Inflammatory Bowel Disease (IBD)

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Inflammatory bowel disease (IBD) is a lifelong intestinal disorder that causes an inflammation of the digestive tract. It involves an abnormal response by the immune system that damages the lining of the digestive system, causing inflammation, ulceration and painful symptoms.

WakeMed’s gastroenterologists understand the intricacies of this complex and chronic condition, and we have access to the latest therapies to provide customized treatment for each patient.

What Are the Types of Inflammatory Bowel Disease?

IBD is an umbrella term, which generally indicates either Crohn’s disease or ulcerative colitis.

  • Crohn’s disease: Crohn’s disease is a recurring inflammatory bowel disease of the gastrointestinal (GI) tract. Crohn’s disease most commonly occurs in the ileum (the lower part of the small intestine) and the colon (large intestine), but it can occur anywhere in the GI tract from the mouth to anus.
  • Ulcerative colitis: Ulcerative colitis is an inflammatory bowel disease that occurs primarily in the colon, or large intestine. It’s characterized by the inflammation and ulceration of the innermost lining of the colon, most commonly affecting the left side of the colon and the rectum.
  • Indeterminate colitis: When IBD is difficult to differentiate and can’t be definitively categorized as Crohn’s disease or ulcerative colitis, it’s called indeterminate colitis.

IBD is not the same thing as irritable bowel syndrome (IBS).

What Are the Symptoms of IBD?

Although the types of IBD are different diseases, each causes the destruction of the digestive system and produces a similar group of life-altering symptoms. IBD is a chronic condition, and symptoms can come and go over the course of a patient’s life. Some patients experience months or years of remission in between flare ups.

Symptoms of IBD vary depending on what parts of the gastrointestinal tract is inflamed. Symptoms can include:

  • Cramps or abdominal pain
  • Diarrhea or rectal urgency
  • Rectal bleeding
  • Fever
  • Loss of appetite
  • Weight loss
  • Anemia
  • Constipation
  • Poor growth
  • Skin tags in the rectal area that may resemble hemorrhoids
  • Abscesses (pockets of pus) in the perianal area

In severe cases, larger ulcers can stiffen in the bowels and cause obstruction (called strictures), or puncture the bowel walls, causing infection in the abdominal cavity and adjacent organs (called fistula). When inflammation is severe, it can also impact other organs in the body, most commonly the joints, liver and skin.

Inflammatory bowel disease also can lead to issues outside of the intestine, including anemia, eye inflammation, skin ulcers, liver disease, kidney stones, impaired growth, joint pain or osteoporosis.

How Do You Diagnose IBD?

Up to 1.5 million Americans are thought to have some form of IBD. Nearly 20 to 30 percent of patients with IBD are diagnosed before the age of 20 years.

Our experts are experienced in accurately diagnosing IBD. We first take a full medical history and perform a physical examination.

Diagnostic tests to confirm IBD may include:

  • Blood tests
  • Stool studies
  • Computed tomography (CT) and magnetic resonance imaging (MRI) scans
  • Colonoscopy, in which a lighted, flexible tube looks at the inner lining of the colon to check for inflammation
  • Capsule endoscopy (aka Pillcam)

What Are The Causes and Risk Factors of IBD?

IBD affects men and women equally and can occur at any age.

Causes of inflammatory bowel disease are still being investigated, but researchers believe that environment, diet, intestinal microbiota and genetics may all play a part.

Current evidence suggests that in people with IBD, a genetic defect affects how the immune system works and how inflammation is triggered in response to an offending agent, like bacteria, a virus or a protein in food.

Approximately 25 percent of IBD patients have a direct relative who also has the disease.

Regionally, IBD is most often found in the United States, Canada and Europe, although cases are rising in industrialized parts of Asia. Jewish Americans are four to five times more likely to develop IBD than the population as a whole.

How Do You Treat IBD?

The goal of treatment is to control inflammation and relieve symptoms of pain, diarrhea and rectal bleeding. Medications can relieve symptoms and also promote the healing of damaged tissue, postpone surgery, keep the disease from flaring up and even put it in remission.

Treatment depends on the location, severity, complications and response to earlier treatment, and can include:

  • Anti-inflammatories: Including mesalamine, sulfasalazine and asacol, these can help decrease inflammation and help in maintaining disease remission.
  • Steroids: Including prednisone and budesonide, and most commonly used for patients with moderate to severe symptoms. Steroids can be taken both orally or rectally.
  • Immunomodulators: Including Imuran, these are given to patients who do not respond to or are unable to take anti-inflammatories or steroids. 
  • Biologic medications: Including Remicade and Humira, and given as IV infusions or injections, these medications reduce inflammation.
  • Antibiotics: May be given to patients who have complications like fistulas or abscesses.
  • Surgery: While usually used as a last resort, ulcerative colitis can be cured by the surgical removal of the colon and rectum. Surgery doesn’t cure Crohn’s disease, however, and the condition often recurs. In cases where surgery is recommended, WakeMed’s patients can benefit from laparoscopic colorectal surgery.
  • Nutritional counseling: Since IBD can reduce the body's ability to absorb necessary nutrients, talking to a nutritionist can also be helpful. We offer our patients nutrition counseling to help them manage their conditions and make smart nutritional choices.

Make an Appointment

If you or someone you care for is experiencing symptoms that concern you, we encourage you to make an appointment with one of WakeMed Cary Hospital's experienced gastroenterologists.