ibd

By Dr. Mageswari Ranjanthran, Lecturer, Sunway Business School, Sunway University

Do you have a friend or family member with inflammatory bowel disease? Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease, are chronic inflammatory disorders of the gastrointestinal tract caused by interactions between genetic, environmental, immunological and microbial factors. While the incidence and prevalence of IBD in Asian populations were relatively lower than those in Western countries, they appear to be gradually increasing. Conjointly, paediatric inflammatory bowel disease (PIBD) in Asia, once considered a rare entity, has seen a sharp increase in incidence over the preceding decade. This epidemiological trend has been consistently observed in both the adult and paediatric Asian populations.

In a serious 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. The exact cause of IBD is unknown, but IBD is the result of a weakened immune system. Possible causes are: The immune system responds incorrectly to environmental triggers, such as a virus or bacteria, which causes inflammation of the gastrointestinal tract. There also appears to be a genetic component.

Still, IBD is a perplexing group of diseases that tends to be difficult to diagnose and treat. Researchers have collected a significant amount of information concerning the genetics, distribution and contributing environmental factors for IBD. Overall, IBD affects people of all genetic backgrounds, but it seems to have a higher prevalence in Western and developing countries. It also tends to be diagnosed most commonly in adolescents and young adults. Although Crohn’s disease and UC do appear to run in families, the connection is not always direct (such as from parent to child). The risk of inheriting the disorder is a complex process with many factors, influenced by both one’s genetic predisposition and environment. IBD is often considered a disease of adolescents and young adults because it is most commonly first diagnosed in people between the ages of 15 and 25 (at least one source indicates peak incidence to be between the ages of 15 and 35 years).

A strong support system is crucial for people with IBD. Yet, living with IBD can complicate relationships with family, friends and significant others. Life with IBD can be a rollercoaster of physical, emotional, social and financial complications, and loved ones often go along for the ride.

The majority of patients (81%) expressed feelings of fatigue, weakness and being worn out in their daily lives during times of flare-up; this percentage was reduced to 61% during remission. Most patients (68%) felt stressed and were psychologically affected even during remission. The predominant symptoms of IBD are diarrhoea, abdominal pain, gastrointestinal bleeding, weight loss, malnutrition and fatigue, which can substantially affect a patient’s quality of life, owing largely to the psychosocial impact of symptoms.

Whether the patient is newly diagnosed or has lived with IBD for many years, it is important to understand the possible impact of IBD on day-to-day life so that the patient can make positive changes to manage the condition better.

IBD has a significant impact on daily life, including work, education, and social relationships. Living with either UC or Crohn’s disease means patients need to balance their condition with a healthy lifestyle. This might mean changes in diet, lifestyle and relationships. IBD can sometimes affect many aspects of life. Even if you feel relatively “well” most of the time, a chronic condition can sometimes feel overwhelming. You may also feel worried about things such as the effect of the either UC or Crohn’s disease on your personal and social life or on your ability to study and work, as well as the potential financial implications.

Preventive health measures can avert morbidity and improve the quality of life of patients with IBD.

A healthy lifestyle matters for IBD patients

Taking medication is just one part of managing IBD. Both UC and Crohn’s disease will react well to positive changes in lifestyle, leading to better symptom control and fewer complications. Lifestyle changes include diet and nutrition planning, exercise, emotional well-being and avoiding smoking and alcohol.

Doctors recommend a daily diet that includes eggs, yogurt, fruit, vegetables, legumes, brown rice, miso and pickled vegetables, along with the occasional glass of milk and green tea. This diet calls for limited animal proteins — fish once a week and meat just once every two weeks. Low-impact or moderate exercise is encouraged for IBD patients. Low-impact activities include, but are not limited to, brisk walking, cycling, swimming, yoga, elliptical and rowing. Low-impact exercise does not mean it is easy or ineffective for IBD patients who are taking small steps towards a healthy lifestyle.

Although emotional upset does not cause IBD itself, in some people, stressful situations or strong emotions may lead to flare-ups of symptoms. This does not mean, however, that everyone who has stress will experience a flare-up, but if you are someone with IBD who knows that stress can be problematic, it is helpful to be prepared and learn stress-management techniques. Stress can be a constant presence in life: Changing jobs, getting married, moving, a death in the family, raising children or caring for elderly parents can cause stress. Simply having a chronic condition can cause IBD. Even minor annoyances of life can be stressful. As a human being, it is impossible to completely eliminate stress-producing events, but it may be possible to change the reaction to stress causes and situations.

Therefore, stress management and switching to a healthy lifestyle are the best practice for preventing IBD. Through tuning in to a healthy body, making healthy choices for their emotional well-being and working closely with health professionals, patients can enhance their quality of life as they live with IBD.

This project is funded by Future Cities Research Institute — Liveable Cities Seed Corn Grant between Lancaster University and Sunway University for ‘Inflammatory Bowel Disease: An emerging tale of two continents with an urgent need for early resolution’ by Prof Roger Pickup and Dr Mageswari Ranjanthran, as principal investigator, and Dr Ooi Pei Boon.

*First Published in The Edge on 11th July 2022