Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic inflammatory condition disease affecting the large and small bowel. It is generally made of two conditions; ulcerative colitis (UC) and Crohn’s disease (CD). Although rare in Malaysia, a recent epidemiological study in Asia including our own suggests that this is increasing. Our recent study (published in abstract) has estimated the incidence to be about 0.7 per 100,000 population-year and the prevalence of about 9 per 100,000 population. Therefore, it is estimated that there are about 2000 existing cases in Malaysia.

The typical symptoms of IBD include diarrhoea with or without blood, abdominal pain, weight loss, fever and joint pain. The cause of IBD is unknown but both genetic and environmental factors play a role. It is not due to a chronic infection as many believe or due to the ‘wrong’ food although early childhood infections and childhood antibiotic use are thought to be potential triggers. Another possible factor is the intake of a Westernized diet (e.g. refined sugars) in childhood and may partly explain the increase seen in Malaysia and other parts of Asia. All these factors lead to an abnormal immunological response where the patient’s own white blood cells and other inflammatory cells attack the gastrointestinal tract leading to prolonged, uncontrolled inflammation (autoimmnunity).

Once IBD has developed in an individual there is generally no long term cure at the present time. Current therapies aim to suppress the inflammation. These include steroids and biologic therapy which specifically target cytokines(proteins produced by inflammatory cells) which mediate the inflammatory process. In some cases where medical therapy fails, surgery is required. The management of IBD should involve a multidisciplinary approach between gastroenterologists, surgeons, psychiatrists (when necessary) as well as dieticians and nurses. It can be associated with a high morbidity and in some cases can lead to mortality. Sufferers of the condition often feel confused, embarrassed and isolated and it is hoped that in time, we will be able to improve not only the medical care for the IBD patient but also effectively address the social and psychological aspects of this disease.