a combination of both)
• bloating
• excessive passage of wind (also known as gas or flatus)
• distension (a visible increase in abdominal girth).
These symptoms often come and go, and symptom severity varies within and between individuals.
What is IBD?
IBD is a relatively vague umbrella term for ongoing inflammation of all or part of the digestive tract. There are two main types of IBD, ulcerative colitis and Crohn’s disease. In Australia, IBD impacts 100,000 people. It is not know how IBD is caused, however there is a genetic link. If one or both parents have IBD, you will be more likely to have it. There are times where people will have little to no symptoms (remission), and times when symptoms are more active (called flare-ups).
Common symptoms of IBD include abdominal pain, persistent diarrhoea (sometimes with blood), unintended weight loss, fatigue, and reduced appetite.
IBD is generally diagnosed after a long course of bloods and imaging, these may include:
Bloods / Pathology (full blood examination, C-reactive protein, nutritional markers)
– Coeliac screening (e.g. genetic or serology testing)
– Faecal calprotectin test
– Colonoscopy +/- gastroscopy
Those who have IBD may be more likely to have other chronic autoimmune conditions such as, type 1 diabetes, rheumatoid arthritis, coeliac disease and thyroid conditions.
Crohn’s
Crohn’s can be found anywhere in the gastrointestinal tract from the mouth to the anus. It generally affects the small and large bowel. The inflammation occurs in all areas of the bowel lining, and the inflammation pattern is described as being discontinuous. As Crohn’s impacts each layer of the bowel lining, it can result in narrowing (called strictures) which can block the bowel leading to bowel obstruction. It may also cause holes in the bowel which open to other organs, or to the skin (fistula), or causes abscesses. Specific complications of Crohn’s disease can include skin tags, and fissures, as well as malabsorption and malnutrition.
Crohn’s impacts 1.3 million people globally. Around 80% of people who live with Crohn’s disease, will require surgery at some point in their lifetime. Some key symptoms for diagnosis of Crohn’s include:
- Abdominal pain (or tenderness) – This can be constant or cramping and can vary by disease location and type
- Bowel obstruction
- Fatigue – Can be due to many factors such as malnutrition, inflammation, or anaemia
- Fever – This can be due to general inflammation or complications such as perforations and abscesses
- Malnutrition
- Perianal lesions – Perianal lesions such as abscesses and sinuses occur in up to 30% of patients with Crohn’s disease
- Prolonged diarrhoea – This can be bloody stool or non-bloody stool
- Risk factors such as age and family history
Ulcerative colitis
Ulcerative colitis (UC) is more common than Crohn’s, with 1.86 billion people diagnosed globally. Ulcerative colitis is found in the colon and rectum (large bowel). UC generally only affects the innermost lining of the bowel, and the inflammation pattern is described as continuous. Ulcers often occur in the bowels innermost lining which can bleed and produce mucus (hence the name, ulcerative colitis – meaning inflammation of the colon and ulcers). Surgery is less common in ulcerative colitis with around 35% of people needing surgery over the duration of their illness. Specific complications of ulcerative colitis can include toxic megacolon and extensive bleeding from deep ulcers in the colon. People with ulcerative colitis are at far greater risk than those with Crohn’s disease for bowel cancer / malignancy. There is no cure for both ulcerative colitis and Crohn’s.
Some key factors for diagnosis of UC include:
- Diarrhoea – This is often bloody, and influenced by the extent and severity of disease
- Rectal bleeding – Frequency and severity depends on how extensive disease is, as well as how severe
- Abdominal pain – This varies with disease activity, and can range from mild to severe
- Fever and unintended weight loss, most often seen in acute severe ulcerative colitis
- Risk factors such as family history
Overlapping symptoms and similarities
Where IBS and IBD can get confused is in the overlapping symptoms. As the symptoms are overlapping, it can be difficult to differentiate between each one.
Common symptoms of both IBD and IBS include abdominal pain, bloating, altered bowel habit, excess flatulence, incomplete emptying of the bowels and nausea. However there are some “red flag” or alarm features that practitioners look out for to differentiate between IBS and other conditions (such as IBD).
These include:
– Unexplained weight loss
– Nocturnal bowel movements
– Rectal bleeding or anaemia
– Persistent daily diarrhoea
– Family history of bowel diseases
– Fever
– Vomiting
– Symptoms that progress or become more severe
It is important to acknowledge that people can experience both IBS and IBD at the same time. Those with IBD who are in remission (decided by medical team) who still experience IBS type symptoms, should be treated for IBS.
Role of nutrition in IBS
Diet and lifestyle change is one of the main management strategies for IBS. Often changes to fibre, fluid, change to diet with help of a dietitian (e.g. trial of the low FODMAP diet, low gluten etc), and elimination of certain foods (reducing certain fat types, alcohol, caffeine or coffee, gas producing foods) can make a significant improvement and difference in symptoms.
Dietitians can also suggest certain supplements that may help with IBS management, such as prebiotics, probiotics, digestive enzymes and others. There is less medical intervention for IBS patients, as most peoples symptoms can be improved with lifestyle change.
Role of nutrition in IBD
IBD involves extensive medical management when compared with IBS. As it does cause structural damage, and is thought of as an autoimmune type of condition, medications and surgery are often involved in management. The most significant impact nutrition (and a dietitian) can have in managing IBD is in:
– Correcting nutrient deficiency
– Ensuring enough energy and protein in consumed (and absorbed) in both active disease and remission.
– Advising on enteral (nutrition via nasogastric tube) or parenteral nutrition (nutrition straight into the blood stream)
– Advise on supplements
– Advise on reduction of specific food groups (depending on triggers)
– Advising on fibre intake
Fibre seems to be a big player in the IBD game. Research has shown that when those who have IBD are in a flare, a low fibre diet is recommended (white breads, vegetables and fruit with no skin, skinless chicken, eggs and fish) and when those with IBD are in remission or periods of inactive disease, a varied diet high in vegetables, legumes and fruit is recommended.
More information
If you are suffering with any of the above symptoms, it is strongly encouraged you seek out your primary care provider (GP in Australia) to get some advice, and have some investigations carried out. This is also important to rule out causes such as bowel cancer.
For more support around Crohn’s and ulcerative colitis, head to Crohn’s and Colitis Australia HERE
For more support around IBS, check out Monash FODMAP for recipes, tips and tricks HERE
I am trained, and have experience in supporting people with IBS, and/or IBD. If you need some extra support with your gut conditions, whether it be IBS, IBD, or just general gut health, book a consultation today!
