Inflammatory
Bowel Disease
People
with inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative
colitis have chronic intestinal inflammation. Symptoms include stomach cramps,
diarrhea and gas. Medications and surgery can help manage IBD flares, putting
the condition into remission.
What
is inflammatory bowel disease (IBD)?
Inflammatory bowel
disease (IBD) is a group of disorders that cause chronic inflammation (pain and
swelling) in the intestines. IBD includes Crohn’s disease and ulcerative
colitis. Both types affect the digestive system. Treatments can help manage
this lifelong condition.
How common is IBD?
Up to three million
Americans have some form of IBD. The condition affects all ages and genders.
IBD most commonly occurs between the ages of 15 and 30.
What are the types of IBD?
Crohn’s disease and
ulcerative colitis are the main types of IBD. Types include:
- Crohn’s disease causes pain and
swelling in the digestive tract. It can affect any part from the mouth to
the anus. It most commonly affects the small intestine and upper part of
the large intestine.
- Ulcerative colitis causes
swelling and sores (ulcers) in the large intestine (colon and rectum).
- Microscopic colitis causes
intestinal inflammation that’s only detectable with a microscope.
What’s the difference between inflammatory bowel disease (IBD)
and irritable bowel syndrome (IBS)?
IBD is a
disease; IBS is a syndrome, or group of symptoms.
The causes and treatments are different.
IBS is a type of
functional gastrointestinal disease. It affects how the
bowels function, causing them to contract more (or sometimes less) often than
usual. IBS is also known as spastic colon or nervous stomach.
IBS doesn’t inflame or
damage the intestines like IBD, so imaging scans can’t detect it and it doesn’t
increase the risk of colon cancer. People with IBS rarely need hospitalization
or surgery.
Can you have IBD and IBS?
Yes, it’s possible to
have both IBD and IBS. While IBD can cause IBS symptoms, there’s no evidence
that having IBS increases your risk of IBD.
What causes IBD?
Researchers are still
trying to determine why some people develop IBD. Three factors appear to play a
role:
- Genetics: As many as 1 in 4 people
with IBD have a family history of the disease.
- Immune system response: The immune
system typically fights off infections. In people with IBD, the
immune system mistakes foods as foreign substances. It releases antibodies
(proteins) to fight off this threat, causing IBD symptoms.
- Environmental triggers: People with a family
history of IBD may develop the disease after exposure to an environmental
trigger. These triggers include smoking, stress, medication use
and depression.
What are IBD symptoms?
IBD symptoms can come
and go. They may be mild or severe, and they may appear suddenly or come on
gradually. Periods of IBD symptoms are IBD flares. When you don’t have
symptoms, you’re in remission.
IBD symptoms include:
- Abdominal (belly) pain.
- Diarrhea (sometimes
alternating with constipation) or urgent need to poop (bowel
urgency).
- Gas and bloating.
- Loss of appetite
or unexplained weight loss.
- Mucus or blood in stool.
- Upset stomach.
Rarely, IBD may also
cause:
- Fatigue.
- Fever.
- Itchy, red, painful eyes.
- Joint pain.
- Nausea and vomiting.
- Skin rashes and sores (ulcers).
- Vision problems.
What are the complications of inflammatory bowel disease (IBD)?
People with IBD have a
higher risk of developing colon (colorectal) cancer. Other potential
complications include:
- Anal fistula (tunnel that
forms under the skin connecting an infected anal gland and the anus).
- Anal stenosis or stricture
(narrowing of the anal canal where stool leaves the body).
- Anemia (low levels of red
blood cells) or blood clots.
- Kidney stones.
- Liver disease, such
as cirrhosis and primary sclerosing cholangitis (bile duct
inflammation).
- Malabsorption and malnutrition
(inability to get enough nutrients through the small intestine).
- Osteoporosis.
- Perforated bowel (hole or tear
in the large intestine).
- Toxic megacolon (severe
intestinal swelling).
How is IBD diagnosed?
Crohn’s disease and ulcerative colitis cause similar symptoms.
No single test can diagnose either condition.
To
make a diagnosis, your healthcare provider will ask about your symptoms. Your
workup may start with a complete blood count (CBC) and stool test to
look for signs of intestinal inflammation.
You
may also get one or more of these diagnostic tests:
- Colonoscopy to examine the large
and small intestines.
- EUS (endoscopic ultrasound) to
check the digestive tract for swelling and ulcers.
- Flexible sigmoidoscopy to
examine the inside of the rectum and anus.
- Imaging
scan,
such as a CT scan or MRI, to check for signs of
inflammation or an abscess.
- Upper endoscopy to examine the
digestive tract from the mouth to the start of the small intestine.
- Capsule endoscopy using a small
camera device that you swallow. The camera captures images as it travels
through the digestive tract.
What are nonsurgical inflammatory bowel disease (IBD)
treatments?
IBD
treatments vary depending on the particular type and symptoms. Medications can
help control inflammation so you don’t have symptoms (remission). Medications
to treat IBD include:
- Aminosalicylates (an anti-inflammatory
medicine like sulfasalazine, mesalamine or balsalazide) minimize
irritation to the intestines.
- Antibiotics treat infections and
abscesses.
- Biologics interrupt signals from the
immune system that cause inflammation.
- Corticosteroids, such as prednisone, keep
the immune system in check and manage flares.
- Immunomodulators calm an overactive immune
system.
You
may also benefit from these over-the-counter IBD treatments:
- Antidiarrheal
medication.
- Nonsteroidal
anti-inflammatory drugs (NSAIDs).
- Vitamins
and supplements like probiotics.
What are surgical treatments for Crohn’s disease?
As
many as 7 in 10 people with Crohn’s disease eventually need surgery when
medications no longer provide symptom relief. During a bowel resection, a
surgeon:
- Removes
the diseased bowel segment.
- Connects
the two ends of the healthy bowel together (anastomosis).
After
surgery, the remaining part of the bowel adapts and functions as it did before.
Approximately 6 in 10 people who undergo surgery for Crohn’s disease will have
a recurrence within 10 years. Another bowel resection may be a good option for
you.
What are surgical treatments for ulcerative colitis?
After
30+ years of living with ulcerative colitis, about 1 in 3 people need surgery.
A
surgeon:
- Removes
the colon (colectomy) or the colon and rectum (proctocolectomy).
- Connects
the small intestine and anus.
- Creates
an ileal pouch that collects stool, which then exits through the
anus.
Rarely,
you may need an ileostomy instead of an ileal pouch. An ileostomy bag attaches
outside of the belly to collect stool.
A proctocolectomy is curative. Symptoms won’t return after surgery to remove the colon and rectum. However, you may have problems with the ileostomy or ileal pouch, such as pouchitis (inflammation and infection).
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