- Inflammatory Bowel Disease Basics
- IBS vs. IBD (Irritable, Leaky Gut) Differences in Pain, Symptoms & Treatments
- What is IBS (irritable bowel syndrome)?
- Where does the pain occur in IBS vs. IBD?
- What are the similarities in signs and symptoms of IBS and IBD?
- What are the differences between the signs and symptoms of IBS vs. IBD?
- What causes IBS vs. IBD?
- What are the treatments of IBS vs. IBD?
- How does diet effect IBS diet vs. IBD?
- Is there a cure for IBS or IBD?
- Inflammatory Bowel Disease
- What Are the Signs & Symptoms of Inflammatory Bowel Disease?
- What Causes Inflammatory Bowel Disease?
- Who Gets Inflammatory Bowel Disease?
- How Is Inflammatory Bowel Disease Diagnosed?
- How Is Inflammatory Bowel Disease Treated?
- What Else Should I Know About Inflammatory Bowel Disease?
- Inflammatory Bowel Disease (IBD): Symptoms, Causes, Tests and Treatment
- Inflammatory Bowel Disease Symptoms
- Inflammatory Bowel Disease (IBD): Symptoms, Diet & Treatment
- Symptoms of internal strictures in IBD
- Internal strictures diagnosis in IBD
- Treatment of strictures in IBD
Inflammatory Bowel Disease Basics
The term inflammatory bowel disease (IBD) describes a group of disorders in which the intestines become inflamed.
It has often been thought of as an autoimmune disease, but research suggests that the chronic inflammation may not be due to the immune system attacking the body itself.
Instead, it is a result of the immune system attacking a harmless virus, bacteria, or food in the gut, causing inflammation that leads to bowel injury.
Two major types of IBD are ulcerative colitis and Crohn's disease. Ulcerative colitis is limited to the colon or large intestine. Crohn's disease, on the other hand, can involve any part of the gastrointestinal tract from the mouth to the anus. Most commonly, though, it affects the last part of the small intestine or the colon or both.
If you have an IBD, you know it usually runs a waxing and waning course. When there is severe inflammation, the disease is considered active and the person experiences a flare-up of symptoms. When there is less or no inflammation, the person usually is without symptoms and the disease is said to be in remission.
IBD is a disease with an unknown cause. Some agent or a combination of agents — bacteria, viruses, antigens — triggers the body's immune system to produce an inflammatory reaction in the intestinal tract.
Recent studies show some combination of hereditary, genetic, and/or environmental factors may cause the development of IBD. It could also be that the body's own tissue causes an autoimmune response.
Whatever causes it, the reaction continues without control and damages the intestinal wall, leading to diarrhea and abdominal pain.
As with other chronic diseases, a person with IBD will generally go through periods in which the disease flares up and causes symptoms, followed by periods in which symptoms decrease or disappear and good health returns. Symptoms range from mild to severe and generally depend upon what part of the intestinal tract is involved. They include:
IBD can lead to several serious complications in the intestines, including:
- Profuse intestinal bleeding from the ulcers
- Perforation, or rupture of the bowel
- Narrowing – called a stricture — and obstruction of the bowel; found in Crohn's
- Fistulae (abnormal passages) and perianal disease, disease in the tissue around the anus; these conditions are more common in Crohn’s than in ulcerative colitis.
- Toxic megacolon, which is an extreme dilation of the colon that is life-threatening; this is associated more with ulcerative colitis than Crohn's.
IBD, particularly ulcerative colitis, also increases the risk of colon cancer. IBD can also affect other organs; for example, someone with IBD may have arthritis, skin conditions, inflammation of the eye, liver and kidney disorders, or bone loss. Of all the complications outside the intestines, arthritis is the most common. Joint, eye, and skin complications often occur together.
Your doctor makes the diagnosis of inflammatory bowel disease your symptoms and various exams and tests:
- Stool exam. You'll be asked for a stool sample that will be sent to a laboratory to rule out the possibility of bacterial, viral, or parasitic causes of diarrhea. In addition, the stool will be examined for traces of blood that cannot be seen with the naked eye.
