Inflammatory bowel diseases (IBDs) are marked by repeated inflammatory attacks on the gut wall. These are thought to result from an exaggerated immune response to elements in the gut contents and particularly in the microbiome, Inflammatory cytokines damage the wall and allow migration of white blood cells and microbes across the wall. The gut microbiota of patients with IBDs generally show significant signs of dysbiosis, including an increase in pro-inflammatory bacteria, such as Escherichia coli or gut-wall-damaging species such as Ruminococcus, and a wider reduction in biodiversity.
Crohn’s disease can affect any part of the gastrointestinal tract most often the small intestine, with symptoms that include diarrhoea, pain, weight loss, fatigue, rectal bleeding, anaemia, nausea, loss of appetite and fevers. There is also frequent involvement of other parts of the body, eg arthritis, uveitis (with eye redness or pain), and skin symptoms. It is a complex condition influenced by genetic, environmental, and immunological factors, and its incidence is increasing worldwide.
Ulcerative colitis is a non-infectious dysentery, a chronic immunological disease of the colon and rectum that causes inflammation and ulcers. It is marked by pain, diarrhoea with blood, nausea, loss of appetite, bowel urgency, fatigue, and fevers.
IBD sufferers display defects in the gut wall barrier, including the composition of the mucus layer and ‘adhesion molecules’ that regulate gut wall permeability. Several studies have shown that changes in intestinal permeability can predict IBD even up to 3 years ahead of an outbreak.
Gut immune disorders may be triggered by pathogens including Helicobacter pylori, Mycobacterium avium and Eschericia coli by the process of molecular mimicry.
Klebsiella is implicated in Crohns (as well as ankylosing spondylitis) through molecular mimciry with HLA-B27 proteins present on white blood cell walls of predisposed individuals.
There are many studies that show dysbiosis is prominent in IBD. In Crohns there is major increase in harmful versus protective microbiome species. In ulcerative colitis, an increase has been noted in harmful bacteria which can produce hydrogen sulphide (a toxic substance to the intestinal lining) and there are lower counts of protective bacteria including Lactobacilli and Bifidobacteria. An unresolved question is how far these are causes (eg there is evidence that dysbiosis starts early in IBD sufferers) or the effects of the disease. either way there is a strong case for remedial probiotic work on the microbiome in all these cases.
A new factor has emerged in recent years, especially in regard to Crohns: the role of bile. This is produced by the liver as a core part of its metabolic activities and as a digestive secretion to help with fat absorption. Bile is essentially a bowel irritant and is our internal laxative principle. If the liver has to dump the wrong sort of metabolites into the bile this can be frankly inflammatory. The link between bile and bowel was recognised throughout history though neglected in scientific medicine until recently. It certainly is an angle that herbal practitioners may use in relieving IBD symptoms.
Diet plays a key role in managing inflammation in the gut. A low starch diet can reduce levels of anaerobic bacteria including Klebsiella and has been found to be helpful in some cases of Crohn’s. Both a diet eliminating grains and the Mediterranean diet were found to reduce symptoms as well. Probiotics and supplemental zinc may improve mucosal barrier dysfunction.
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