Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a broad term used to describe two disorders that involve chronic inflammation of the gastrointestinal (GI) tract, known as Crohn’s disease and Ulcerative Colitis. This prolonged inflammation results in damage to various portions of the GI tract, including the small bowel, large intestine, rectum, and perianal region.

What is Crohn's disease?

Crohn's disease occurs when there is redness and swelling (inflammation) and sores along your digestive tract. It is part of a group of diseases known as inflammatory bowel disease or IBD.

Crohn’s disease is a long-term, chronic illness that may come and go at different times in your life. In most cases, it affects the small intestine, most often the lower part called the ileum. In some cases it affects both the small and large intestines.

Sometimes the inflammation may be along your whole digestive tract. This includes your mouth, your food pipe (esophagus), your stomach, the first part of your small intestine or duodenum, your appendix, and your anus.

What causes Crohn's disease?

Experts don’t know what causes Crohn's disease. It may be that a virus or a bacteria affects the body's infection-fighting system (immune system). The immune system may create an abnormal inflammation reaction in the intestinal wall that does not stop.

Many people with Crohn’s disease have abnormal immune systems. But experts don’t know if immune problems cause the disease. They also don’t know if Crohn’s disease may cause immune problems. Stress does not seem to cause Crohn's disease.

Who is at risk for Crohn’s disease?

Crohn's disease may happen at any age. It most often affects people ages 15 to 35 years old. It can also happen in children or older people. It affects men and women equally.

You may be more at risk for Crohn’s disease if you:

  • Have a family history of Crohn’s disease. In most cases this is a close relative such as your father, mother, brother, sister, or child.
  • Have an Eastern European background, especially Jews of European descent
  • Are white
  • Live in a developed country, in a city, or in a northern climate
  • Smoke

What are the symptoms of Crohn's disease?

Each person’s symptoms may vary. Symptoms may include:

  • Belly or abdominal pain, often in the lower right area
  • Diarrhea, sometimes bloody
  • Rectal bleeding
  • Weight loss
  • Fever
  • Joint pain
  • A cut or tear in the anus (anal fissure)
  • Rashes

You may have no symptoms for a long time, even years. That is called being in remission. There is no way to know when remission may occur or when your symptoms will return. The symptoms of Crohn's disease may look like other health problems. Always see your healthcare provider to be sure.

How is Crohn's disease diagnosed?

You may be checked for signs of Crohn's disease if you have had long-term or chronic:

  • Belly or abdominal pain
  • Diarrhea
  • Fever
  • Weight loss
  • Anemia, a loss of healthy red blood cells that can make you feel tired

Your provider will look at your past health and give you a physical exam.

Other tests for Crohn's disease may include the following:

  • Blood tests. These are done to see if you have fewer healthy red blood cells (anemia) because of a loss of blood. These tests also check if you have a higher number of white blood cells. That might mean you have an inflammatory problem.
  • Stool culture. This is done to see if you have any abnormal bacteria in your digestive tract that may cause diarrhea or other problems. A small sample of your stool is collected and sent to a lab. In 2 or 3 days the test will show if you have abnormal bacteria or if you have lost blood. It will also show if an infection by a parasite or bacteria is causing your symptoms.
  • Upper endoscopy or EGD. This test looks at the inside of your food pipe or esophagus, stomach, and the top part of your small intestine, called the duodenum. This test uses a thin, lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. He or she can also take a small tissue sample or biopsy if needed.
  • Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores, or bleeding. A long, flexible, lighted tube called a colonoscope is used. It is put into your rectum up into the colon. This tube lets your provider see the lining of your colon and take out a tissue sample or biopsy to test it. He or she may also be able to treat some problems that may be found.
  • Biopsy. Your healthcare provider will take a tissue or cells from the lining of your colon to look at it under a microscope.
  • Upper GI series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your esophagus, stomach, and the first part of your small intestine, called the duodenum. You will swallow a chalky fluid called barium. Barium coats the organs so that they can be seen on an X-ray. Then X-rays are taken to check your digestive organs.
  • Lower GI series or barium enema. This test checks your large intestine, including the colon and rectum. A thick, chalky fluid called barium is put into a tube. It is inserted into your rectum as an enema. Barium coats the organs, so they can be seen on an X-ray. An X-ray of your belly will show any narrowed areas called strictures. It will also show any blockages or other problems.
  • CT scan (CAT scan). This test uses X-ray images to create a view of the intestine. It may be done with an IV and oral contrast.
  • MRI. This test uses a magnetic field and radiofrequency energy to create a view of the abdomen, pelvis, and intestine. It may be done with IV contrast, and in some cases, rectal contrast.

