The Best Tools for Managing Inflammatory Bowel Disease
If you have inflammatory bowel disease (IBD), you may experience diarrhea, abdominal pain and cramping, fever, and fatigue—symptoms that can cause significant disruption in your daily life. However, with the right treatment, most IBD patients are able to keep their disease in check.
“The inflammatory bowel diseases are chronic inflammatory conditions affecting various segments of the gastrointestinal tract. If left undiagnosed and untreated, they can progress from conditions that are purely inflammatory to conditions requiring surgical intervention. Fortunately, there are now many treatment options available to control IBD. With early recognition and treatment, patients should be able to enjoy healthy, symptom-free living,” says Weill Cornell Medicine gastroenterologist Adam Steinlauf, MD.
WHAT YOU SHOULD KNOW
IBD is not IBS!
Many people confuse IBD with irritable bowel syndrome (IBS), but the diseases are very different. IBS is a collection of functional bowel disorders characterized by a change in bowel habits associated with abdominal discomfort, which is usually relieved by a bowel movement. This disorder cannot be diagnosed with imaging studies or endoscopic evaluation, since it is not caused by structural issues. Treatment is aimed at controlling the disturbed bowel function and/or the associated discomfort.
Types of IBD
In IBD, the lining of the digestive tract becomes inflamed. There are two main forms of IBD: ulcerative colitis (UC) and Crohn’s disease. UC starts in the rectum and can extend through the colon. Crohn’s disease can affect any section of the digestive tract, from the mouth to the anus, and may involve a short or large segment of bowel.
Diagnosing IBD
Doctors are able to diagnose IBD by taking a careful history of your symptoms, performing a detailed physical exam, doing an endoscopy or colonoscopy to look for inflammation, and taking tissue samples for biopsy. If you have IBD, the biopsy will reveal an infiltration of the tissue with various types of white blood cells that are responsible for causing inflammation.
While blood tests can’t confirm a diagnosis, they can reveal important information, such as if you have infection, anemia, or deficiencies in certain vitamins and minerals.
Medication Options
Although there is no cure for IBD, medications can be highly effective in putting the disease into remission and suppressing symptoms. Anti-inflammatories, such as mesalamine, can be effective in treating mild cases of UC, but immune-suppressing therapies are generally needed for more severe cases of UC and for Crohn’s disease. Medications called biologics, which stop the action of proteins that produce inflammation, are helpful for some patients. These include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and certolizumab (Cimzia).
In the past few years, the FDA has approved three new drugs for moderate-to-severe UC and Crohn’s. These medications, which also have an anti-inflammatory effect, are natalizumab (Tysabri), vedolizumab (Entyvio), and ustekinumab (Stelara).
Other types of medications used for IBD include aminosalicylates, which reduce inflammation in the lining of the intestine; corticosteroids, which reduce inflammation; and immunodilators, which decrease inflammation by depressing the immune system.
“Because many of these medications have potential side effects, it is important that patients with IBD consult with physicians who are comfortable and experienced prescribing such medications. The risks and benefits of all treatment options should be considered, and the patient and the physician should decide together which option is best,” says Dr. Steinlauf.
Beyond Medication
Surgery may be considered if medications don’t adequately control symptoms, or if complications arise, such as ulcers, fistulas (an ulcer that extends from the intestine to another area of the body), abscesses, and bowel obstruction. Surgery may involve removal of a portion of the intestine (resection), or expanding an area of the intestine that has narrowed (stricturoplasty).
In severe cases of UC, removing the colon may be necessary. In some cases. the small intestine is then fashioned into a pouch and attached to the anus as a reservoir for stool, allowing the patient to use the bathroom normally.
If you have IBD but your current treatment isn’t relieving all of your symptoms, talk to your doctor—a more effective alternative may be available.
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