Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD) refers to a chronic inflammation of the intestines not due to infections or other identifiable causes.
What Is Inflammatory Bowel Disease?
Inflammatory Bowel Disease (IBD) causes chronic inflammation of the intestines not due to infections or other identifiable causes. There are two main types of IBD: ulcerative colitis and Crohn’s disease. Ulcerative colitis affects only the lining of the large intestine (the colon), while Crohn’s disease can involve any part of the intestine, small or large, and irritate not only the lining, but also deeper layers.
It is estimated that about 3.1 million Americans suffer from IBD. Males and females are affected equally. Ulcerative colitis and Crohn’s disease may occur at any age, including young children but occur most often in young adults. Most cases of ulcerative colitis and Crohn’s disease are diagnosed before age 30. Crohn’s disease tends to occur in families and in certain ethnic groups, such as Eastern European Jews. About 5 percent to 8 percent of patients may have a family member with IBD and about 20 percent to 25 percent of patients may have a close relative with the condition. However, it can occur in any ethnic group and in members of families where no one else has these diseases.
What Are the Symptoms of Inflammatory Bowel Disease?
The most common symptoms are:
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Diarrhea, sometimes with blood and mucus
- Loss of appetite and weight loss
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Unexplained fever and tiredness
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Delayed growth and maturation, particularly with Crohn’s disease
What Causes Inflammatory Bowel Disease?
It is currently believed that there is not one single cause of IBD. Rather, it occurs in individuals as a result of multiple factors such as genetics, overactive immune system, abnormal microbiome, and environmental factors. For unknown reasons, the immune system becomes abnormally active against the individual’s own system. It targets not only the intestine, but sometimes other organs such as the skin, joints, eyes, or the liver.
How Is Inflammatory Bowel Disease Diagnosed?
The diagnosis of IBD may be suspected on the basis of the medical history, but the final determination depends on the results of diagnostic tests. The workup may include:
- Blood tests
- Stool infectious workup to rule out an infection and stool inflammatory marker
- Endoscopy with biopsy of the upper and lower intestine
- X-rays
How Is Inflammatory Bowel Disease Treated?
The aim of treatment is to heal the intestines and confirm this on repeat endoscopy. Even though a medical cure is not yet possible, control of symptoms and disease can be very effective in majority of patients. The number of medications available continues to increase and new treatments can be expected in the future. The most common medications used to treat IBD are:
- Antibiotics such as metronidazole and ciprofloxacin
- ASA anti-inflammatory drugs such as Asacol®, Azulfidine®, Colazol®, Pentasa®, Rowasa® and Lialda®
- Steroids, such as prednisone, prednisolone or budesonide
- Immunomodulators such as Imuran®(azathioprine), Purinethol®(6MP, and methotrexate
- Biologics, such as Remicade®, Inflectra (Biosimilar to Remicade®) Humira®, Cimzia®, Entyvio®, Stelara® and Xeljanz®
- Nutritional therapy can be used to induce and maintain remission in Crohn’s disease
Is Surgery an Option to Treat Crohn's Disease?
Because there is a high risk of recurrence after surgery, this option is reserved for complications such as an obstruction from a narrowed area of the intestine, fistulizing disease, abscesses, chronic pain, bleeding, or when using all other medicine does not work.
Is Surgery an Option to Treat Ulcerative Colitis?
Yes. The complete removal of the large intestine is called a total colectomy and is the first operation. Usually done when patients have not responded to other medical therapies. Majority of patients the small intestine is reconnected to the anus so that there is no need to wear a permanent bag (ostomy), although a temporary ostomy is needed. The process to reconnect a patients intestines is usually done either in two or three operations. Usually, during the second operation, they form a j-pouch. A j-pouch is a pouch or reservoir that is formed from their small intestines that is used to act as a rectum to store stool until eliminated. The third operation removes the ostomy and a patient's intestines are connected to the j-pouch then to the anus.