- Complete blood count. A nurse or lab technician will draw blood, which will then be tested in the lab. An increase in the white blood cell count suggests the presence of inflammation. And if you have severe bleeding, the red blood cell count and hemoglobin level may decrease.
- Other blood tests. Electrolytes (sodium, potassium), protein, and markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may be drawn to look at disease severity. Perinuclear antineutrophil cytoplasmic antibody (pANCA) levels may be up in ulcerative colitis. In addition, specific tests for sexually transmitted diseases may be done.
- Barium X-ray. Although seldom used, it can check the upper gastrointestinal (GI) tract — the esophagus, stomach, and small intestine — for abnormalities caused by Crohn's disease. You swallow a chalky white solution that coats the intestinal tract so it will be visible on X-rays. If a barium study is used to check the lower GI tract, you will be given an enema containing barium and asked to hold it in while X-rays are taken of the rectum and colon. Abnormalities caused by either Crohn's or ulcerative colitis may show up in these X-rays.
- Other radiologic tests. Computed tomography (CT scan), magnetic resonance imaging (MRI), and ultrasound have also been used in the diagnosis of Crohn’s disease and ulcerative colitis.
- Sigmoidoscopy. In this procedure, a doctor uses a sigmoidoscope, a narrow, flexible tube with a camera and light, to visually examine the last one-third of your large intestine, which includes the rectum and the sigmoid colon. The sigmoidoscope is inserted through the anus and the intestinal wall is visually examined for ulcers, inflammation, and bleeding. The doctor may also take samples — biopsies — of the intestinal lining with an instrument inserted through the tube. These will then be examined in a laboratory under a microscope.
- Colonoscopy. A colonoscopy is similar to a sigmoidoscopy, except that the doctor will use a colonoscope, a longer flexible tube, to examine the entire colon. This procedure gives you a look at the extent of disease in the colon.
- Upper endoscopy. If you have upper GI symptoms such as nausea and vomiting, a doctor will use an endoscope, a narrow, flexible tube with a camera and light, that will be inserted through the mouth — to examine your esophagus, stomach, and duodenum, which is the first part of your small intestine. Ulceration occurs in the stomach and duodenum in up to one every 10 people with Crohn's disease.
- Capsule endoscopy. This test may be helpful to diagnose disease in the small intestine, such as in Crohn’s disease. You swallow a small capsule that has a camera in it. Pictures are taken of the esophagus, stomach and small bowel and then sent to a receiver you wear on a belt. At the end of the procedure, the pictures are downloaded from the receiver onto a computer. The camera is passed through your body into the toilet.
Treatment for IBD involves a combination of self-care and medical treatment.
Although no specific diet has been shown to prevent or treat IBD, dietary changes may be helpful in managing your symptoms. It's important to talk with your doctor about ways to modify your diet while making sure you get the nutrients you need.
For instance, depending on your symptoms, the doctor may suggest that you reduce the amount of fiber or dairy products that you consume. Also, small, frequent meals may be better tolerated.
In general, there is no need to avoid certain foods unless they cause or worsen your symptoms.
One dietary intervention your doctor may recommend is a low-residue diet, a very restricted diet that reduces the amount of fiber and other undigested material that pass through your colon.
Doing so can help relieve symptoms of diarrhea and abdominal pain. If you do go on a low-residue diet, be sure you understand how long you should stay on the diet, because a low-residue diet doesn't provide all the nutrients you need.
Your doctor may recommend that you take vitamin supplements.
Another important aspect of self-care is to learn how to manage stress, which may worsen your symptoms. One thing you might want to do is to make a list of things that cause you stress and then consider which ones you can eliminate from your daily routine.
Also, when you feel stress coming on, it can help to take several deep breaths and release them slowly by blowing out. Learning to meditate, creating time for yourself, and regular exercise are all important tools for reducing the amount of stress in your life.
Participating in a support group puts you in contact with others who know exactly the effect IBD has on your day-to-day life, because they are going through the same things you are. They can offer support and tips on how to deal with symptoms and the effect they have on you.
