Understanding Inflammatory Bowel Disease
by Laurie Wertich Medically reviewed by C.H. Weaver M.D.
Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations—called an autoimmune response.
There are two types of IBD, Crohn’s disease and ulcerative colitis; both manifest as chronic immune-mediated inflammation of your gastrointestinal system. While they both cause similar symptoms, they are managed differently. Crohn’s disease may affect any part of your gastrointestinal system, from your mouth to the anus. Ulcerative colitis, however, is limited to the colon, otherwise known as the large intestine.
It is estimated that 1.4 million Americans have IBD, which tends to run in families and affects males and females equally.
What Are the Symptoms of Crohn’s Disease?
It is often difficult to diagnose which form of IBD is present because both Crohn’s disease and ulcerative colitis cause similar symptoms. Both illnesses are marked by the immune system’s abnormal response, which leads to chronic inflammation of the gastrointestinal tract.
Symptoms related to inflammation of the GI tract:
- Rectal bleeding
- Urgent need to move bowels
- Abdominal cramps and pain
- Sensation of incomplete evacuation
- Constipation (can lead to bowel obstruction)
General symptoms that may also be associated with IBD:
- Loss of appetite
- Weight loss
- Night sweats
- Loss of normal menstrual cycle
Some people with Crohn’s disease also get mouth sores, skin rashes, joint pain, and eye redness.
How is Crohn’s Disease Diagnosed?
Crohn’s disease is diagnosed by looking directly at the gastrointestinal tract. In order to get an accurate picture of your colon or large intestine, doctors may perform a procedure called colonoscopy. During a colonoscopy, the doctor puts a thin tube into your rectum and advances it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon and the last part of your small intestine. Other imaging techniques and procedures can also be used to help doctors see your upper gastrointestinal system.
How is Crohn’s Disease Treated?
People with Crohn’s disease often need lifelong treatment, which may consist of medicine, surgery, and lifestyle changes; however, with effective treatment, many people are able to live fairly normal lives with Crohn’s disease.
There are many different medicines that help reduce the symptoms of Crohn’s disease. Almost all of these medicines work by reducing inflammation and the body’s immune response. Some medicines treat symptoms when they are at their worst. Other medicines help keep symptoms from starting up or coming back. Doctors sometimes also prescribe antibiotics to people with Crohn’s disease.
- Aminosalicylates are fast-acting anti-inflammatory drugs typically used to treat flare-ups and are intended for short-term use. They can be administered orally or directly into your rectum. These drugs help control the inflammation by delivering a compound containing 5-aminosalicylic acid (5-ASA) to the bowel. Examples of aminosalicylates are sulfasalazine, mesalamine, olsalazine, and balsalazide. These medications are used for both ulcerative colitis and Crohn’s disease; however, they are much more effective for ulcerative colitis and are being used less often for Crohn’s disease.
- Corticosteroids inhibit the body’s inflammatory response in IBD.
- Immunomodulators are medicines that work by quieting down the immune system, helping to reduce inflammation and control the disease. These medicines can be administered orally or by injection; examples of immunomodulators include azathioprine, 6-mercaptopurine, and methotrexate.
- Biologic Therapiesare divided into two main classes: The first, anti-TNF agents, block the protein tumor necrosis factor alpha; the second, anti-integrins, block integrins, which are proteins used by white blood cells to travel to areas of active inflammation, such as the intestine. There are several anti-TNF agents available; one integrin receptor antagonist is available; and, other biologics in development. Examples of anti-TNF biologic therapies for Crohn’s disease are infliximab, adalimumab, and certolizumab pegol. An example of anti-integrin biologic therapy for Crohn’s disease is natalizumab.
- Antibiotics are often used to reduce intestinal bacteria.
Surgery may be helpful if medicines are unable to control your symptoms or if they cause side effects that you can’t tolerate. Surgery does not cure the disease, but it can help you to feel better and help you return to normal activities. The most common types of surgery to treat Crohn’s disease include:
- Strictureplasty: This surgery can be performed to widen an area of the bowel that has narrowed, without removing any portion of the small intestine.
- Resection: A resection involves removing portions of the intestines affected by Crohn’s disease, and then joining together the two ends of healthy intestine in a procedure called anastomosis.
- Colectomy: A colectomy is surgical removal of the colon, and a proctocolectomy is removal of the colon and rectum. If only the colon is affected, a colectomy may be needed. But if the colon and rectum are affected, a proctocolectomy may be needed, along with ileostomy. If the rectum must be removed the end of the small intestine or ileum is attached to the abdominal through a stoma (opening) in order to allow drainage of intestinal waste out of the body; this is referred to as a colostomy, or an external bag worn over the opening to collect waste.
- Abscesses and fistulas: Sometimes abscesses (pus-filled mass) need to be removed surgically; surgery may also be required if a fistula (abnormal tract) is causing symptoms that don’t respond to medication.
There are many things you can do that may improve your symptoms, including:
- Reduce consumption of foods that make your symptoms worse. For instance, some people have problems with foods that have a lot of fiber, such as fruits and vegetables. Note that if you start cutting foods out of your diet, your doctor might suggest that you take a multivitamin and a folic acid supplement. If you stop eating dairy, you should take calcium and vitamin D. These supplements will make up for nutrients you might be missing.
- If you smoke, quit. Smoking makes symptoms worse and increases the chances that you will need surgery.
- Avoid medicines such as ibuprofen (brand names include Motrin or Advil) and naproxen (brand name Aleve)
Does Crohn’s Disease Lead to Colon Cancer?
Crohn’s disease can, in some cases, lead to colon cancer; your risk depends on how long you’ve had it and whether your colon is affected. People with Crohn’s disease that affects the colon should get screened early and often for colon cancer. Screening guidelines recommend patients undergo a colonoscopy a few years after being diagnosed and continue to have colonoscopies every 1 to 2 years thereafter.