Did you know inflammatory bowel disease (IBD), which involves chronic inflammation of all or part of your digestive tract, affects an estimated 1.6 million Americans. Here Tahira Saifuddin, MD, gastroenterologist, PPG - Gastroenterology, focuses primarily on ulcerative colitis and Crohn’s disease.
What is IBD and is there a cure?
Inflammatory bowel disease (IBD) encompasses Crohn’s disease and ulcerative colitis, both chronic, which can be in remission and then flare up. There is no cure at this time, though they can be managed with medical and surgical therapies by a multidisciplinary team of healthcare providers.
What parts of the body are affected by IBD?
Those suffering from ulcerative colitis experience inflammation only of the inside lining of the colon, which can start in the rectum and spread throughout the whole colon. Crohn’s can involve any part of the GI tract, from the mouth to the rectum. The complications with Crohn’s are different, and can include the formation of fistulas or abscesses around the rectum.
What are the symptoms of IBD?
Symptoms include abdominal pain, diarrhea, bloody diarrhea, weight loss and anemia. Some cases present with additional complications, like arthritis, skin rashes, painful nodules on shins, lesions on extremities, sores in the mouth, and other manifestations like eye inflammation and liver problems.
What causes IBD? Is gluten a factor?
Inflammatory bowel disease is a multifactorial disorder, with environmental, dietary and genetics factors contributing to the manifestation of the disease. Patients may have a genetic predisposition with clustering of IBD in family members. Antibiotics, some other medications, and even non-gastrointestinal surgeries can trigger IBD. Some people may have sensitivities to gluten but gluten sensitivities do not trigger IBD.
What types of treatment are available for IBD?
The immune system changes and heightens in response to IBD. Medical therapies to suppress inflammation are used to treat IBD. Steroids like prednisone or budesonide are generally used to calm the inflammation acutely. Unfortunately these medications have long term side effects and cannot be used for long term management.
Other anti-inflammatory medications used to treat IBD are referred to as “mesalamine agents”. These medications are mostly effective in ulcerative colitis for long term maintenance. They are available in oral pills and also topical preparations like suppositories and enemas.
Immune modulators will suppress inflammation and serve as steroid sparing agents. Examples include methotrexate and Azathiopurine, and 6- MP. All these medications can have long term side effects and need monitoring with lab tests and regular doctor visits.
Biological therapies are designer drugs developed to suppress inflammation and are used in long term maintenance regimes. Several different mechanisms are available in the market to treat both Crohn’s disease and ulcerative colitis. These medications are usually given as subcutaneous injections or infusions. Again, all medications can have side effects, but the healthcare provider will utilize risk benefits assessment to decide what the best management option for the patient is.
Antibiotics are used for management of inflammatory bowel disease only in the case of an abscess or infection. Broad-spectrum antibiotics can alter the gut microbiome and can lead to flares of IBD. Probiotics do have a role in management of inflammatory bowel disease, especially ulcerative colitis.
Is surgery ever helpful for IBD?
Total colectomy or removal of the entire colon can be a cure for ulcerative colitis. This surgery is performed electively if the patient has failed medical therapy or iron and is at a very high risk of cancer. This surgery can be performed in an emergent situation if the patient develops a condition called toxic megacolon or severe fulminant colitis.
With Crohn’s disease, surgeries are usually performed if the patient experiences bowel obstructions, penetrating or stricturing disease, or perianal disease. Unfortunately, surgery does not offer a cure for Crohn’s disease. There is always a risk of recurrence, especially at the site of anastomosis. The risk of Crohn’s disease recurrence after surgery is significantly higher in patients or active smokers and therefore smoking cessation is highly encouraged for patients with inflammatory bowel disease
Does having IBD put me at risk for colon cancer?
Ongoing untreated inflammation does increase the risk of colon cancer in both ulcerative colitis and Crohn’s colitis. This risk increases with the duration of disease. That's why it's so important to perform surveillance colonoscopies in patients who have had Crohn’s and ulcerative colitis for over 8 years or longer.
Does stress contribute to IBD?
There are definitely links between irritable bowel syndrome (IBS) and stress. Stress certainly can contribute to the exacerbation of GI symptoms in both irritable bowel syndrome and inflammatory bowel disease
Is there anything people can do to prevent IBD? What about probiotics?
Eat clean! A healthy diet comprised of fresh fruits and vegetables and avoidance of highly processed foods, and excessive sugars can be helpful. Avoiding unnecessary antibiotics is helpful. Certain dietary regimens like the low FODMAP diet can help in patients with IBD and irritable bowel syndrome, especially if they experience bloating and cramping. As noted above, probiotics can be very helpful in maintaining a good gut microbiome. Smoking cessation is highly recommended.
Do you have any additional tips for managing IBD?
Take the medications recommended by your doctor, talk to your healthcare provider about things you want to try, be careful with supplements that aren’t FDA approved, which can make claims that are not authentic. Holistic treatments should be a complement to traditional treatments. Never abandon your traditional treatment. Talk to your doctor about vaccinations for preventable infections especially when you are on medications that can suppress your immune system. Patients on immunosuppressive therapies should avoid live vaccines.
Patients who have had multiple courses of steroids can be at risk of bone loss and should be screened for osteopenia and osteoporosis with a bone density scan.
For more, visit Crohn's and Colitis Foundation of America. If you suspect you might be suffering from IBD, contact your primary care physician.