Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a term that refers to both ulcerative colitis and Crohn's disease.

  • Ulcerative colitis is a disease of the colon in which inflammation of the lining of the large intestine occurs.
  • Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine.

When inflamed, the lining of the intestinal wall is red and swollen, becomes ulcerated, and bleeds. It is important to know about each of these illnesses and how they may affect you.

Causes
Symptoms
Diagnosis
Treatment
Causes: 

The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause IBD.

One possible cause is an immune system malfunction when an abnormal immune response causes the immune system to attack the body’s own cells in the digestive tract. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease.

Symptoms: 

Inflammatory bowel disease symptoms vary, depending on the severity and location of inflammation. Symptoms may range from mild to severe.

Signs and symptoms that are common to both Crohn's disease and ulcerative colitis include:

  • Diarrhea
  • Low grade fever and fatigue
  • Abdominal pain and cramping
  • Nausea and vomiting
  • Blood in your stool
  • Reduced appetite
  • Unintended weight loss
Diagnosis: 

Your doctor will likely diagnose inflammatory bowel disease only after ruling out other possible causes for your signs and symptoms, including ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. He or she will use a combination of tests. To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:

Blood tests

  • Tests for anemia or infection.
  • Fecal occult blood test. This is a test that looks for hidden blood in your stool.

Endoscopic procedures

  • Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Clusters of inflammatory cells called granulomas, if present, help confirm a diagnosis of Crohn's disease.
  • Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last section of your colon (sigmoid).
  • Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum). While it is rare for these areas to be involved with Crohn's disease, this test may be recommended if you are having nausea and vomiting, difficulty eating or upper abdominal pain.
  • Capsule endoscopy. This test is used to help diagnose Crohn's disease. You swallow a capsule that has a camera in it. The images are transmitted to a computer you wear on your belt, after which the camera exits your body painlessly in your stool.
  • Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don't reach.

Imaging Procedures

  • X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications, such as a perforated colon.
  • Computerized tomography (CT) scan. You may have a CT scan — a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
  • Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography). Unlike CT, there is no radiation exposure with MRI.
  • Small bowel imaging. This test looks at the part of the small bowel that can't be seen by colonoscopy. After you drink a liquid containing barium, doctors take an X-ray of your small intestine. While this technique may still be used, it has largely been replaced by CT or MRI enterography.
Treatment: 

Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease.

Immune System Suppressors

These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. Instead, they suppress the immune response that releases inflammation-inducing chemicals in the intestinal lining.

Antibiotics

Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn's disease.They may be used in addition to other medications or when infection is a concern — in cases of perianal Crohn's disease, for example. However, there's no strong evidence that antibiotics are effective for Crohn's disease.

Surgery

If diet and lifestyle changes, drug therapy, or other treatments don't relieve your IBD signs and symptoms, your doctor may recommend surgery.

Learn more about Inflammatory Bowel Disease