Inflammatory Bowel Disease (IBD)

Understanding inflammatory bowel disease (IBD)

Inflammatory bowel disease encompasses two main conditions: Crohn's disease and ulcerative colitis. Both involve chronic inflammation of the gastrointestinal tract, but they differ in location and depth of tissue involvement. Crohn's can affect any part of the digestive tract from mouth to anus with patchy, transmural inflammation. Ulcerative colitis is limited to the colon and rectum with continuous superficial inflammation. IBD affects approximately 1.3% of adults in Western countries and requires lifelong management ^[1].

Crohn's disease vs. ulcerative colitis

Crohn's disease features skip lesions, areas of healthy tissue between inflamed sections, and can penetrate through all layers of the bowel wall, leading to complications like strictures, fistulas, and abscesses. Ulcerative colitis begins in the rectum and extends continuously upward through the colon in a uniform pattern. Both conditions share symptoms including abdominal pain, diarrhea, rectal bleeding, fatigue, and weight loss, though the specific presentation varies by disease location and severity.

The role of inflammation

IBD involves dysregulated immune responses where the body mistakenly attacks its own intestinal tissue. Genetic susceptibility combined with environmental triggers, such as gut microbiome changes, smoking (for Crohn's), and possibly diet, initiates this inflammatory cascade ^[4]. Chronic inflammation drives tissue damage, increases cancer risk over time, and can cause systemic complications affecting joints, skin, eyes, and liver. Controlling inflammation is the primary treatment goal to prevent long-term damage.

Dietary approaches for IBD management

No single diet cures IBD, but nutritional strategies help manage symptoms and support remission ^[2]. During flares, low-residue or liquid diets reduce bowel irritation. The Specific Carbohydrate Diet (SCD) and Mediterranean diet show promise for maintaining remission. Avoiding personal trigger foods, commonly dairy, high-fiber foods during flares, and alcohol, helps individual symptom control. Working with a registered dietitian specializing in IBD ensures adequate nutrition while respecting disease activity.

Gut health and the microbiome

IBD patients typically show reduced microbial diversity with shifts toward pro-inflammatory bacterial species ^[3]. Antibiotic use, Western dietary patterns, and environmental factors may contribute to this dysbiosis. Emerging therapies targeting the microbiome, including fecal microbiota transplantation, specific probiotic strains, and prebiotic fibers, show potential as adjunct treatments. Vitamin D deficiency is common in IBD patients and correlates with increased disease activity ^[5].