Inflammatory bowel disease (IBD) is a group of conditions affecting the colon and small intestine. IBD is very common, affecting 1 out of every 250 persons in America. Crohn's disease has a high incidence rate in the Jewish population, and all types of IBD have a strong genetic component. About 10% of IBD patients are under 18.
The two major types of IBD are Crohn's disease and ulcerative colitis, although there are other, rarer forms of colitis that fall under the umbrella of IBD.
The precise cause of IBD remains unknown. These inflammatory conditions are most likely caused by the body's immune system reacting abnormally to bacteria in the intestine. When this happens, white blood cells infiltrate the intestinal lining,producing substances that harm your internal tissues.
Although the two diseases are very different, Crohn's disease and ulcerative colitis present with such similar symptoms that they often are mistaken for each other. Both conditions can manifest in abdominal pain, diarrhea, rectal bleeding, internal cramps, weight loss, vomiting and changes in the stool.
Successful management of IBD requires early and accurate diagnosis of IBD and implementation of appropriate medical, surgical, and nutritional therapy with a fully integrated program based model aimed at optimizing patient care, postgraduate education and clinical and translational research in IBD. Physicians can give a precise diagnosis based on a variety of tests, including stool analysis, barium enemas, blood tests, and colonoscopy with biopsy of the patient's lesions.
Colonoscopy remains the most definitive method of diagnosing types of IBD. In this procedure, your physician inserts a thin, lighted camera tube that facilitates a view of the entire colon. During the endoscopy, tissue samples from inside the colon can be biopsied, or removed for analysis. In the laboratory, the biopsied cells are tested for granulomas, or clusters of inflamed cells. Because Crohn's disease results in granulomas and ulcerative colitis does not, colonoscopy continues to present a reliable method of precise IBD diagnosis.
In addition to routine endoscopic methods, upgraded PillCam small bowel capsule endoscopy, CT/MRI enterography, antegrade and retrograde balloon enteroscopy and other modalities are available to our IBD patients. With the recent advent of balloon-assisted enteroscopy, this has enabled our gastroenterologists to treat complicated strictures endoscopically deep within the small intestine that in the past were only able to be treated surgically.
There is currently no medical cure for IBD. Thus, the goal of treatment is to increase quality of life for patients and achieve symptom remission, which allows the intestinal tissues to heal. Once the primary symptoms are under control, certain medicines can greatly reduce the frequency of what physicians call "flare-ups."
Commonly prescribed drugs for IBD include corticosteroids, which reduce inflammation in the intestines, and immunosuppressives,which help control the body's immune response and can often maintain and extend a patient's remission. Other drugs include metronidazole, an antibiotic affecting the immune system, and mesalazine, a bowel-specific anti-inflammatory drug.
Other treatment includes biologic therapy through agents like infliximab, which block chemicals involved in the inflammatory and immune response. With infliximab infusions, two-thirds of patients with Crohn's disease improved; this biologic therapy also succeeded in closing most fistulas in the Crohn's patient population.
In advanced forms of IBD, your physician may consider surgical treatment, although results vary widely according to the specific type of disease. Crohn's disease can be exacerbated and complicated by surgical intervention, while ulcerative colitis can in certain cases be treated by dramatic procedures such as colectomy, or the surgical removal of the colon.
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