Inflammatory Bowel Disease Trivia Quiz

Answer: Auto-immunity

Although these can all cause bowel problems with similar symptoms, the main categories of IBD are auto-immune where the antibodies or similar mechanisms attack the intestines in one way or another. It is mainly genetic, with twin studies showing a high correlation, and has so far been linked with 32 different genetic mutations as the main underlying cause of the auto-immune reaction.

It can further be aggravated by environmental causes, including smoking and previous infection (Mycobacterium avium subspecies paratuberculosis [MAP] has been found to spark a faulty immune response which becomes IBD for example).

Other factors such as diet and stress are commonly found to aggravate most existing conditions. It is not directly caused by cancer but can become cancerous if severe.

Answer: Crohn's disease and ulcerative colitis

Although they have very similar symptoms, ulcerative colitis (UC) and Crohn's disease are different and make up the great majority of IBDs. There are various other forms of chronic colitis, which can be caused by restricted blood supply (ischaemia), an abnormal increase in lymphocytes, Behcet's disease, which affects all mucosa outside the colon, and when not possible to be certain, indeterminate colitis.

Diverticulitis is caused by weakness in the intestinal wall causing the formation of pouches which become infected, while enteritis involves any part of the intestine and normally describes an acute and temporary infection. Irritable bowel syndrome imitates milder symptoms of IBD but is not found to be inflammatory and is still unknown in cause and little better in treatment.

Answer: Location

Unlike ulcerative colitis (the clue is in the name), Crohn's disease usually starts in the terminal ileum and is not restricted to the colon and rectum but can spread to the entire alimentary tract from the mouth to the anus. The damage itself is also different, as ulcerative colitis only reaches the gut's epithelial lining, while Crohn's disease can penetrate the entire gut. Crohn's appears in patches while UC involves contiguous areas of damage. There is a fairly long table used by the medical profession to distinguish the two.

But in initial presentation the common symptoms of chronic flare-ups of diarrhea, intestinal pain, possible vomiting and weight loss make it hard to tell exactly what is causing it before tests. The causes are both generally known (discussed elsewhere in the quiz) and similar, and although can develop more in people over 65, age is not a distinguishing factor.

Answer: True

Being mainly auto-immune in cause, some types of IBD often come with diverse inflammation elsewhere, including arthritis, liver, skin and eye problems depending on the cause. Behcet's disease is another form of IBD which attacks the mucosa of the skin leaving ulcers, so it can also appear anywhere, such as the inside of the mouth and eyes as well as other organs such as the liver and the entire muscular system.

Answer: Anti-inflammatories

Since IBD is an inflammatory disease, steroids and similar anti-inflammatory drugs are the main treatment, especially for long term use, although they are almost guaranteed to cause side effects such as weight gain, Cushing's syndrome and osteoporosis. Antibiotics should not be used as there is no infection involved unless there is a complication, in which case would only be used for that specific instance. Diet is another treatment as often certain foods can be discovered to increase the inflammation and tests can be carried out for sensitivity. Exercise is usually beneficial but only for general fitness and within the scope of the individual patient.

Since the disease is auto immune, immunosuppressants are also commonly used but carry their own risks as you would expect from a lowered overall immune system.

Answer: Colonoscopy

Faecal tests are usually used as the first step in eliminating certain alternatives, but once suspected direct inspection of the intestinal inner lining by colonoscopy is by far the most revealing way to discover IBD or whatever else is causing the symptoms, most notably diarrhoea. Ulcers, their extent and severity, and any other different causes such as diverticuli (pouches like small hernias) or tumours are all visually detectable directly. Blood tests are also useful also in detecting other causes such as infections and parasites.

A biopsy may also be taken during the colonoscopy especially to see if any lesion is cancerous.

Answer: Surgery

If other treatment is not effective eventually the bowel becomes so damaged it is not possible to recover and has to be cut out entirely. A colostomy is usually put in place to allow the bowel to heal without being used for about six months, but if the amount removed is too great this may have to be permanent.

But this is a result of the surgery and not a treatment in itself. The damaged bowel needs to be removed entirely, while a colostomy alone would simply bypass the bowel without preventing any further damage. New treatments and research are constantly being investigated so it may be possible to reduce the number of cases which go far enough to require surgery in future.

Answer: False

Unfortunately there is no permanent cure yet for chronic IBD and treatments have always been palliative, with numerous side effects from the strength of the drugs required, and surgical which does not stop the disease spreading in the case of Crohn's, and leaves the patient without part or all of the bowel for ulcerative colitis, which can hardly be described as a vast improvement, especially if it requires a permanent colostomy.

The second aim after reducing symptoms is to increase the onset and extent of remission periods. Research continues, and there are also many alternative treatments currently being researched.

The only exception is not caused by medical treatment: as IBD tends to come in acute phases a small number of sufferers have simply stopped having them naturally.

Answer: Electrical stimulation

Helminthic therapy (the introduction of small worms) has been found to improve IBD symptoms, as has cannabis oil, which is thought to either imitate natural substances used to operate the bowel or slow down the peristalsis to calm the diarrhoea and related symptoms.

As fungal infection can cause similar symptoms, even though no fungus is thought to be involved, they also seem to be effective in treatment. Faecal bacteriotherapy, where bacteria in the faeces of healthy people has been found to improve the symptoms of IBD, although originally applied to kill the bacteria in Clostridium difficile. To my knowledge there is no record of any results gained or attempted from the application of electricity.

Answer: Bacteria

Although many auto-immune diseases like lupus and arthritis attack healthy tissue, Crohn's disease is thought to be caused by a release of TNF (tumour necrosis factor) in the bowel and alimentary canal which kills all bacteria including the ones we need for digestion.

The direct and indirect effects (from the lack of required bacteria) cause the damage to the gut lining and in severe cases work their way through, causing perforation which requires immediate surgery. The mucosa is affected by Behcet's disease, which also extends beyond the colon to the entire body wherever it can be found.