The goal of medical treatment is to suppress the abnormal inflammatory response so intestinal tissue has a chance to heal. As it does, the symptoms of diarrhea and abdominal pain should be relieved. Once the symptoms are under control, medical treatment will focus on decreasing the frequency of flare-ups and maintaining remission.
Doctors frequently take a stepwise approach to the use of medications for inflammatory bowel disease. With this approach, the least harmful drugs or drugs that are only taken for a short period of time are used first. If they fail to provide relief, drugs from a higher step are used.
Treatment typically begins with aminosalicylates, which are aspirin- anti-inflammatory drugs such as balsalazide (Colazal), mesalamine (Asacol, Apriso, Lialda, Pentasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine).
Mesalamine can be taken orally or be administered as a rectal suppository or enema to treat ulcerative colitis. Because they are anti-inflammatory, they are effective in both relieving symptoms of a flare-up and maintaining remission.
The doctor may also prescribe anti diarrheal agents, antispasmodics, and acid suppressants for symptom relief. You should not take anti-diarrheal agents without a doctor’s advice.
If you have Crohn's disease, especially if it's accompanied by a complication such as perianal disease (diseased tissue around the anus), the doctor may prescribe an antibiotic to be taken with your other medicines. Antibiotics are less commonly used for ulcerative colitis.
If the first drugs don't provide the adequate relief, the doctor will ly prescribe a corticosteroid, which is rapid-acting anti-inflammatory agent.
Corticosteroids tend to provide rapid relief of symptoms along with a significant decrease in inflammation.
However, because of side effects associated with their long-term use, corticosteroids are used only to treat flare-ups and are not used for maintaining remission.
Immune modifying agents are the next drugs to be used if corticosteroids fail or are required for prolonged periods. These medications are not used in acute flare-ups, because they may take as long as 2 to 3 months to take action.
These medications target the immune system, which releases the inflammation-inducing chemicals in the intestine walls.
Examples of the most common immunosuppressives are azathioprine (Imuran), methotrexate (Rheumatrex), and 6-mercaptopurine, or 6-MP (Purinethol).
Biologic therapies are antibodies that target the action of certain other proteins that cause inflammation.
Infliximab (Remicade) and infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra), a biosimilar to Remicade, are drugs approved by the FDA to treat moderate to severe Crohn's disease when standard medications have been ineffective. They belong to a class of drugs known as anti-TNF agents.
TNF (tumor necrosis factor) is produced by white blood cells and is believed to be responsible for promoting the tissue damage that occurs with Crohn's disease.
Other anti-TNF agents approved for Crohn's disease are adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, and certolizumab (Cimzia). An alternative to anti-TNF treatment for Crohn's disease are biologics that target integrin, two of which are natalizumab (Tysabri) and vedolizumab (Entyvio). Another drug, ustekinumab (Stelara), blocks IL-12 and IL-23.
Adalimumab (Humira), adalimumab-atto (Amjevita), certolizumab (Cimzia), golimumab (Simponi, Simponi Aria), Infliximab (Remicade), infliximab-abda (Renflexis), and infliximab-dyyb (Inflectra) are some of the anti-TNF drugs currently approved by the FDA for ulcerative colitis.
If you are not responding to the drugs recommended for IBD, talk with your doctor about enrolling in a clinical trial. Clinical trials are the way new treatments for a disease are tested to see how effective they are and how patients respond to them. You can find out about clinical trials at the Crohn's & Colitis Foundation of America web site.
Surgical treatment for IBD depends upon the disease. Ulcerative colitis, for instance, can be cured with surgery, because the disease is limited to the colon.
Once the colon is removed, the disease doesn't come back. However, surgery will not cure Crohn's disease, although some surgeries may be used.
Excessive surgery in people with Crohn's disease can actually lead to more problems.
There are several surgical options available for people with ulcerative colitis. Which one is right for you depends on several factors:
- The extent of your disease
- Your age
- Your overall health
The first option is called a proctocolectomy. It involves the removal of the entire colon and rectum. The surgeon then makes an opening on the abdomen called an ileostomy that goes into part of the small intestine. This opening provides a new path for feces to be emptied into a pouch that's attached to the skin with an adhesive.