How is Crohn’s disease treated?

Your healthcare provider will create a care plan for you based on:

  • Your age, overall health, and past health
  • How serious your case is
  • How well you handle certain medicines, treatments, or therapies
  • You have family planning goals (such as getting pregnant)
  • If your condition is expected to get worse
  • What you would like to do

Treatment has 3 goals:

  • Ease symptoms such as belly or abdominal pain, diarrhea, and rectal bleeding
  • Control redness or swelling (inflammation)
  • Help with getting the right nutrition

Treatment may include:

  • Medicine. Some medicines may help ease abdominal cramps and diarrhea. Medicines often reduce inflammation in the colon. If you have a more serious case, you may need medicines that affect your body's infection-fighting system (immune system). These are given as pills, injections (called biologics), or combinations of both. It is very important to discuss the pros and cons of medicine with your doctor, and not to stop the medicines without their knowledge. Sometimes stopping a medicine will limit its ability to help you again in the future.
  • Diet. No special diet has been shown to help prevent or treat Crohn's disease. However, a special diet called an elemental diet can treat Crohn's disease in some situations. In some cases, symptoms are made worse by milk, alcohol, hot spices, or fiber.
  • Supplements. Your healthcare provider may suggest nutritional supplements or special high-calorie liquid formulas. These may be helpful for children who are not growing fast enough.
  • IV or intravenous feeding. In rare cases IV feeding may be used for people who need extra nutrition for a short period of time.
  • Surgery. Surgery may help Crohn’s disease, but it can’t cure it. The swelling or inflammation often returns next to the area where the intestine was removed.

In addition, if your colon is involved in the Crohn's disease, you will need colonoscopy at various intervals because of your increased risk of colon cancer.

Surgery options

Surgery may help to reduce long-term or chronic symptoms that don’t get better with therapy. Surgery may also fix some problems such as a blocked intestine, a hole or perforation, an abscess, or bleeding.

Types of surgery may include:

  • Draining abscesses in or near fistulas. An abscess is a collection of pus or infection. Treatment includes antibiotics and injectables such as biologics, but sometimes surgery is needed.
  • Bowel or intestinal resection. The diseased section of intestine is removed. The two healthy pieces of intestine are attached. This surgery shortens your intestines.
  • Ostomy. When part of the intestine is removed, then a new way to remove stool from your body is created. The surgery to create the new opening is called an ostomy. The new opening is called a stoma. There are different types of ostomy surgery. The type of surgery that is done will depend on how much and what part of your intestines is removed.

Ostomy surgery may include:

  • Ileostomy. The colon and rectum are removed and the bottom part of your small intestine (ileum) is attached to the new opening or stoma.
  • Colostomy. This surgery creates an opening in your belly or abdomen. A small part of the colon goes through this opening up to the surface of the skin. In some cases a short-term colostomy may be done. This is used when part of the colon has been removed and the rest of the colon needs to heal.
  • Ileoanal reservoir surgery. This may be done instead of a permanent ileostomy. It is done in 2 surgeries. First the colon and rectum are removed and a short-term ileostomy is performed. Then the ileostomy is closed. Part of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.

What are the complications of Crohn’s disease?

Crohn’s disease may cause other health problems. These may include:

  • A blocked intestine
  • Arthritis
  • Skin problems
  • Gallstones
  • Problems with your liver function
  • Rips or tears, called fissures, in your anus
  • Eye or mouth redness or swelling (inflammation)
  • Colon cancer, if your colon is involved with the Crohn's disease
  • A lack of some nutrients, such as calories, proteins, and vitamins
  • Too few red blood cells or too little hemoglobin in your blood (anemia)
  • A type of tunnel, called a fistula, in nearby tissues. This can get infected.
  • A nervous system disorder where legs feel painful, called restless leg syndrome
  • Bone weakness, either because bones are brittle (osteoporosis) or because bones are soft (osteomalacia)

Crohn's disease can also lead to a condition called malabsorption. The intestines help to digest and absorb foods. Malabsorption occurs when food is not digested well and nutrients are not absorbed into the body. This can lead to poor growth and development. Malabsorption may occur when the digestive tract is inflamed or if short bowel syndrome occurs after surgery.

