Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a lifelong intestinal disorder that causes an inflammation of the digestive tract. It involves an abnormal response by the immune system that damages the lining of the digestive system, causing inflammation, ulceration and painful symptoms.

WakeMed’s gastroenterologists understand the intricacies of this complex and chronic condition, and we have access to the latest therapies to provide customized treatment for each patient.

What Are the Types of Inflammatory Bowel Disease?

IBD is an umbrella term, which generally indicates either Crohn’s disease or ulcerative colitis.

• Crohn’s disease: Crohn’s disease is a recurring inflammatory bowel disease of the gastrointestinal (GI) tract. Crohn’s disease most commonly occurs in the ileum (the lower part of the small intestine) and the colon (large intestine), but it can occur anywhere in the GI tract from the mouth to anus.
• Ulcerative colitis: Ulcerative colitis is an inflammatory bowel disease that occurs primarily in the colon, or large intestine. It’s characterized by the inflammation and ulceration of the innermost lining of the colon, most commonly affecting the left side of the colon and the rectum.
• Indeterminate colitis: When IBD is difficult to differentiate and can’t be definitively categorized as Crohn’s disease or ulcerative colitis, it’s called indeterminate colitis.

IBD is not the same thing as irritable bowel syndrome (IBS).

What Are the Symptoms of IBD?

Although the types of IBD are different diseases, each causes the destruction of the digestive system and produces a similar group of life-altering symptoms. IBD is a chronic condition, and symptoms can come and go over the course of a patient’s life. Some patients experience months or years of remission in between flare ups.

Symptoms of IBD vary depending on what parts of the gastrointestinal tract is inflamed. Symptoms can include:

• Cramps or abdominal pain
• Diarrhea or rectal urgency
• Rectal bleeding
• Fever
• Loss of appetite
• Weight loss
• Anemia
• Constipation
• Poor growth
• Skin tags in the rectal area that may resemble hemorrhoids
• Abscesses (pockets of pus) in the perianal area

In severe cases, larger ulcers can stiffen in the bowels and cause obstruction (called strictures), or puncture the bowel walls, causing infection in the abdominal cavity and adjacent organs (called fistula). When inflammation is severe, it can also impact other organs in the body, most commonly the joints, liver and skin.

Inflammatory bowel disease also can lead to issues outside of the intestine, including anemia, eye inflammation, skin ulcers, liver disease, kidney stones, impaired growth, joint pain or osteoporosis.

How Do You Diagnose IBD?

Up to 1.5 million Americans are thought to have some form of IBD. Nearly 20 to 30 percent of patients with IBD are diagnosed before the age of 20 years.

Our experts are experienced in accurately diagnosing IBD. We first take a full medical history and perform a physical examination.

Diagnostic tests to confirm IBD may include:

• Blood tests
• Stool studies
• Computed tomography (CT) and magnetic resonance imaging (MRI) scans
• Colonoscopy, in which a lighted, flexible tube looks at the inner lining of the colon to check for inflammation
• Capsule endoscopy (aka Pillcam)

What Are The Causes and Risk Factors of IBD?

IBD affects men and women equally and can occur at any age.

Causes of inflammatory bowel disease are still being investigated, but researchers believe that environment, diet, intestinal microbiota and genetics may all play a part.

Current evidence suggests that in people with IBD, a genetic defect affects how the immune system works and how inflammation is triggered in response to an offending agent, like bacteria, a virus or a protein in food.

Approximately 25 percent of IBD patients have a direct relative who also has the disease.

Regionally, IBD is most often found in the United States, Canada and Europe, although cases are rising in industrialized parts of Asia. Jewish Americans are four to five times more likely to develop IBD than the population as a whole.

Medical Treatment Options

Medication

Medication is the treatment of choice for most patients. Medications can control and/or prevent inflammation of a child’s intestines and help:

• Relieve symptoms
• Promote the healing of damaged tissue
• Put the disease in remission
• Keep the disease from flaring up
• Postpone surgery

Nutritional Therapy

Exclusive or partial nutritional therapy has been shown to induce and maintain remission in patients. This novel therapy can be critical for children who have growth failure and are at risk of nutritional failure.

Steroids

These are most commonly used for patients with moderate to severe IBD.

• Prednisone
• Budesonide

Anti-inflammatory

5-Aminosalicylic Acid (5-ASA): These medications have been widely used for IBD patients to decrease inflammation in the bowel. They are weaker agents but may help in maintaining disease remission. (Examples include: Mesalamine, Sulfasalazine, asacol)

Immunomodulators

• Thiopurines: 6-Mercaptopurine (6-MP) or Imuran: This medication is given to those individuals who do not respond to or are unable to take the 5-ASA or steroid medications. It directly inhibits the immune system that causes the intestinal damage of IBD.
• Methotrexate
• Tacrolimus

Biologic Medications

These medications act against chemicals that cause inflammation in our body and are provided as IV infusions or injections (examples: Infliximab — Remicade or Adalimumab — Humira)

Surgical Treatment Options

Surgery may be needed if a child’s medication is ineffective; a child has severe side effects from the medication; or a child develops complications such as fistulas, abscesses or bowel obstructions. Surgery may help correct complications and improve a child’s well-being and quality of life, but Crohn’s disease cannot be cured so the patient must be prepared in case the disease returns.