Another commonly used surgery is called ileoanal anastomosis. The surgeon removes the colon and then creates an internal pouch that connects the small intestine to the anal canal. This allows feces to still exit through the anus.
Even though surgery will not cure Crohn's disease, approximately 50% of people with Crohn's require surgery at some point. If you have Crohn's disease and require surgery, your doctor will discuss your options with you. Be sure you ask questions and understand the goal or goals of the surgery, its risks and benefits, and what could happen if you don't have the surgery.
When you have an IBD, the symptoms will come and go over a period of many years. That doesn't mean they control you; managing your condition with the help of your health care providers is the best way to stay as healthy as possible in the long term.
SOURCE: National Digestive Diseases Information Clearinghouse, National Institutes of Health.FDA. “FDA approves Inflectra, a biosimilar to Remicade.” “FDA approves Amjevita, a biosimilar to Humira.”Crohn's & Colitis Foundation of America.”Maintenance Therapy.” “What is Crohn's Disease?” “What is Ulcerative Colitis?”
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IBS vs. IBD (Irritable, Leaky Gut) Differences in Pain, Symptoms & Treatments
- IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) are not the same problem with the digestive tract.
- IBS usually causes no ulcers or lesions in the bowel, and it involves only the colon.
- IBD is a term used for a group of bowel diseases that cause inflammation in the digestive tract. The most common forms of IBD are ulcerative colitis (UC) and Crohn's disease.
- IBD causes ulcers in the tissue of the digestive tract that may occur almost anywhere from the mouth to the anus. (Crohn's disease can affect any portion of the GI tract, while ulcerative colitis only affects the large and small intestine, rectum, and anus).
- Researchers don not know the exact cause of IBS or IBD, however, they suspect multiple factors may cause IBS, and an immune system problem may cause IBD.
- These diseases are often confused because they have some similar symptoms (for example, persistent diarrhea, abdominal pain, and nausea and/or vomiting), they sound similar, and have almost identical abbreviations.
- There is no cure for IBS or IBD, (Crohn's disease and UC), but IBD has more serious symptoms than IBS. For example; ulcers in the bowel, rectum, or anus; rectal bleeding, and anemia. Treatment requires medication, and some patients need surgery.
- IBS is treated and managed with medications and lifestyle changes diet and stress reduction.
What is IBS (irritable bowel syndrome)?
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IBS (irritable bowel syndrome) is a common disorder of the large intestine (colon) that causes symptoms of cramping, abdominal pain, bloating, gas, diarrhea, and/or constipation.
Researchers and doctors do not know the exact cause of IBS, but they suspect that multiple factors, for example, foods, stress, hormones, or other illnesses combined with gut bacteria trigger abnormal bowel muscle contractions in the gastrointestinal (GI) nervous system.
Where does the pain occur in IBS vs. IBD?
Abdominal pain in IBS may be spread over a wide area of the abdomen, but it can localize in the lower left area of it. The pain may intensify while eating meals, when gas is present in the GI tract, and from abdominal bloating. A bowel movement may reduce the pain.
Abdominal pain in IBD may occur anywhere in the abdomen, and its location may suggest the type of IBD that you may have (for example, left-sided abdominal pain is a classic symptom of ulcerative colitis).
Constipation can be a problem for people with irritable bowel syndrome, or IBS. Foods that trigger constipation, and thus trigger IBS symptoms include:
- Chewing gum
Click for more foods that cause constipation »
What are the similarities in signs and symptoms of IBS and IBD?
Initially, it is difficult for doctors to diagnose IBS and IBD because sometimes some of the symptoms are similar, for example:
What are the differences between the signs and symptoms of IBS vs. IBD?
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Symptoms unique to IBS are:
- Changes in bowel movement
- Changes in how the stools look
- Abdominal bloating
- Whitish mucus in the stool
- A feeling of not having finished a bowel movement.
- Sexual dysfunction
- Urinary frequency and urgency
Some people with IBS have IBS-D in which diarrhea is one of the primary symptoms, or IBS-C in which constipation is one of the primary symptoms.