Common symptoms of malabsorption include the following:

  • Loose stool, or diarrhea
  • Large amounts of fat in the stool, called steatorrhea
  • Weight loss or poor growth
  • Fluid loss or dehydration
  • Lack of vitamins and minerals

Key points

  • Crohn's disease is when there is redness and swelling (inflammation) and sores or ulcers along your digestive tract.
  • It is a type of inflammatory bowel disease (IBD).
  • In most cases it affects the small intestine. But it may affect your whole digestive tract.
  • It is a long-term, chronic condition.
  • There is no cure. Making some diet changes may help ease symptoms.
  • Most people with Crohn's disease need to stay on long-term medication to limit the development of other medical problems in the future. Surgery may be needed.

Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is part of a group of diseases called inflammatory bowel disease (IBD).

It is when the lining of your large intestine (the colon or large bowel) and your rectum become red and swollen or inflamed. In most cases the inflammation begins in your rectum and lower intestine and moves up to the whole colon.

Ulcerative colitis does not normally affect the small intestine. But it can affect the lower section of your small intestine (the ileum).

The inflammation causes diarrhea, making your colon empty itself often. As the cells on the lining of the colon die and come off, open sores or ulcers form. These ulcers may cause pus, mucus, and bleeding.

In most cases, ulcerative colitis starts when you are between the ages of 15 and 30 years old. Sometimes children and older people get it. It affects both men and women and seems to run in some families (is hereditary).

Ulcerative colitis is a long-term, chronic disease. There may be times when your symptoms go away and you are in remission for months or even years. But the symptoms will come back.

If only your rectum is affected, your risk of colon cancer is not higher than normal. Your risk is higher than normal if the disease affects part of your colon, and greatest if it affects your whole colon.

In rare cases, when severe problems happen, ulcerative colitis can lead to death.

What causes ulcerative colitis?

Experts don’t know what causes ulcerative colitis. It may be that a virus or bacteria affect the body's infection-fighting system (immune system). The immune system may create abnormal redness and swelling (inflammation) in the intestinal wall that does not go away.

Many people with ulcerative colitis have abnormal immune systems. But experts don’t know if immune problems cause the disease. They also don’t know if ulcerative colitis may cause immune problems. Having stress or being sensitive to some foods does not seem to cause ulcerative colitis.

Right now there is no cure except for surgery to remove the colon.

Who is at risk for ulcerative colitis?

Some things may make you at higher risk for ulcerative colitis. These include your:

  • Age. The disease most often starts when you are between the ages of 15 and 30 years old.
  • Family history. Having a family member or close blood relative with ulcerative colitis raises your risk of getting the disease.
  • Race and ethnicity. It happens more often in whites and people of Jewish background

What are the symptoms of ulcerative colitis?

Each person’s symptoms may vary. The most common symptoms include:

  • Belly pain
  • Bloody diarrhea
  • Extreme tiredness (fatigue)
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Loss of body fluids and nutrients
  • Loss of blood (anemia) caused by severe bleeding

In some cases, symptoms may also include:

  • Skin sores
  • Joint pain
  • Redness and swelling (inflammation) of the eyes
  • Liver disorders
  • Weak and brittle bones (osteoporosis)
  • Rashes
  • Kidney stones

The symptoms of ulcerative colitis may look like other health problems. Always see your healthcare provider to be sure.

How is ulcerative colitis diagnosed?

Your healthcare provider will give you a physical exam and do some blood tests. The blood tests will check your red blood cells and white blood cells. If your red blood cell count is low, this is a sign of anemia. If your white blood cell count is high, this is a sign of redness and swelling (inflammation).

