Bowel movements keep your digestive tract clear. However, when there is inflammation in the digestive tract, various bowel disorders occur in the body. These Inflammatory Bowel Disorders (IBDs) include persistent inflammation, which can affect numerous body parts, like joints, liver, and gallbladder. To learn more about the long-term complications of IBDs, we spoke to Dr Santosh Kumar Enaganti, Head of Department and Senior Consultant - Medical Gastroenterology and Hepatology, Yashoda Hospitals, Hyderabad.
What Are Inflammatory Bowel Disorders?
Dr Enaganti said, "IBDs are a group of conditions, which cause long-term (chronic) inflammation in the intestine (small and large bowel)." Explaining the types of IBD, he said that ulcerative colitis affects the large intestine, causing ulcers on its inner lining. On the other hand, Crohn's disease, which is another type of IBD, can affect any part of the intestine, causing swelling.
Long-Term Complications of Inflammatory Bowel Disorders
Dr Enaganti said, "Since it is a chronic disorder, it is going to stay for a long time." He added, "We cannot cure but manage this disorder. In this condition, diagnosis plays an important role and when it is delayed multiple long-term complications occur, which can be divided into three groups."
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Complications in Children
"In children, the complications include anaemia and low protein levels, which affect their growth and performance in school," said Dr Enaganti. He added that the management of IBD requires frequent visits to the healthcare centre and get multiple screenings, which may hamper the child's mindset.
Complications in Adults
Dr Enaganti said, "Adults may face complications, like narrowing of the bowel, leading to intestinal obstructions, involvement of multiple intestinal segments leading to repeated episodes of pain, requiring medications and hospitalisation."
He said that a patient may also experience an increased stool frequency requiring access to the toilet all the time. "This has a negative impact on the food intake, leading to nutritional complications, like weight loss, osteoporosis, and anaemia," he added.
He said, "People who have Crohn's disease may develop bowel narrowing and constriction in its end stage. The bowel can leak and involve other loops of the bowel and in some cases, the anal area, developing fistulas," A fistula is an abnormal connection between two usually unconnected organs or vessels. He added that fistulas can be common in the peri-anal area and in between the bowel loops.
Dr Enaganti said, "For adults who suffer from ulcerative colitis, the complication includes shortening of the bowel, increased stool frequency, and low haemoglobin levels. They generally do not suffer from bowel narrowing and require surgeries."
He said that in elderly patients suffering from Crohn’s disease, there can be multiple bowel constrictions because they would have the disease for a long period of time before it is diagnosed. "As their initial symptom, they may have an intestinal obstruction," he added.
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Reactions to Medication
Dr Enaganti said that there can also be adverse reactions due to medications given for IBD in some patients. The reactions include bone-marrow suppression and pancreatitis with immune-suppressant medications. "This is the reason they need regular monitoring of blood through diagnostic tests is important," he added.
People can also develop reactivation of tuberculosis as a result of a weak immune system. These complications may happen when they are exposed to an infected person or due to biological therapy, which is a form of medical therapy used to control severe IBD in India.
Final Stage Complication
Dr Enaganti said, "Patients can also have a slightly increased risk of bowel malignancy, because of the chronic inflammation, particularly if it is not well controlled." He added that this is the reason, one needs to do a surveillance colonoscopy to look for the signs and proper management.
He pointed out, "After three years of the first diagnosis, we advise a colonoscopy once or twice a year if there are any abnormalities noted on the surveillance colonoscopy, which is rare."
Impact on Mental Health
"People suffering from IBD can develop mental health issues, like depression and anxiety because of the severity of the disease," said Dr Enaganti. He added that they need social and peer support, to improve their quality of life alongside treatment.