Inflammatory bowel disease (IBD) affects as many as 1.6 million people in the U.S., and those numbers are on the rise. The majority of those diagnosed are in their teens and 20s. Why is IBD becoming more common, and what do teens, millennials and their parents need to know?
“IBD is an all-encompassing term that describes a spectrum of diseases involving chronic inflammation of the digestive tract,” says Adam Kaufman, MD, gastroenterologist at Lankenau Medical Center, part of Main Line Health. “On one end of the spectrum is ulcerative colitis, and on the other end of the spectrum is Crohn’s disease. The symptoms of the two are quite similar, but the areas affected in the gastrointestinal (GI) tract are different.”
Ulcerative colitis is a condition that causes long-lasting inflammation and ulceration in the innermost lining of the large intestine (colon) and rectum. Crohn's disease can impact any portion along the GI tract, and often spreads deep into affected tissues.
What causes IBD?
While the exact cause of IBD is not entirely understood, Dr. Kaufman explains it is thought to be a combination of four factors.
- A genetic component that may increase an individual’s susceptibility
- Certain environmental exposures, including smoking and other potential theories such as antibiotic use early in life, while many are still unknown
- A change in the microbiome, the population of the microorganisms that live in our gut, like bacteria, viruses and fungi
- A fault in the immune system that triggers the body to mistakenly attack harmless bacteria, leading to inflammation
Recognizing signs and symptoms
Common symptoms related to inflammation of the GI tract include:
- Persistent diarrhea
- An urgent need to move bowels
- Abdominal cramps and pain
- Rectal bleeding/bloody stools
- Difficulty distinguishing between stools and gas
General symptoms that may also be associated with IBD include:
- Loss of appetite
- Falling off the childhood growth curve
- Weight loss
- Vitamin and mineral deficiencies
- Night sweats
- Loss of normal menstrual cycle
Why teens and millennials?
“The onset of IBD typically occurs during the second or third decade of life,” says Dr. Kaufman. “The number of those affected is growing, as is the case with other autoimmune diseases. There are several theories as to why IBD is becoming more prevalent, but at this juncture, there is no definitive evidence regarding the exact cause.”
Dr. Kaufman believes the increase points to the way we live today compared to generations before us.
“IBD is what we call a first world disease,” he explains. “IBD has not been present in third world countries, but is now occurring in nations as they become more industrialized. Our genes have not changed much over the last 100 years, but the environment around us has. For example, the food we eat today is much more processed, and contains hormones and antibiotics. It’s very different from the food of yesterday. I think our environment definitely plays a role. We refer to this theory as the hygiene hypothesis.”
Diagnosis and treatment
While the symptoms of IBD seem rather obvious, it is often unrecognized and confused with irritable bowel syndrome (IBS). To effectively identify ulcerative colitis and Crohn’s disease, physicians need to combine several different tests, which may include colonoscopy, endoscopy, capsule studies, imaging and bloodwork, in addition to gathering a detailed patient history.
IBD is a chronic disease. There is no cure. But with proper treatment, IBD can be well-managed. Treatment includes diet and nutrition, medication, and in some cases, surgery.
“While a diagnosis of IBD can seem very scary, it’s important to know that with treatment, you can live a very normal, healthy life,” says Dr. Kaufman. “There are many people with IBD living life to the fullest and fulfilling all of their goals, including Olympic swimmer Kathleen Baker who won a silver medal at the last summer games. Young people should not be embarrassed to talk about their symptoms and how those symptoms might be impacting their lives. We need to remove the stigmas associated with IBD. The earlier we can treat IBD, the more we can change its natural course. Most importantly, young people need to understand the importance of continuing to take their medication, even after they begin to feel better. Treating IBD is a lifelong commitment.”
If you have concerns about IBD, begin by talking to your primary care physician or your child’s pediatrician. Dr. Kaufman also recommends visiting the Crohn’s & Colitis Foundation website, where he serves as co-chair of the medical advisory committee for the foundation’s Delaware Valley chapter and was awarded the GI Doctor Honored Hero Award in May 2017.
Join Dr. Kaufman on Thursday, September 28, at Lankenau Medical Center to learn more about GI disorders, including Crohn's and colitis, in teens and young adults.