Inflammatory Bowel Disease

What is inflammatory bowel disease?

Inflammatory Bowel Disease (IBD) is an inflammation of the digestive tract (gut) caused by abnormal immune system activity. There are two types of IBD: ulcerative colitis (UC) and Crohn’s disease (CD).

UC always involves inflammation of the rectum (the last part of the colon before the anus). It can eventually lead to inflammation throughout the whole colon.

CD generally involves inflammation in the area where the small intestine and large intestine meet (the ileocecal valve). But it can affect any part of your gut from the mouth to the anus.

Both are chronic diseases that come and go. Sometimes you will have active symptoms (flares), followed by stretches of time with no or fewer symptoms. Many people require long-term treatment to control symptoms and decrease chronic inflammation.

Most common IBD symptoms

The symptoms of inflammatory bowel disease differ for each type.

Ulcerative colitis symptoms

You will have bloody diarrhea and a sudden intense need to have a bowel movement. Severe inflammation of the rectum may make you feel like you need to have another bowel movement immediately after your previous one. But nothing may come out. This is called tenesmus.

Crohn’s disease symptoms

Common symptoms of CD include abdominal pain, diarrhea, weight loss or decreased rate of growth in children, and a mass in the abdomen. When CD causes severe right lower abdomen pain and fever, it may be confused with appendicitis.

Both UC’s and CD’s symptoms may overlap with certain intestinal infections. Those, though, will go away on their own or after taking antibiotics.

Main symptoms

Ulcerative Colitis

• Cramping, abdominal pain
• Frequent bloody diarrhea—may wake you up at night
• Urgent need to have bowel movements, often with very little warning
• Feeling that you still need to pass stool, even when nothing is coming out
• Fever

Crohn’s Disease

• Abdominal pain. Tends to be in the right lower part of the abdomen, but it can be anywhere. Often cramping-type pain.
• Fever
• Weight loss. Children may stop growing at the usual rate.
• Diarrhea
• Palpable (can feel with your hand) mass in your abdomen
• Severe nausea and vomiting (if there’s an intestinal blockage from severe inflammation)

How do you get inflammatory bowel disease?

Genes play a role in IBD—meaning you may have been born with an increased risk of developing IBD. If a sibling or parent has IBD, you have a higher risk of IBD. Smoking cigarettes increases the risk of CD.

Next steps

Go to the ER if you (or a child) have severe abdominal pain with bloody diarrhea, weight loss, fever, or a lump in the abdomen. If you are frequently having blood in your stool, go to an ER.

If you have a an urgent need to have bowel movements, tenesmus, weight loss, pain around the anus, stool coming from your vagina, or air or stool in your urine, call your doctor and ask for an urgent appointment.

Why it happens

The immune system plays a role in IBD, but exactly how is not clear. Differences between UC and CD symptoms are likely caused by different patterns of inflammation.

In UC, inflammation is mostly in the inner layer of the gut. In CD, the inflammation occurs through the full thickness of the gut wall. This is why you may get fistulas between your gut and other organs. Potential causes of IBD that are being studied include:

• Genetics, particularly genes involved with immune system function.
• Environment (including diet).
• The normal bacteria and other microorganisms that exist in your gut (the “microbiome”).

Inflammatory bowel disease treatment

Your doctor should refer you to a gastroenterologist (specialist in digestive system diseases) to confirm a diagnosis of IBD. Diagnostic tests include:

• Colonoscopy. A long flexible camera is inserted through the anus to look at the inside of the large intestine. It takes small pieces of tissue to be examined.
• If CD is suspected, you  will also have an upper endoscopy. It uses a similar device except it is inserted through your mouth to examine your esophagus, stomach, and part of your small bowel.
• Your doctor may do a video capsule endoscopy. It’s a small pill camera that is swallowed and takes pictures of the digestive tract.
• Another option is a special imaging study called magnetic resonance enterography or MRE.

After a diagnosis of UC or CD is made, treating IBD is focused on eliminating the underlying gut inflammation. And letting the gut heal. When this happens it is called “remission.” A variety of medications may be used.

Medication may be changed to keep the disease in remission and prevent more inflammation. Most people with IBD will have recurrence of symptoms (“flares”). If flares are severe, surgery may be required to remove parts of the bowel.

Medication

Many medications are used to treat UC and CD. Which one your doctor recommends will depend on several factors, including what parts of your digestive tract are affected and other chronic illnesses you may have. For women, it also depends on whether they plan on becoming pregnant.

Depending on the medicine, it may be given orally, rectally, by injection, or intravenously (in a hospital or outpatient infusion center).

Surgery

IBD may require surgery. Up to 30% of people with UC will have surgery, usually because medications are not controlling it.

The most common surgery removes the entire colon. The surgeon then creates a pouch from part of your small intestine that allows stool to pass through your anus.

Surgery is also sometimes required in CD. However, some complications of CD (such as abscess formation) can be treated in other ways by an Interventional Radiologist. Your gastroenterologist will help you decide on the best treatment.

Follow up

Once you start taking medication, you will likely notice an improvement within a few days to weeks. Continue to take all of your medications as prescribed, even if you start to feel better. Your gastroenterologist will schedule follow-up appointments to check how you are doing.

You will also need repeat colonoscopies and upper endoscopies to check if  lesions are healing. Colonoscopies are also needed to watch for colon cancer. Colon cancer is more common in UC (and CD that affects the colon).