Inflammatory Bowel Disease

Overview

Inflammatory bowel diseases (IBDs) are chronic autoimmune conditions where the immune system becomes overactive and causes inflammation and ulceration of the digestive tract. IBD is a lifelong disease that requires long-term care and support to control symptoms, heal the organs, and prevent flare-ups and complications. Our providers are here to help with the diagnosis, evaluation, and treatment of IBD.

Types of IBD

Ulcerative colitis (UC) affects the large intestine (colon and rectum). This almost always affects the rectum and affects varying portions of the rest of the colon.
Crohn's disease can affect any part of the digestive tract from the mouth to the anus, but most commonly involves the small intestine and colon. Complications such as bowel obstructions, fistulas (abnormal connections from the intestines), and abscess (infections) may develop.
Microscopic colitis affects the colon and can only be detected with biopsies under a microscope. It is not technically a type of IBD, but can cause chronic diarrhea and may later progress into IBD.

Symptoms

Common symptoms of IBD include chronic diarrhea, abdominal pain or cramping, and blood or mucus in the stool. Less frequent symptoms include unexplained weight loss, fatigue, fever, nausea and vomiting, mouth sores, and anal pain. IBD may also rarely cause symptoms outside of the digestive tract including eye pain or redness, skin rashes, and joint pains and swelling.

Diagnosis and testing

Our care team consists of physicians, nurse practitioners, and nurses. In addition to a physical exam and a review of your medical history, your care team will likely use a combination of tests to determine the cause of your symptoms. These tests may include:

Lab tests including blood tests or stool tests
Colonoscopy – this is the most important test for IBD. This test allows visual examination and biopsies of the lining of your intestines and confirms the diagnosis of IBD. This test also evaluates for healing or worsening of IBD over time.
Upper endoscopy, capsule endoscopy, flexible sigmoidoscopy – in addition to a colonoscopy, these tests allow visual examination and biopsies of other portions of the digestive tract.
Imaging tests including X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans.

Treatment

Goals of care include clinical remission (where patients feel well with no further symptoms), mucosal healing (where the lining of the digestive tract has healed and looks normal), prevention of flare-ups, and prevention of complications. Treatment of IBD is determined by its severity and the extent to which the digestive tract is involved.

Medications to reduce inflammation and heal the organs include:

Oral medications including steroids, 5-aminosalicylates such as mesalamine, sulfsalazine, and immunomodulators such as azathioprine, 6-mercaptopurine, and methotrexate
Rectal suppositories or enemas including steroids and 5-aminosalicylates
Biologic therapies given by injections under the skin (including adalimumab, certolizumab, golimumab, ustekinumab, and risankizumab)
Biologic therapies given by infusions into the vein (including infliximab, vedolizumab, ustekinumab, and risankizumab)
Small molecule oral medications for severe disease that can be considered as alternatives to biologics (including tofacitinib, upadacitinib, and ozanimod)

Surgery is sometimes required for treatment of IBD. This requires a multidisciplinary approach to care involving coordination between your gastroenterologist and a surgeon. This would be indicated in severe IBD that does not respond to medications or to treat potential complications of IBD such as bowel obstructions, fistulas (abnormal connections from the intestines to the skin or other organs), abscess (pockets of infection and pus), and cancerous changes. As many as 30 percent of people with UC and 70 percent of people with Crohn's disease will require surgery at some point in their lifetimes.

Lifestyle modifications

There is no way to prevent IBD. These lifestyle modifications can help reduce inflammation and prevent flare-ups:

Diet - There are no specific diets that have been proven to help treat IBD. However, a healthy, low fat diet is recommended. Temporarily avoiding certain food groups may also help during flare-ups.
Hydration - drink plenty of water to prevent dehydration, especially during flare-ups.
Smoking cessation – smoking can worsen Crohn's disease and should be avoided.
Avoidance of certain over the counter medications - minimize use of any aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen which may worsen IBD. Acetaminophen is safe to use in IBD.
Manage stress – stress can also trigger a flare-up.

Prognosis

IBD is a lifelong disease, but it is manageable in the majority of patients and should not shorten life expectancy. With long-term care, people with IBD are able to maintain remission, prevent flare-ups and complications, and live healthy lives.

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Inflammatory Bowel Disease