Overview of IBD: Characteristics, symptoms, and complications

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of idiopathic conditions characterized by chronic gastrointestinal (GI) tract inflammation.1 The most common subtypes are Crohn’s disease (CD) and ulcerative colitis (UC).2

Crohn’s disease
Silhouette of person with GI tract highlighted Characteristics
  • Can affect any portion of the GI tract, predominantly the ileum3,4
  • Potential transmural involvement of all tissue layers (full-thickness inflammation)3 
Symptoms may include diarrhea, abdominal pain, weight loss, fever, rectal bleeding, perianal disease, signs of malnutrition, abdominal mass, and growth failure in children and adolescents.4,6 

  • Complications may include bowel obstruction, stricture, perforation, fistula, abscess, and cancer3,4,6
  • Increased risk of colorectal cancer3
    - Related to length of disease (more than 8 to 10 years)
    - Related to length of colon involved
Ulcerative colitisSilhouette of person with ulcerative colitis highlighted
  • Limited to the colon and rectum3,5
  • Inflammation is limited to mucosal layer of colonic tissue3,5 
Symptoms may include bloody diarrhea, abdominal pain, weight loss, fever, anemia, rectal bleeding, and signs of malnutrition.5,6 

  • Complications may include perforated bowel and toxic megacolon3
  • Increased risk of colorectal cancer3
    - Related to length of disease (more than 8 to 10 years)
    - Related to length of colon involved

Prevalence and costs: The burden of IBD

Prevalence of IBD

IBD affects millions of people worldwide.

Map showing IBD cases per country

Economic burden

  • Annual indirect costs are estimated at an additional $5.5 billion in the United States, between €8 billion and €28 billion in Europe, and more than $1 billion in Canada7-10
  • In addition, productivity losses due to absenteeism and short-term disability also contribute to the indirect costs of IBD11

Managing IBD: Multiple therapeutic options

IBD can be managed through several options, including therapeutic, dietary, and surgical.

Therapeutic agents for IBD



  • MOA undetermined12

Safety profile

  • Nausea4
  • Vomiting4
  • Heartburn4
  • Diarrhea4
  • Headache4



  • Glucocorticoid receptors13

Safety profile

  • Weight gain5
  • Acne5
  • Facial hair5
  • Hypertension5
  • Diabetes5
  • Mood swings5
  • Bone mass loss5
  • Increased risk of infection5



  • Purine biosynthesis14
  • Cell proliferation14

Safety profile

  • Nausea4,5
  • Vomiting4,5
  • Diarrhea4
  • Fatigue5
  • Pancreatitis5
  • Hepatitis5
  • Reduced white blood cell count5
  • Increased risk of infection4



  • TNF-α14

Safety profile

  • Increased risk of infection, including opportunistic infections15
  • Tuberculosis15
  • Increased risk for lymphoma development



  • Luminal bacteria16

Safety profile

  • Metallic taste16
  • Coating of the tongue16
  • Nausea16
  • Vomiting16
  • Diarrhea16
  • Abdominal pain16
  • Headache16
  • Dark urine16
  • Lightheadedness16
  • Anxiety16
  • Agitation16
  • Confusion16
  • Photosensitivity16



  • Gut motility14

Safety profile

  • Constipation17
  • Flatulence17
  • Bloating17
  • Euphoria17
  • Excessive caloric intake17
  • Gastrointestinal discomfort17

Therapeutic agents for IBD


  • No single diet or eating plan exists that will work for every patient18
  • Patients should follow a normal, healthy diet as tolerated18
  • Certain foods (eg, caffeine, fresh fruit, raw vegetables, foods that are high in fiber, fat, and sugar, etc) should be avoided to alleviate diarrhea and cramping related to IBD18


  • Smaller, more frequent meals are recommended for patients19
  • Oral liquid supplements during CD and UC flares19
  • A daily multivitamin/mineral complex may be beneficial in patients with IBD19
  • If required, enteral tube-feeding supplementation or parenteral nutrition may be necessary19


  • Approximately 25% to 40% of patients with UC will require surgery at some time during the course of their illness20
  • Approximately 70% to 80% of patients with CD will require surgery within their lifetime21
  1. Knigge KL. Inflammatory bowel disease. Clin Cornerstone. 2002;4(4):49-60.

