Don’t Let Inflammatory Bowel Disease Restrict Your Activities
Severe diarrhea, abdominal pain, bloody stools: These are just three of many manifestations of inflammatory bowel disease (IBD).
Although these symptoms can be uncomfortable and disruptive, most people are able to keep their disease in check. In fact, chances are good that you know someone with IBD, but you don’t know they have the disease.
“When IBD is controlled, you can do whatever you want. IBD should not limit or define your life,” says Weill Cornell gastroenterologist Brian Bosworth, MD.
WHAT YOU SHOULD KNOW
IBD is an autoimmune disease, which means the immune system turns against the body and attacks healthy tissue. This puts you at risk for other autoimmune diseases, such as rheumatoid ar-thritis, lupus or heart disease, regardless of your age. Recently, it was discovered that IBD patients with no history of heart disease are at increased risk of developing heart failure when their IBD flares.
Types of IBD
In IBD, the lining of the digestive tract becomes inflamed. There are two 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. Both forms of IBD tend to develop in adolescence or young adulthood, but there is a second peak of onset in the 50s and 60s.
Diagnosing IBD
Doctors make a diagnosis by taking a history of your symptoms, performing a physical exam, doing an endoscopy or colonoscopy, and taking a tissue sample for biopsy. If you have IBD, the biopsy will reveal an influx of white blood cells that are responsible for causing inflammation, redness, diarrhea, and pain. The shape of the glands that produce mucous also will change in response to chronic inflammation.
A simple test that uses compounds found in stool samples has been developed to distinguish between UC and Crohn’s. However, it is not yet on the market.
Taming the tiger
Although there is no cure for IBD, medications can be highly effective in putting the disease into remission and suppressing symptoms. Topical anti-inflammatories, such as mesalamine, can be effective in treating UC, but immune-suppressing therapies are generally needed for Crohn’s disease. Early use of medication that blocks a chemical messenger that allows inflammation-causing white blood cells to talk to each other has been shown to be helpful in some patients. These include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and certoli-zumab (Cimzia).
In May 2014, the FDA approved an entirely different type of drug for moderate-to-severe UC and Crohn’s. Vedolizumab (Entyvio) prevents white blood cells from moving out of the blood-stream into the colon wall, where they can cause inflammation. “This drug is very promising. It seems to work well and has a good safety profile,” says Dr. Bosworth.
Surgery for some
Unfortunately, medications don’t always control symptoms or prevent the disease from worsening. Patients with Crohn’s may develop an ulcer that forms an abnormal connection from the intestinal wall to the bladder, vagina, or external skin (fistula); alternatively, the bowel may become narrowed and obstruct the passage of stool. In these patients, surgery may be needed.
Surgery may involve removal of a portion of the intestine (resection), or opening the narrowed area (stricturoplasty).
In severe UC, removing the colon (large intestine) can end the problem. The small intestine is then fashioned into a J-shaped pouch and attached to the anus, allowing the patient to use the bathroom normally. “This surgery truly can be life-altering,” says Dr. Bosworth.
Looking ahead
According to Dr. Bosworth, we are closer than ever to conquering IBD. “Other medications that will be coming to market in the next several years will offer many other advantages,” he says.
As research produces a better understanding of how IBD progresses, he is confident its aggressive onslaught will be stopped.
“There may be no cure at this time, but it’s coming,” says Dr. Bosworth.
IBD IS NOT IBS!
Many people confuse IBD with irritable bowel syndrome (IBS), but the diseases are very differ-ent. In IBS, miscommmunication between nerves and muscles causes the bowel to move too fast or too slow. Symptoms include spasms, cramps, or urge incontinence, which are relieved by moving the bowels. IBD, on the other hand, is a result of inflammation caused by the body’s own immune system.
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