Will The Inflammatory Bowel Disease (IBD) Get Worse?

Predicting the course of the disease in a given individual is very difficult. However, this is something that almost every patient who has been recently diagnosed with IBD wants to know.

 

Both Crohn's disease and ulcerative colitis are chronic, lifelong disorders that have a tendency to fluctuate in severity over time. The disease seemingly gets better or worse on its own for no apparent reason. It is not uncommon for a person with IBD to be quite well for a period of months or years, only to experience a flare or recurrence of symptoms over a period of days to weeks. Similarly, some people go on for many months or, in some cases, for years with chronic symptoms that do not respond to treatment only to find that for some reason the symptoms begin to improve on their own.

 

 

There is no question that the severity of the first attack of IBD tends to predict the subsequent course of the disease. Not all of the subsequent flares are necessarily as severe as the first one, but they still cause symptoms, require treatment, and have a significant impact upon a person's life. Patients with first attacks that are less severe tend to have a lower risk of having subsequent flares, but the risk is still present years after the original attack.

 

 

When a flare of the disease occurs, there is usually no particular reason that can be identified for it occurring at that particular time in the course of a person's disease. It is natural to try and attribute the flare to various events that may have occurred in someone's life or to various foods that they may have eaten. For example, if you develop a flare of Crohn's disease, you may say that it was because you were eating a lot of junk food or because you are very busy at work, under considerable stress, and not getting enough rest.

 

Since Crohn's disease and ulcerative colitis are quite variable in their presentation from person to person, it makes sense that the factors causing flares also vary from person to person. Identifying these factors requires careful observation by patient and doctor to determine what might bring on a flare.

 

 

Some people will have very mild disease symptoms that don't interfere with their day-to-day activities, whereas others will be almost incapacitated by the severity of the symptoms. It is difficult to predict which category someone will fall into when the disease is first diagnosed.

Similar to the risk of flares, the chance of having more aggressive or severe disease tends to be higher if the first presentation is more severe. Exceptions do occur. Someone may have a severe flare at the first presentation, but once it has settled with treatment, the disease will go into a prolonged period of remission, during which time the person may have very few or no symptoms. This scenario is more common in individuals with ulcerative colitis than with Crohn's disease.

 

Disease that is very limited — for example, ulcerative colitis affecting only the rectum — may progress and worsen. In this case, the area of inflammation or disease usually remains confined to the rectum and remains stable for many years. However, in approximately 10% to 20% of patients, the inflammation will extend to involve more of the colon, and the patient may become much sicker and more symptomatic when a flare occurs.