Healthy balanced diet is best first defence against bowel problems

TO keep up these days with the huge proliferation of acronyms is challenging. Even the intended meanings of some commonly used ones are up for debate.

Take LOL, for example. Most people take it to mean “Laugh out loud” but many choose to believe it means “Lots of laughs” or even “Lots of love”. Who is right? Is there even a true “right”.

OMG, FYI, and DIY are other commonly used ones. FYI and DIY are obviously a bit similar but not too confusing as their meanings are sufficiently separate.

But, in other circumstances, an acronym can cause chaos, which brings me to the topic of this week’s column. IBS and IBD are two very similar acronyms and both relate to conditions affecting the bowel.

As such, they are often mixed up and confused. But in reality there are very clear and important differences.

IBS stands for irritable bowel syndrome, a relatively benign spectrum of troubling bowel symptoms, often related to stress, with no discernible pathological calling card. In other words, the walls of the bowel in IBS look perfectly normal and no long-term damage occurs.

Not so with IBD — inflammatory bowel disease. IBD is a term encompassing three main diseases of the bowel which may be familiar to many people: Crohn’s disease, ulcerative colitis and microscopic colitis. In all three of these conditions, evidence can be collected to show inflammation and damage to the walls of the gut. In the case of microscopic colitis, one can only visualise damage and inflammation to the walls of the colon by taking biopsies and examining them microscopically.

In the case of both Crohn’s and ulcerative colitis (UC), the inflammation and ulceration can be seen with the naked eye.

When we refer to the digestive system, generally it is divided into sections, from the mouth, through the oesophagus (food pipe), stomach, small intestine, large intestine (made up of the colon and the rectum) and finally to the anus. Crohn’s is different from UC in that it can cause ulceration in any of the above locations. In contrast, UC is confined to the colon.

All three conditions are thought to be autoimmune. In other words, they are caused by an overreaction of the body’s own immune system, in the same way that diabetes mellitus affects the pancreas or that rheumatoid arthritis affects the joints.

In the UK, it is estimated that around one in 123 people suffer from Crohn’s or UC. In contrast to many diseases, it tends to present at a relatively young age, most commonly before people reach 30.

As the symptoms begin to take hold, a sufferer may experience cramping pain in the abdomen, accompanied by frequent and urgent diarrhoea, sometimes with blood and mucus.

Swollen joints and fatigue may be present in certain cases and the longer this goes on it is likely an iron deficiency anaemia will develop along with weight loss and a lack of appetite.

In Crohn’s, the patient may also experience cracked fissures around the anus and excessive ulceration in the mouth.

Certainly, IBD is not a pleasant thing to have and, if the above picture develops, it is very important to go to your GP. A change in bowel habit, especially to more loose stools and especially accompanied by blood or mucus is always a red flag for something more serious.

Although people who suffer from IBS may experience erratic bowel habits, swinging from constipation to diarrhoea, it is not associated with blood, mucus and certainly not loss of appetite or weight loss. If you do see your doctor about these symptoms, it is likely that some blood tests will be ordered to check on inflammatory markers and sometimes a stool sample to check something called a faecal calprotectin is requested which can point towards IBD.

In any age group, the other thing to think about with these symptoms, especially but not exclusively in an older age group, is cancer. Therefore a FIT (faecal immunochemical test) stool sample should also be requested to check for any microscopic blood mixed in with the stools.

In a severe flare-up, it is possible that an admission to hospital will be arranged to provide immediate treatment. This is likely to consist of steroids in the first instance which are very good at reducing inflammation.

However, longer term they are not ideal due to side effects over time and so other medications are available beyond that point either in tablet form or sometimes in enema form or suppositories.

More recently, biologic medications have been developed that can be effective at dampening the body’s immune system and reducing the flares.

In some cases, however, despite all efforts, the damage to the bowel is severe enough to warrant removing sections of it surgically. The result is often formation of a stoma (this is where the new end of the bowel is brought to the surface of the stomach to act as the new anus). This is no small procedure and the stigma surrounding stomas is not to be underestimated, especially in younger people. While these can sometimes be reversed (after the bypassed area of bowel has settled for example), in other cases these are more permanent.

In the recent past, there has been a much-publicised shift towards the role of gut flora (the micro-organisms that inhabit our intestines) in gut health and this has become a focus of research when addressing IBD.

We hold trillions of bacteria in our guts that make up our microbiome. A healthy balance of the right ones here is thought to be important in maintaining the health of the gut.

Although the correct equilibrium is different for each individual, should the microbiome become unbalanced (dysbiosis) there is a suspicion among some that this may contribute to IBD. However, it is uncertain whether the opposite is actually the case and that IBD causes dysbiosis. The old chicken and egg conundrum.

The good news is that we are more advanced at investigating it and managing it than we used to be. Whereas we now have access to endoscopies that film the inside of the gut and take biopsies, or MRI scans that can achieve a wider impression of the extent of inflammation, a century or more ago all physicians could utilise was quite a lot of guesswork.

Even at the beginning of the 20th century, those suffering from IBD would be diagnosed with intestinal tuberculosis.

The assumption that this was an infective process was understandable but no doubt resulted in a lot of unnecessary and harmful treatments, irrigating the colon with potassium permanganate being one of them.

In contrast to some medical conditions, there is not much one can do to prevent IBD if it is going to occur. There is thought to be a large genetic element and autoimmune conditions often flare seemingly at random.

However, I’ve already mentioned the gut microbiome field of research and I don’t think there is any harm in keeping an eye on this.

Ensuring one consumes enough fibre to facilitate regular bowel habits and avoiding unnecessary antibiotics is a good start.

There is a feeling that western diets (in particular processed foods) lack certain beneficial bacteria so trying to maintain a healthy balance diet is always important as is the avoidance of smoking (although weirdly it is thought that actually smoking can help with UC — don’t ask me why and that certainly doesn’t mean you should go out and buy a packet of cigarettes!).

Ultimately, don’t leave it if you are experiencing the symptoms I’ve mentioned. Prompt investigation and treatment can make a big difference.