According to HealthLine, Inflammatory Bowel Disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract, which comprises the mouth, oesophagus, stomach, small intestine, and large intestine. Dr Hanna Aberra Bayisa a consultant gastroenterologist and hepatologist at King Faisal Hospital Kigali, says that Inflammatory Bowel Disease is a family of immune-mediated chronic, incurable systemic conditions characterised by chronic relapsing immune activation and inflammation that primarily affect the gastrointestinal tract. “Ulcerative colitis (UC) and Crohn’s disease (CD) are the two major types of IBD which share many clinical and epidemiologic characteristics, suggesting that underlying causes may be similar. UC always begins in the rectum and extends upwards to involve all or part of the colon exclusively, while CD can affect any part of the gastrointestinal (GI) tract from the mouth to the anus,” she explains. Dr Bayisa says anyone of any age can get IBD, but primarily children and young adults, and it can result in direct or indirect death. “Fatal complications can include haemorrhage, sepsis (infection), malnutrition, drug toxicity, and cancer. Mortality rates may vary geographically; for example, mortality rates are lower in Europe and North America because of the better healthcare system,” Dr Bayisa explains. Causes “The exact cause isn’t known but it clearly involves a combination of genetic, dietary, bacteriological, and environmental factors. The body’s immune system is activated by one of several factors including bacteria, viruses, or medications, causing inflammation in the gut (bowel) wall,” explains Dr Bayisa. She, therefore, continues that under normal conditions, a harmonious balance exists between the commensal microbiota and epithelial cells that line the interior of the intestines and immune cells (IECs) within the tissues. A consensus hypothesis is that there exists a loss of tolerance and dysregulation of the immune response to commensal intestinal flora in genetically susceptible individuals. Each of these host compartments can be affected by specific environmental agents like smoking, antibiotics, NSAIDs, or enter pathogens in a genetically susceptible host, cumulatively disrupting the innate immune system’s steady state. The result is a chronic state of dysregulated inflammation and tissue damage. “It must always be remembered that multiple infectious agents and medical therapies may damage the GI tract, mimicking IBD, including bacteria like salmonella, C. difficile, STD’s, Yersinia, viruses like cytomegalovirus, medications like NSAIDs, chemotherapy, and radiation therapy,” she clarifies. Symptoms “The symptoms are very variable depending on duration, severity, which part of the gut (bowel) is affected and the involvement of other non-GI organs including liver, skin, eyes, joints and excessive blood clotting,” Dr Bayisa explains. She adds that the symptoms also tend to go through periods when they are more severe and periods when they are much less severe. Examples are; • Abdominal pain and cramps • Diarrhoea may be bloody with an urgent need to open bowels • Fever • Weight loss • Loss of appetite. Dietary strategies to manage the symptoms Jacques Bahenda, a registered nutritionist and dietician based in Kigali, explains that nutritional recommendations for IBD are different for the two diseases, Ulcerative Colitis, and Crohn’s disease, and for each individual patient. “It is very important and good to first discuss the treatments that are right for you with a registered dietitian and with your doctor. Information regarding dietary treatments for IBD is often confusing, many people receive information telling them to avoid entire food groups or specific foods. But there is no need to avoid foods unless they worsen your symptoms, you can try to restrict as few foods as possible to increase the chances of getting a balanced, nutritious diet,” he says. Diet strategies for Ulcerative Colitis • Follow a low residue diet to relieve abdominal pain and diarrhoea. • Avoid foods that may increase stool output such as fresh fruits and vegetables, prunes, and caffeinated beverages. • Decrease alcohol consumption. Diet strategies for Crohn’s disease • Smaller, more frequent meals are better tolerated and can maximise nutritional intake. • If you have lactose intolerance, follow a lactose-free diet. • If you have strictures, it is very important to avoid nuts, seeds, and beans. Bahenda says that there is no food that has been proven to treat or prevent IBD, but some diet strategies can help control the symptoms.