Symptoms unique to IBD (Crohn's disease and ulcerative colitis) are more serious, and include:
What causes IBS vs. IBD?
Although some patients may show microscopic areas of inflammation in IBS, the causes are speculative and may include hyperreactivity to bacterial gut infections, accelerated or delayed transit of contents through the GI tract (diarrhea or constipation), and abnormal bowel contractions caused by triggers such as foods or stress.
The exact cause of IBD is not known. Researchers suggest the IBD types are caused by an immune system malfunction in the bowel tissue, with a genetic predisposition to develop IBD, and the individual’s response to gut microorganisms.
What is irritable bowel syndrome or IBS? See Answer
What are the treatments of IBS vs. IBD?
Treatment for IBD includes anti-inflammatory drugs aminosalicylates and corticosteroids, immune system suppressors (many types azathioprine, cyclosporine, and methotrexate), and antibiotics (metronidazole or ciprofloxacin). Some patients may require surgery (removal of the entire colon and rectum or in others, removal of damaged segments of small bowel).
Treatment for IBS is mainly diet, however, several drugs, for example, alosetron (Lotronex), rifaximin (Xifaxan), lubiprostone (Amitiza) are approved to treat IBS.
Other medications may be used to reduce symptoms of either condition, for example, Tylenol, antiemetics, laxatives, and antidepressants.
How does diet effect IBS diet vs. IBD?
An IBD diet is designed to reduce any bowel problems aggravated by food. Recommendations include:
- Limit dairy products.
- Eat low-fat foods.
- High-fiber foods may aggravate IBD.
- Avoid spicy foods, alcohol, and caffeine.
- Eat small meals.
- Drink plenty of water.
- Consider taking a multivitamin.
- The diet for IBS is far simpler.
- Drink plenty of water.
- Avoid any foods that make you bloated or “gassy.”
- Do not over-eat fiber as this may cause gas and bloating. Probiotics may help reduce symptoms.
If you have irritable bowel syndrome or inflammatory bowel disease diet changes may be useful for patients with IBS, and especially IBD, to seek advice from a dietician.
Is there a cure for IBS or IBD?
There is no cure for IBD, but treatments can reduce symptoms. There are claims that IBS can be cured with treatments. Discuss treatments with your primary care doctor and your gastroenterologist.
Lehrer, J. “Irritable Bowel Syndrome.” Medscape. Updated: Apr 04, 2017. Rowe, W. “Inflammatory Bowel Disease.” Medscape. Updated: Jun 17, 2016.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a condition that causes parts of the intestine (bowel) to get red and swollen. It's a chronic condition, which means it lasts a long time or constantly comes and goes.
There are two kinds of IBD: Crohn's disease and ulcerative colitis. These diseases have many things in common, but there are important differences:
- Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus (where poop comes out). The inflammation of Crohn's disease damages the entire bowel wall.
- Ulcerative colitis happens only in the large intestine, or colon. It causes sores called ulcers that affect the inner lining of the colon.
What Are the Signs & Symptoms of Inflammatory Bowel Disease?
The most common symptoms of inflammatory bowel disease are belly pain and diarrhea. Other symptoms include:
- blood in the toilet, on toilet paper, or in the stool (poop)
- low energy
- weight loss
Inflammatory bowel disease can cause other problems, such as rashes, eye problems, joint pain and arthritis, and liver problems. Children with inflammatory bowel disease may not grow as well as other kids their age and puberty may happen later than normal.
What Causes Inflammatory Bowel Disease?
The exact cause of IBD is not clear. It is probably a combination of genetics, the immune system, and something in the environment that triggers inflammation in the gastrointestinal tract. Diet and stress may make symptoms worse, but probably don't cause inflammatory bowel disease.
Who Gets Inflammatory Bowel Disease?
IBD tends to run in families. But not everyone with IBD has a family history of the disease. Inflammatory bowel disease can happen at any age, but is usually diagnosed in teens and young adults.
How Is Inflammatory Bowel Disease Diagnosed?
Inflammatory bowel disease is diagnosed with a combination of blood tests, stool (poop) tests, and X-rays. Medical imaging tests, such as CT scans and MRI, might be done too.
