Inflammatory Bowel Disease (IBD)

IBD is an abbreviation for Inflammatory Bowel Disease, a chronic, intestinal illness that causes abdominal pain, diarrhea, constipation, bleeding and many other symptoms. There are two forms of IBD including  ulcerative colitis (UC) and Crohn’s disease (CD). Both forms of IBD are caused by inflammation within the intestinal lining. The inflammation is not caused by a bacteria or infection but is due to the body’s immune system attacking the gut lining. IBD is an example of an autoimmune disease. The treatments for IBD usually involves taking an immunosuppressant medication to calm down the immune system and is very effective. Most patients require lifelong medication to control inflammation. Many IBD patients mistakenly believe they should take medications on a ” as needed basis” rather than daily. Inadequate treatment due to medication noncompliance leads to more complications, hospitalizations, and surgeries. Fortunately, medications have been much more tolerable and side effects are minimal, in most cases.

The Center for Disease Control estimates that 3 million people in the US suffer from Crohn’s and UC. Worldwide IBD appears to be highest in industrialized countries – Western Europe having similar rates to the US. Of concern is the rapid increase in IBD in countries with traditionally a very low rate such as Africa, Asia, and South America. . There appears to be a connection between the western diet and developing this condition but the causes of this disease remains poorly understood.

How Does Crohn’s Disease Differ From Ulcerative Colitis?

Crohn’s disease can cause inflammation anywhere in the gastrointestinal tract including mouth, stomach, small intestines and large intestines. Ulcerative colitis, on the other hand, is located only in the lower intestines and always begins in the rectum. Crohn’s disease is also associated with fistula and abscess formation in the abdomen while UC is not.

A fistula is an abnormal connection between two organs. In the case of Crohn’s disease, the inflammation is deep and penetrates through the intestinal wall and continues to burrow into neighboring organs. A fistula always begins on the intestinal side and can invade anything in its path. Fistulous tracts can occur between the intestines and the adjacent urinary bladder, other parts of the bowel, the vagina, or a fistula may just empty into the abdominal cavity resulting in a fluid collection. Fluid collections can often be seen on a CT scan and they can become infected – this is called an abscess.  Ulcerative colitis, however, rarely penetrates the intestinal wall and fistula and abscess are not typical.

How is IBD Diagnosed?

Any patient with a long history of intermittent cramping, diarrhea, abdominal pain, or blood in stool should be evaluated for IBD. A good medical exam, basic lab tests and X-rays are an important part of the work up. A direct view of the intestines with a fiberoptic endoscope is necessary to determine if “colitis” is present.

In patients with IBD, the lining of the intestine may appear swollen, irritated, ulcerated and scarred. The lining may appear to have multiple large polyps that turn out to be areas of inflammation when biopsied. These are called pseudopolyps.

Colonoscopy is the most common test for both looking directly at the colon and small bowel lining and obtaining samples to study in the laboratory. Biopsy studies are needed to confirm IBD. When Crohn’s or UC are present, the pathologist will report the microscopic presence of chronic inflammation within the tissue samples consistent with colitis.

What Do We Do Once a Diagnosis of IBD Has Been Made?

It depends. There are several key pieces of information that need to be considered. Most important is how severe is the colitis? A patient having bloody diarrhea, 10 or more stools per day, who is dehydrated and losing weight may need to be hospitalized and placed on IV steroids. Patients with less severe, but very active IBD can be managed as an outpatient and are typically placed on a steroid taper – usually prednisone. A high dose is initiated and then over several weeks, the dose is reduced. Once the colitis is under control we switch to a milder immunosuppressant which is taken longterm.

It is important to know that IBD rarely goes away and is not curable. Management requires lifetime monitoring and immunosuppressant medication to prevent more flare ups. Annual medical visits are very important along with nutritional consulting, lab monitoring and periodic endoscopy.

Lastly, IBD can be very tough on the individual, not just physically but also psychologically, spiritually, mentally. It can really wear someone down. Managing diet, nutrition, lifestyle, and having a supportive community is critical to staying healthy and balanced. We understand that IBD patients need more than average support and increased access to the clinic. A term called Medical Home is being described around the country as an idea to have more open access and contact with IBD patients -this is a concept that we support. A large Australian study looked at the effect of a health coach or nurse monitoring IBD patients at home. The results were dramatic and demonstrated that with some extra attention, individuals with Crohn’s or UC do much better.

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