Other tests for ulcerative colitis include:

  • Stool culture. Checks for any abnormal bacteria in your digestive tract that may cause diarrhea and other problems. To do this, a small stool sample is taken and sent to a lab. In 2 or 3 days, the test will show if abnormal bacteria, bleeding, or infection are ­present.
  • Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the inside or lining of your food pipe (esophagus), stomach, and the top part of your small intestine (duodenum). This test uses a thin, lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. He or she can also take a small tissue sample (biopsy) if needed.
  • Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube called a colonoscope is put into your rectum up into the colon. This tube lets your healthcare provider see your colon lining and take out a tissue sample (biopsy) to test it. He or she may also be able to treat some problems that may be found.
  • Biopsy. Your healthcare provider will take out a tissue sample or cells from the lining of your colon. This will be checked under a microscope.
  • Lower GI (gastrointestinal) series, also called barium enema. This is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine (the ileum). You will be given a metallic fluid called barium. Barium coats the organs so they can be seen on an X-ray. The barium is put into a tube and inserted into your rectum as an enema. An X-ray of your belly will show if you have any narrowed areas (strictures), blockages, or other problems.
  • Blood tests. No blood test can diagnose or rule out ulcerative colitis, but many tests can be helpful to monitor the disease and sometimes help better define the disease.

How is ulcerative colitis treated?

Your healthcare provider will create a care plan for you based on:

  • Your age, overall health, and past health
  • How serious your case is
  • If your condition is expected to get worse
  • Your intended family plans, such as getting pregnant
  • What you would like to do
  • How well you handle certain medicines, treatments, or therapies

There is no special diet for ulcerative colitis. But you may be able to manage mild symptoms by not eating foods that seem to upset your intestines.

Medical treatment may include:

  • Medicines. Medicines that reduce redness and swelling (inflammation) in your colon may help to ease your belly cramps. More serious cases may need steroids, medicines that fight bacteria (antibiotics), or medicines that affect your infection-fighting system (immune system). Steroids are not a good choice for long-term management. Therefore, your healthcare provider will discuss medicines for long-term control. This may include pills, injections, or a combination. In addition, placing a medicine into the rectum (foam, enema, or suppository) can be very helpful in controlling your symptoms.
  • Hospitalization. This may be needed if you have severe symptoms. The goal will be to give you the nutrients you need, stop diarrhea, and replace lost blood, fluids, and electrolytes (minerals). You may need a special diet, IV (intravenous) feedings, medicines, or sometimes surgery.
  • Surgery. Most people don’t need surgery. But some people do need surgery to remove their colon. That might happen if you have heavy bleeding, are very weak after being ill for a long time, have a hole (perforation) in your colon, or are at risk for cancer. You may also need surgery if medical treatment fails or if the side effects of steroids and other medicines become harmful.

There are several types of surgery, including the following:

  • Proctocolectomy with ileostomy. This is the most common surgery. It is done when other medical treatment does not help. Your entire colon and your rectum are removed. A small opening (stoma) is made in your belly wall. The bottom part of your small intestine (the ileum) is attached to the new opening. Your stool will come out of this opening. It will collect in a drainage bag that will be attached to you.
  • Ileoanal anastomosis. Your whole colon and the diseased lining of your rectum are removed. The outer muscles of your rectum stay in place. The bottom part of your small intestine (the ileum) is attached to the opening of your anus. A pouch is made out of the ileum. The pouch holds stool. This lets you pass stool through your anus in the normal way. You will still have fairly normal bowel movements. But your bowel movements may happen more often. They may also be more watery than normal.

If your colon remains inside, you will need a colonoscopy at various intervals because of your increased risk of colon cancer.

What are the complications of ulcerative colitis?

Ulcerative colitis is a long-term, chronic condition. It can lead to problems over time, including:

  • Loss of appetite, leading to weight loss
  • Lack of energy (fatigue)
  • Severe bleeding (hemorrhage)
  • Hole or tear (perforation) in the colon
  • Infection of the colon
  • Severe fluid loss (dehydration)
  • Joint pain
  • Eye problems
  • Kidney stones
  • Weak, brittle bones (osteoporosis)
  • Colon cancer, if ulcerative colitis affects much of or the whole colon over a long period of time

In rare cases, when severe problems occur, ulcerative colitis can lead to death.

When should I call my healthcare provider?

Call your healthcare provider right away if:

  • Your symptoms come back after they have gone away
  • Your symptoms worsen
  • You have new symptoms

Key points about ulcerative colitis

  • Ulcerative colitis is when the lining of your large intestine and your rectum become red and swollen or inflamed.
  • It is part of a group of diseases called inflammatory bowel disease (IBD).
  • It affects men and women equally and seems to run in some families (is hereditary).
  • It is a long-term, chronic disease.
  • Experts don’t know what causes it.
  • While medicines can't cure it, they can control symptoms in most cases.