The doctor will examine a stool sample for the presence of blood, and might look at the colon with an instrument called an endoscope, a long, thin tube attached to a TV monitor.
In this procedure, called a colonoscopy, the tube is inserted through the anus to allow the doctor to see inflammation, bleeding, or ulcers on the wall of the colon.
During the procedure, the doctor might do a biopsy, taking small samples that can be sent for further testing.
How Is Inflammatory Bowel Disease Treated?
IBD is treated with medicines, changes in diet, and sometimes surgery. The goal of treatment is to relieve symptoms, prevent other problems, and prevent future flare-ups.
A doctor may recommend:
- anti-inflammatory drugs to decrease the inflammation
- immunosuppressive agents to prevent the immune system from causing further inflammation
- biologic agents to block proteins that cause inflammation
- nutrition therapy to give the bowel a chance to heal
Because some medicines make it harder to fight infections, it's important that your child be tested for tuberculosis and have all recommended vaccines before starting treatment.
Surgery may be necessary if:
- the bowel gets a hole
- the bowel becomes blocked
- bleeding can't be stopped
- symptoms don't respond to treatment
What Else Should I Know About Inflammatory Bowel Disease?
Poor appetite, diarrhea, and poor digestion of nutrients can make it hard for people with inflammatory bowel disease to get the calories and nutrients the body needs.
Children with IBD should eat a variety of foods, get plenty of fluids, and learn to avoid foods that make symptoms worse. Some children may need supplements, calcium or vitamin D.
Kids who are not growing well may need additional nutrition support.
Kids and teens with IBD can feel different and might not be able to do the things their friends can do, especially during flare-ups. Some struggle with a poor self-image, depression, or anxiety.
They may not take their medicine or follow their diet.
It's important to talk to your health care professional if you're concerned about your child's mood, behavior, or school performance.
Parents can help teens with IBD take on more responsibility for their health as they get older.
The Crohn's and Colitis Foundation is a good resource for more information and support.
Reviewed by: J. Fernando del Rosario, MD
Date reviewed: October 2017
Inflammatory Bowel Disease (IBD): Symptoms, Causes, Tests and Treatment
Inflammatory bowel disease is a group of disorders that cause chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the two most common of these diseases, affecting nearly 2 million Americans.
Inflammatory Bowel Disease Symptoms
Crohn’s disease and ulcerative colitis are similar in many ways. They both cause swelling and sores along the tissue that lines the digestive tract and can cause abdominal pain and frequent diarrhea.
Crohns disease can develop anywhere in the digestive tract, from the mouth to the rectum, and penetrates into the deep layers of the lining.
Ulcerative colitis usually affects only the outermost layer of the tissue lining the colon (the large intestine).
There is still much to be learned about Crohn’s disease and ulcerative colitis, and laboratory and clinical research into their causes and treatments is under way at The Cleveland Clinic Digestive Disease Center and the Lerner Research Institute.
Scientists estimate that seven people 100,000 in the United States develop Crohn’s disease, and 10 to 15 people in 100,000 develop ulcerative colitis.
The exact cause of these diseases is unknown, but the latest research suggests that they may be caused by a malfunction in the body’s immune system.
Both Crohn’s disease and ulcerative colitis appear to run in families, and certain environmental factors may also increase an individual’s risk for Crohn’s disease and ulcerative colitis.
Crohn’s disease and ulcerative colitis are so similar that they often are mistaken for each other. Making an accurate diagnosis is important so that an individual can receive the most effective treatment for his or her disease.
Cleveland Clinic gastroenterologists have extensive experience in diagnosing Crohn’s disease and ulcerative colitis and are skilled in distinguishing between the two symptoms and test results.
They use a variety of tests to diagnose inflammatory bowel disease:
Two newer blood tests are useful in diagnosing inflammatory bowel disease. These tests check for anemia or signs of infection by identifying certain antibodies in the blood, but they are only about 80 percent accurate.
A barium enema is a test that allows the doctor to perform an X-ray examination of the lower portion of the digestive tract. To perform this test, barium, a safe dye, is placed in the colon as an enema.
