Dwight D Eisenhower, the 34th President of the United States, once said: “For every obstacle there is a solution. Persistence is the key. The greatest mistake is giving up”.
One might assume that he was referring to his valiant exploits as a military general in World War II or as supreme commander of NATO, and perhaps he was.
However those who live with inflammatory bowel disease (IBD) might suggest he may also have been alluding to, if only subconsciously, his struggle with Crohn’s disease.
Crohn’s disease is one of several conditions classified and grouped in the spectrum of IBD.
Crohn’s and ulcerative colitis are the most common and it is estimated that at least 20,000 people in Ireland live with these conditions.
IBD is described as a chronic bowel condition resulting in inflammation of part or all of the elementary tract from the mouth to the anus.
Symptoms include persistent diarrhoea (sometimes bloody) and or constipation, nausea, vomiting, fever (sometimes in the form of night sweats), anaemia, fatigue, cramps which can be severe, abdominal pain and weight loss.
Specialist doctors called gastroenterologists have dedicated their professional lives in part to finding ways to treat and manage this ‘obstacle’ to living a healthy life as Eisenhower put it.
The cause of IBD is not clear, we know it mostly develops in early life, with peak incidence around the ages of 15 to 35 and a smaller peak in those in their 50s and 60s.
It is suggested that perhaps a combination of environmental, auto-immune and inflammatory factors contribute to its development as well as family history of the disease and tobacco smoking.
IBD should not be confused with short self-limiting conditions or infections that manifest with similar symptoms and are easily treatable. The diagnosis of IBD is more complex.
It begins with a referral from your family doctor to a gastroenterologist if there is a high degree of suspicion and your symptoms don’t resolve.
The gastroenterologist will start with a full physical examination, some blood tests to discover if the common bio-markers of inflammatory disease are elevated and if there are signs of anaemia or deficiencies in iron, proteins and minerals which can be associated with this group of conditions. Abdominal ultrasound and CT scans can also help with diagnosis and management.
The gastroenterologist may suggest one or all the following specialist procedures in a dedicated department called endoscopy.
Colonoscopy: This test is performed to enable the gastroenterologist view the entire colon with a flexible, lighted scope with a camera at one end.
During the procedure, small samples of tissue (biopsies) can be taken for laboratory analysis which can assist the specialist make a more definitive diagnosis.
For example, inflammatory cells called granulomas, if present, help confirm a diagnosis of Crohn’s disease.
Upper gastrointestinal endoscopy: In this procedure, the gastroenterologist uses a similar slender and flexible tube to examine the oesophagus, stomach and first part of the small intestine called the duodenum.
If a diagnosis of IBD is confirmed the specialist will recommend several treatments including, steroids, anti-inflammatory medication called Aminosalicylates, antibiotics, dietary supplements and in some cases immune system suppressing drugs or biologic therapies which interrupt inflammatory responses.
Once in remission, which can last for weeks, months or years, there is a lot you can do to manage the condition including taking your medication as prescribed, eat healthily and avoid foods that may trigger a flare-up of symptoms, ensure you get adequate sleep, drink alcohol in moderation and don’t smoke.
If IBD is something you are concerned about speak to your family doctor or visit www.iscc.ie, the Irish Society for Colitis and Crohn’s Disease, for more information and peer group support.
Mater Private Hospital
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