What you should know about inflammatory bowl disease
December 01, 2012
More than one million Americans suffer from inflammatory bowel disease, but with individualized treatment and follow-up care, most of them “can lead normal, pain-free lives,” says Dr. Greg Albers, a gastroenterologist with the UCI Health Inflammatory Bowel Disease Program.
Crohn’s disease and ulcerative colitis, known collectively as inflammatory bowel disease (IBD), share similar symptoms: severe cramps, diarrhea, chronic abdominal pain, fever and rectal bleeding. Although each affects the digestive system differently, the two diseases are often mistaken for one another, making expert diagnosis essential.
Early intervention with a range of targeted drug treatments is vital. Especially promising are new biological therapies that target the body’s immune system, said Albers, a fellowship-trained expert in stomach and intestinal disorders.
“Biologics are playing a big role in treating patients who might otherwise go directly to surgery,” he said. “Now we can get the disease the under control in a great many cases. They’ve really been lifesavers.”
The causes of IBD are not definitively known, nor is there a cure at this time. However, both ulcerative colitis and Crohn’s disease “are believed to be an overactive immune-system response to bacteria in the digestive system,” Albers said. Biological therapies “work directly on the immune system to make it less reactive to the bacterial flora in the gut.”
In Crohn’s disease, inflammation appears in patches and can penetrate all layers of the intestinal lining. It can occur anywhere along the digestive tract. By contrast, the inflammation and sores caused by ulcerative colitis affect just the top layer of the lining in the colon, or large intestine. Early and aggressive treatment may delay or prevent some ulcerative colitis patients from developing colon cancer, Albers said.
Other medications work topically on the intestinal lining to reduce inflammation. An additional approach is to change the digestive system’s balance with a combination of antibiotics and probiotics, or friendly bacteria, that may “stabilize and strengthen the intestinal lining, as well as decrease inflammation,” Albers said.
Testing for IBD usually involves a physical exam, blood tests, X-rays and endoscopic procedures. Colonoscopy is considered the gold standard for diagnosing IBD. But even with the most advanced testing, it can be difficult for doctors to distinguish between Crohn’s and ulcerative colitis. For this reason, the disease is classified as indeterminate colitis in about 10 percent of all cases.
For many patients, medications can manage the condition, resulting in long periods of remission. For others, surgery is the only answer.
Some patients with Crohn’s disease undergo a resection, which involves removing the damaged portion of the intestine and reconnecting the healthy segments. UC Irvine’s highly trained colorectal surgeons perform resections through tiny incisions, significantly reducing postoperative pain and speeding recovery. In other cases of Crohn’s disease, when the colon must be removed, surgeons create a passageway for an external ostomy bag.
In ulcerative colitis patients, surgeons routinely create a pouch from a section of the small intestine and attach it to the anus, eliminating the need for an ostomy bag.
"Treatment for IBD is highly individualized," IBD program director Dr. Nimisha K. Parekh said. She is one of a team of more than 20 dedicated specialists who provide leading edge care for patients suffering from a wide range of digestive diseases, including IBD. Patients are seen at UC Irvine’s H.H. Chao Comprehensive Digestive Disease Center in Orange and at Gottschalk Medical Plaza on the university campus in Irvine.
Learn more about Dr. Albers ›
Learn more about Dr. Parekh ›