What’s Inflammatory Bowel Disease? Are processed foods and low fibre diets to blame?

The diagnosis is often delayed because of a lack of awareness about the disease in the community, lack of access to colonoscopy and confusion about other diseases like haemorrhoids, abdominal tuberculosis, and cancer. Here Dr Sharma explains IBD’s occurrence, its impact on overall health, diagnostic challenges and treatment options.

What are the reasons for an increase in IBD across north India?

The rise in the incidence of IBD in South Asia is a recent phenomenon and not completely understood. The increase in incidence, especially in urban areas of North India, is associated with the Westernisation of lifestyles, especially changing dietary habits, increased use of processed food, reduction in fibre intake and possibly use of more allergenic varieties of foodgrains. Increased stress levels, improved diagnostics, and better disease recognition are also to be considered.

Some of it could be genetic but certainly one does not expect any huge genetic variations over such a short period to explain the increased numbers of IBD. There are also some interesting facets — Crohn’s disease is more common in South India while ulcerative colitis is more common in the north. Ulcerative colitis is a type of IBD that affects the large intestine while Crohn’s may affect both the large and small intestine.

What symptoms should one look out for?

These may include abdominal pain, diarrhoea, rectal bleeding and sometimes intestinal obstruction. These individuals may be malnourished and have weight loss and are at an increased risk of acquiring infections. The symptoms can be intermittent and may flare up at times. Any persistent change in bowel habits should also prompt a consultation with a healthcare professional.

The Lancet study says that diagnosis is often delayed because of the lack of awareness about the disease in the community, lack of access to colonoscopy and confusion about other diseases like haemorrhoids, abdominal tuberculosis and cancer. What are your views on this?

I agree that there can be diagnostic delays due to a lack of awareness, limited access to diagnostic tools, and confusion with other diseases. Increased awareness, accessibility to healthcare facilities and a high index of suspicion amongst physicians can help in the early detection and management of IBD. While as of now, there is no known permanent cure for IBD, the symptoms can often be managed effectively through therapies. We have often noticed that rectal bleeding is ignored and believed to be due to piles while the diagnosis of diseases like colon cancer and IBD gets delayed.

How does IBD impact overall health? What are diagnostic challenges?

IBD, including conditions like Crohn’s disease and ulcerative colitis, can have a significant impact on overall health, affecting physical well-being, quality of life and even mental health. The burden of healthcare and therapy costs is well recognised in chronic diseases including IBD. The diagnostic challenge lies in its overlapping symptoms with other GI diseases, thus requiring a comprehensive evaluation. In India, differentiating from infectious mimics, especially gastrointestinal tuberculosis, is a significant challenge.

Do our sedentary lifestyle, high-sugar, high-fat diet have a role to play? Is there any specific age group most affected?

A sedentary lifestyle, high-sugar and high-fat diet are considered potential risk factors for IBD. There isn’t a specific age group that’s more affected, but it’s often first noticed in young adulthood. Moreover, these may not be operative for each patient individually. The cause is multifactorial with an interplay of genetic and environmental factors.

What are treatment options? Are there any latest techniques, medicines or diagnostic facilities to detect and treat IBD?

Management of IBD is usually multifaceted. Drug therapies are helpful in controlling symptoms, helping avoid surgery and reducing the risk of cancers associated with IBD. Aggressive disease may need aggressive therapy which could modify the natural course of the disease. One hopes that the recent advances in the understanding of the disease would help provide cheaper and more effective therapeutic options.

What are your suggestions for managing IBD?

It’s crucial to have an open communication with your healthcare provider about your symptoms and concerns. The management plan should be personalised, depending on the severity of symptoms, triggering factors and individual preferences. The management is multifaceted and includes aspects of preventive care (vaccinations, bone and mental health assessment), drug therapy (which is cost-effective and controls the disease effectively), prevention and screening for complications like colon cancer. Certain complications may require surgical intervention. Everyone with IBD is unique, and what works for one person may not work for another. Therefore, it’s important to approach treatment and management on a personalised basis, with patience and perseverance. Most patients would be on some form of treatment lifelong which helps them lead an almost normal life.

Some patients with IBD may also have IBS. What causes IBS?

Irritable Bowel Syndrome (IBS) is different from IBD. However, like IBD, the etiology of IBS remains elusive, but it indeed appears to be a multifactorial disorder. Factors such as altered gut-brain communication, changes in the gut microbiota, prior GI infections, stress and dysmotility are thought to contribute to its development. A personalised approach, considering these factors, is usually adopted for its management.

The role of diet in IBS is significant. Many people with IBS find that certain foods can trigger or worsen their symptoms. A diet high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) can exacerbate symptoms. These compounds are found in a wide range of foods, including certain fruits, vegetables, dairy products, legumes, nuts, seeds and grains. Avoiding these foods cannot be recommended as a long-term measure because of the adverse impact of such a restrictive diet on nutritional status. Unclean or undercooked food may result in flare-ups.