  2. Eksteen B, Liaskou E, Adams DH. Lymphocyte homing and its role in the pathogenesis of IBD. Inflamm Bowel Dis. 2008;14(9):1298-1312.

  3. Crohn’s and Colitis Foundation of America. The Facts About Inflammatory Bowel Diseases. 2011.http://www.ccfa.org/assets/pdfs/ibdfactbook.pdf. Accessed July 15, 2013.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Crohn’s disease. 2011.http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/. Accessed March 28, 2012.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Ulcerative colitis. 2011.http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/. Accessed March 28, 2012.

  6. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347(6):417-429.

  7. Park KT, Bass D. Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis. 2011;17(7):1603-1609.

  8. Yu AP, Cabanilla LA, Wu EQ, Mulani PM, Chao J. The costs of Crohn’s disease in the United States and other Western countries: a systematic review. Curr Med Res Opin. 2008;24(2):319-328.

  9. Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010;31(7):693-707.

  10. Canadian Digestive Health Foundation. Statistics. http://www.cdhf.ca/digestive-disorders/statistics.shtml. Accessed February 22, 2012.

  11. Gibson TB, Ng E, Ozminkowski RJ, et al. The direct and indirect cost burden of Crohn’s disease and ulcerative colitis. J Occup Environ Med. 2008;50(11):1261-1272.

  12. Hanauer SB. Review article: aminosalicylates in inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20(Suppl 4):60-65.

  13. Nicolaides NC, Galata Z, Kino T, Chrousos GP, Charmandari E. The human glucocorticoid receptor: molecular basis of biologic function. Steroids. 2010;75(1):1-12.

  14. Pithadia AB, Jain S. Treatment of inflammatory bowel disease (IBD). Pharmacol Rep. 2011;63(3):629-642

  15. Kaser A, Tilg H. Novel therapeutic targets in the treatment of IBD. Expert Opin Ther Targets. 2008;12(5):553-563

  16. Perencevich M, Burakoff R. Use of antibiotics in the treatment of inflammatory bowel disease. Inflamm Bowel Dis. 2006;12(7):651-664.

  17. Ginsburg PM, Bayless TM. Managing functional disturbances in patients with inflammatory bowel disease. Curr Treat Options Gastroenterol. 2005;8(3):211-221.

  18. Crohn’s and Colitis Foundation of America. Diet and Nutrition. http://www.ccfa.org/info/diet. Accessed April 23, 2012.

  19. Eiden KA. Nutritional considerations in inflammatory bowel disease. Pract Gastroenterol. 2003;27(5):33-54.

  20. Crohn’s and Colitis Foundation of America. Surgery for ulcerative colitis.http://www.ccfa.org/info/surgery/surgeryuc. Accessed April 16, 2012.

  21. Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults.Gut. 2004;53(suppl 5):V1-V16.

  22. Stedman’s Medical Dictionary. 27th ed. New York, NY: Lippincott Williams & Wilkins; 2000.

  • Idiopathic: denoting a disease of unknown cause22

  • Ileum: the third and longest portion of the small intestine, about 12 feet in length in humans22

  • Transmural: through any wall, as of the body or of a cyst or of any hollow structure22

  • Perianal: surrounding the anus22

  • Stricture: a circumscribed narrowing or stenosis of a hollow structure22

  • Perforation: abnormal opening in a hollow organ or viscus22

  • Fistula: an abnormal passage from one epithelial surface to another epithelial surface22

  • Abscess: a circumscribed collection of purulent exudate frequently associated with swelling and other signs of inflammation22

  • Colorectal: relating to the colon and rectum, or to the entire large bowel22

  • Colon: the division of the large intestine extending from the cecum to the rectum22

  • Rectum: the terminal portion of the digestive tube, extending from the rectosigmoid junction to the anal canal22

  • Toxic megacolon: acute, nonobstructive dilation of the colon, seen in fulminating ulcerative colitis and Crohn’s disease22

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