If a child experiences severe symptoms and does not respond to medication, he may need surgery to remove all or part of his colon. Most people with ulcerative colitis never need surgery. If it does become necessary, many patients find comfort in knowing that after surgery, ulcerative colitis can potentially be cured and they can resume their normal, active lives.

Our IBD-trained surgeons will recommend removal of the colon when there is massive bleeding, severe illness, a rupture of the colon, risk of cancer or when drug treatments fail or cause side effects that threaten the patient's health. Several types of surgeries may be done. Patients are encouraged to consider all factors (needs, personal lifestyle and expectations) before making the decision to go ahead with surgical options.

Crohn's Disease

Crohn’s disease is named for Burrill Crohn, the gastroenterologist who first described it in 1932. Crohn’s disease is a recurring inflammatory disease of the gastrointestinal (GI) tract, similar to ulcerative colitis. Crohn’s disease most commonly occurs in the ileum (the lower part of the small intestine) and the colon (large intestine), but it can occur anywhere in the GI tract from the mouth to anus.

Crohn's Disease Symptoms

The symptoms of Crohn’s disease vary greatly from person to person. Some individuals will experience only mild symptoms while others may have severe symptoms or complications. Some symptoms may include:

• Diarrhea
• Cramps/abdominal pain
• Fever
• Rectal bleeding
• Loss of appetite
• Loss of energy (fatigue)
• Weight loss
• Anemia
• Poor growth
• Constipation
• Skin tags in the rectal area that may resemble hemorrhoids
• Abscesses (pockets of pus) in the bottom (perianal) area

In mild forms, Crohn’s disease causes small erosions, called ulcers, along the GI tract. In more severe cases, deeper and larger ulcers form. These larger ulcers can stiffen in the bowels and cause obstruction (called strictures), or puncture the bowel walls, causing infection in the abdominal cavity and adjacent organs (called fistula).

Also, in more severe cases, this condition can involve other organs in the body, most commonly the joints (i.e. knees, ankles and wrists), the liver and the skin. The same type of inflammation that is seen in the GI tract can be observed in these other organs.

Possible Complications of Chron's Disease

• Blockage of the intestine is the most common complication. This happens because the intestinal wall tends to get thick with swelling and scar tissue, causing the passageway to become narrower.
• Sores or ulcers may tunnel past the affected area and get into nearby areas, such as the bladder, vagina, rectum or skin around the anus. These are called fistulas and can become infected. Usually they can be treated with medicine, but sometimes surgery is needed to remove them.
• Poor nutrition is common among IBD patients. Too little protein, calories and vitamins may result from not eating enough food, intestinal loss of protein or poor absorption of food and nutrients.
• Other complications include arthritis, skin problems, inflammation of the eyes and mouth, kidney stones, gallstones or other diseases of the liver and biliary (ductal) system. Some of these problems can be taken care of during treatment for Crohn's disease. Others may need to be treated separately.

Treatment for Crohn’s Disease

Treatment for Crohn's disease depends on the location, severity, complications and response to earlier treatment. The goal of the IBD Program's specialists is to control inflammation, correct nutrition problems and relieve symptoms of pain, diarrhea and rectal bleeding. At this time, treatment can control the disease but not cure it.

Some patients have long periods, sometimes years, when the symptoms go away. However, Crohn's disease usually appears several times randomly over the course of a person's lifetime. This makes it hard for doctors to know for certain whether a treatment helped or not. Patients may need medical care for a long time, including regular visits to the doctor's office.

Ulcerative Colitis

Ulcerative colitis is an inflammatory disease that occurs in the colon. It is characterized by the inflammation and ulceration of the innermost lining of the colon and most commonly affects the left side of the colon and the rectum.

Ulcerative Colitis Symptoms

The symptoms of ulcerative colitis will vary from person to person. Some symptoms may include:

• Cramps/abdominal pain
• Diarrhea or rectal urgency
• Rectal bleeding
• Fever Loss of appetite
• Weight loss
• Anemia
• Constipation
• Poor growth

In some cases, this condition can involve other complications such as joint pain, eye problems, skin rash or liver disease. However, these complications are more common with Crohn’s disease.

Make an Appointment

If you or someone you care for is experiencing worrisome symptoms, we encourage you to make an appointment with one of our adult gastroenterologists, pediatric gastroenterologist or colorectal surgeons.