Inflammatory bowel disease (IBD) refers to a group of diseases that involve chronic inflammation of all or part of the GI tract. The main diseases considered as IBD include Ulcerative Colitis and Crohn's disease . Collagenous colitis and lymphocytic colitis also are considered inflammatory bowel diseases but are often not grouped together with the classic inflammatory bowel diseases. The symptoms of these diseases usually include diarrhea, abdominal pain, fatigue and weight loss. IBD symptoms can range in severity from mild disease to severe disease that can be life-threatening.
IBD is different from Irritable Bowel Syndrome (IBS) which is a group of symptoms that do not result in underlying damage to the GI tract.
Crohn's disease is a chronic inflammatory process involving the intestinal tract anywhere from the mouth to the anus. The most commonly affected areas of the intestinal tract are the last part of the small intestine (ileum), large intestine (colon and rectum), and the anus.
Any age group may be affected, but the majority of patients are young adults between 16 and 40 years old. Crohn's disease occurs most commonly in people living in northern climates. It affects men and women equally and appears to be common in some families. About 20 percent of people with Crohn's disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease; however there is no clear pattern for how this disease is passed down to other relatives. The exact cause of this disease is not known; however, current theories consider an immunologic (the body's defense system) and/or bacteria-mediated cause.
Symptoms of Crohn's disease can be present at various times over a lifetime. Some people have long periods, sometimes for years, when they are free of symptoms (remission). Some people may have persistent or severe disease without remission. There is no way to predict when or how symptoms will occur in an individual.
Common symptoms can include:
- Abdominal cramping/pain
- Weight loss
- Anal pain or drainage
- Perianal abscesses
- Anal Fissures
- Skin lesions
- Joint pain
Crohn's disease is a chronic condition and there is currently no cure. Medical therapy with one or more drugs provides a means to control Crohn's disease and its symptoms. The most common drugs prescribed are immune-modulating agents like 6-mercaptopurine, azathioprine and methotrexate and biologic agents like Remicade, Humira, and other novel agents. These medications are often used in combination therapy. Steroids are sometimes used for "flares" of Crohn's disease.
Your gastroenterologist (GI) will work with you to develop a treatment regimen. If you do not have a gastroenterologist or have a new diagnosis of Crohn's disease, your surgeon will guide you in establishing the care that you need.
In more advanced or complicated cases of Crohn's disease that can not be treated with medical therapy, surgery may be required. This decision is best reached through consultation with your gastroenterologist and your colon and rectal surgeon. Surgery is often effective and can offer long-term relief of symptoms, with many patients never requiring additional operations. However, surgery is not "curative", and serves to treat only the complications of the disease. For this reason, it is important to continue medical treatment and regular follow-up with your gastroenterologist.
Surgical technique for Crohn's disease follows a conservative approach, with a limited resection of the intestine (removal of the diseased portion of the bowel) being the most common procedure. Emergency surgery is sometimes necessary when complications, such as a perforation of the intestine, obstruction (blockage) of the bowel, or significant bleeding occurs with Crohn's disease. Other less urgent indications for surgery may include abscess formation, fistulas (abnormal communications from the intestine), severe anal disease or persistence of disease despite medical treatment.
In summary, surgical therapy for this complex disease process is best conducted by a team of doctors experienced in the management of Crohn's disease. North Texas Colon and Rectal Associates work closely with Gastroenterologists to customize a surgical plan for each person.
Ulcerative Colitis is a chronic inflammation of the superficial lining of the large bowel (colon). Ulcerative Colitis usually occurs in teenage years to young adulthood but can be diagnosed at any age. The cause remains unknown and no one can predict who will develop this condition. The severity of the disease can also vary with some people experiencing minimal to no symptoms and some people experiencing severe inflammation. Ulcerative Colitis is a chronic condition that cannot be cured, but the symptoms and risks of the disease can be managed with medication and or surgery. The most important risk of Ulcerative Colitis is the increased risk of developing colorectal cancer; therefore it is very important that people with Ulcerative Colitis are followed closely by a gastroenterologist or colorectal surgeon and that appropriate surveillance is performed. Studies show that people with inflammatory bowel disease, like Ulcerative Colitis, live full, productive lives and live just as long as people without these diseases.
Ulcerative Colitis can be associated with another disease that occurs outside of the GI tract including liver disease, skin disorders, eye disorders and kidney stones.
Symptoms can range from mild to severe. With treatment, symptoms can decrease or disappear for long periods of time and their disease can enter "remission". Even during remission when symptoms are not present, it is important to continue medications that keep inflammation from coming back.
Common symptoms can include:
- Cramping – abdominal pain
- Lower GI bleeding
- Weight loss
Initial treatment of Ulcerative Colitis is medical, using antibiotics and anti-inflammatory or immune-modulating medications. These are usually necessary on a long-term basis. Steroids (prednisone) has significant side effects and is usually only used for short periods. "Flare-ups" of the disease are episodes when symptoms are more prominent or can become severe. These episodes can often be treated by increasing the dosage of medications or adding new medications that work in combination to reduce inflammation. Hospitalization may be necessary to support a person through a "flare-up".
Surgery is indicated for patients who have life-threatening complications Ulcerative Colitis, such as massive bleeding, perforation, or infection. Surgery may also be necessary for those who have the chronic form of the disease but are not able to manage symptoms with medical therapy alone or when cancer or precancerous changes in the colon are diagnosed. There are multiple surgical options available for this illness and the type of surgery performed is customized depending on the circumstances surrounding the individual. Your surgeon will work with you to tailor a treatment plan that works best for you.