Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) - Crohn’s Disease and Ulcerative Colitis

WHAT IS INFLAMMATORY BOWEL DISEASE?

Inflammatory bowel disease (IBD) is a general term used to describe conditions that cause chronic inflammation in the digestive tract.  This includes two specific conditions:

• Ulcerative colitis (UC): This condition primarily involves the large intestine (colon) and is characterized by continuous and superficial inflammation.
• Crohn’s disease (CD): This condition most commonly affects the end of the small intestine (ileum) and the beginning of the colon, but it may also affect any part of the gastrointestinal tract.  It is characterized by deep inflammation, involving the entire thickness of the wall and “skip” lesions where normal bowel is seen between inflamed areas.

At Loma Linda University Health, we offer a variety of therapies and treatments for IBD and other complex perianal diseases.  

WHAT ARE THE SYMPTOMS OF INFLAMMATORY BOWEL DISEASE (IBD)?

Patients with inflammatory bowel disease can have various clinical presentations and symptoms depending on the severity of the inflammation and which parts of the intestine are involved. Symptoms may include:

• Diarrhea
• Blood in the stool
• Fever
• Fatigue
• Abdominal pain and cramping
• Decreased appetite
• Weight loss

WHAT CAUSES INFLAMMATORY BOWEL DISEASE (IBD)?

Despite numerous studies, the actual cause of the inflammatory bowel diseases remains unclear. However, it is likely that these chronically recurring episodes of inflammation in the intestine are related to a complex interaction between various environmental factors and a hereditary predisposition for these diseases.

Researchers do know that IBD is not more prevalent in one personality type over another. This is because the underlying cause is biological, not emotional, and is not caused by nerves.

HOW IS INFLAMMATORY BOWEL DISEASE DIAGNOSED?

IBD is most commonly diagnosed by colonoscopy with biopsies. Sometimes upper endoscopy or capsule endoscopy may be required to assess the upper gastrointestinal tract and the small bowel. Imaging studies such as a CT scan or MRI of the abdomen may be used to further evaluate the extent of the condition. At Loma Linda University Health, blood tests and stool studies are commonly ordered as well to aid in the diagnosis and evaluate the patient’s overall medical condition.

HOW IS INFLAMMATORY BOWEL DISEASE TREATED?

While there is no cure for IBD, there are treatments that can suppress the inflammation. Suppressing inflammation offers relief from symptoms like diarrhea and abdominal pain. More importantly, it allows for intestinal tissue healing to lower the risk of long term complications.  

The most commonly prescribed treatment for IBD is medical therapy. There are a number of medications that are currently approved for both Crohn’s disease and ulcerative colitis. Our doctors recommend therapy based on a number of variables, including age, gender, disease severity and extent of involvement. Medical treatments include:

• Anti-inflammatory drugs
• Immune system suppressors
• Biologics
• Small molecules (a new class of oral therapies)
• Antibiotics
• Antidiarrheal medications
• Pain relievers
• Iron supplements
• Calcium and vitamin D supplements

Diet and complementary and alternative therapies can be used as an addition to medical therapies. Your doctor may recommend a special diet given via a feeding tube, or nutrients injected into a vein to treat your IBD. If you have a stenosis or stricture in the bowel, your doctor may recommend a low fiber diet.

Surgery can also be part of the treatment in cases of disease that does not respond to medications. It may also be needed if complications such as obstructions, fistulas or abscesses occur. The type of surgery needed depends on the involvement of the disease.

For those with Crohn's disease: About 50% of people with Crohn's disease will require at least one surgery in their lifetime. Although surgery does not cure Crohn's disease, it can help address the symptoms of CD. Surgery may be needed when there is an obstruction (or blockage), perforation (abnormal opening in the GI tract), infection that cannot be treated with antibiotics alone, and persistent disease that does not respond to medical therapy. During surgery, your surgeon may remove a damaged portion of your intestine. If possible, a reconnection of the bowel is performed. Without medical therapy, the disease often recurs; frequently, this happens near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.

WHAT ARE THE COMPLICATIONS OF INFLAMMATORY BOWEL DISEASE?

If left untreated, complications of inflammatory bowel disease can be serious. These include:

• Vomiting
• Diarrhea
• Bloating
• Abdominal
• Crampy abdominal pain
• Intestinal bacterial overgrowth

Further Complications if your inflammatory bowel disease is left untreated include:

• Loss of muscle tone of the colon
• Perforation (rupture) of the bowel
• Toxic megacolon causing high white blood cell count, high fever, pain, and tenderness.
• distension
• Increased risk of colorectal cancer
• Intestinal obstruction
• Abscesses (a pocket of pus caused by an infection)
• Fistulas (deep sores or ulcers within the intestinal tract)
• Abnormal passages between the bladder, intestines and vagina
• Fissures (tears or cracks in the lining of the anus)
• Malnutrition and malabsorption preventing the body from absorbing nutrients

WHO IS AT RISK FOR INFLAMMATORY BOWEL DISEASE?

Generally speaking, inflammatory bowel disease is most prevalent in caucasians living in developed countries. Additionally, IBD does appear to run in families. Men and women tend to be affected equally.

NEXT STEPS

Seek medical intervention. If you believe you may have inflammatory bowel disease, be proactive and seek a medical evaluation. To request an appointment at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.