It coats the lining and creates a silhouette of the entire large intestine, which includes the colon, rectum and anus, and a portion of the small intestine on X-ray.
For patients in whom Crohn’s disease does not affect higher sections of the digestive tract, a barium enema may be the only test needed for diagnosis.
A flexible sigmoidoscopy provides an internal, real-time view of the lowest two feet of the colon.
The doctor inserts a slender, flexible, lighted tube through the rectum and examines the tissue lining this section of the colon, looking for inflammation, ulcers or other problems that signal inflammatory bowel disease.
The sigmoidoscopy is very useful for diagnosing disease in the lowest portion of the colon, but it does not allow the doctor to see problems that might exist higher in the colon or in the small intestine.
A colonoscopy is the most definitive test for diagnosing inflammatory bowel disease. The doctor inserts a thin, flexible, lighted tube that is long enough to view the entire colon, from the anus to the small intestine, with the attached camera.
During this procedure, the doctor also can take tissue samples from inside the colon that can be tested in the laboratory for clusters of inflamed cells called granulomas.
These clusters are present in Crohn’s disease but not ulcerative colitis, so this is a very useful test for distinguishing the two diseases.
In the early stages of both Crohn’s disease and ulcerative colitis, medication is the recommended treatment.
The goal of medical treatment is to suppress the abnormal inflammatory response and allow the intestinal tissues to heal.
Once diarrhea and abdominal pain are under control, medical treatment can reduce the frequency of flare-ups and maintain remission. At this time, there is no medical treatment that will cure inflammatory bowel disease.
In more advanced disease, surgery is often necessary. The type of operation performed and the prognosis are specific to each disease. For details about treatments, please see the appropriate sections under Crohn’s disease and ulcerative colitis.
Drugs are an effective means for treating early inflammatory bowel disease, relieving symptoms and maintaining remission. The most commonly prescribed drugs for inflammatory bowel disease are:
- Corticosteroids such as prednisone and methylprednisolone. These powerful drugs reduce the inflammation in the intestines and can aid in the treatment of fistulas.
- Aminosalicylates such as sulfasalazine and olsalazine. These are aspirin- anti-inflammatory agents, often used as the first-line treatment in early disease.
- Immunosuppressives such as 6-mercaptopurine and azathioprine. These drugs control the immune response and can help maintain a remission and reduce the dose of corticosteroids.
- Metronidazole, an antibiotic with immune system effects. It is helpful in patients with fissures or abscesses, particularly in anal disease.
The Cleveland Clinic Center for Inflammatory Bowel Disease is at the forefront of research in this field, pioneering advances that translate to better treatments for patients with these diseases.
Researchers here participated in recent studies that led to the discovery of the first gene associated with Crohn’s disease. By adding to our understanding of the causes of Crohn’s disease, this discovery will aid in developing better therapies. Ongoing research is pursuing the hunt for more genes related to inflammatory bowel disease.
The Cleveland Clinic is the first center in the world to use optical coherence tomography, a sophisticated new imaging technique, in inflammatory bowel disease patients. This technology allows the layers of the intestinal wall to be examined and evaluated for detecting microscopic areas of inflammation and differentiating between Crohn’s disease and ulcerative colitis.
Several studies are in progress on how to best use existing medications to treat inflammatory bowel disease, as well as to test promising new drugs such as infliximab.
Reviewed by a Cleveland Clinic medical professional.
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Inflammatory Bowel Disease (IBD): Symptoms, Diet & Treatment
When inflammation is present for a long time (chronic), it sometimes can cause scarring (fibrosis). Scar tissue is typically not as flexible as healthy tissue.
Therefore, when fibrosis occurs in the intestines, the scarring may narrow the width of the passageway (lumen) of the involved segments of the bowel. These constricted areas are called strictures.
The strictures may be mild or severe, depending on how much they block the contents of the bowel from passing through the narrowed area.
Crohn's disease is characterized by inflammation that tends to involve the deeper layers of the intestines. Strictures, therefore, are more commonly found in Crohn's disease than in ulcerative colitis. Additionally, strictures in Crohn's disease may be found anywhere in the gut.
Remember that the intestinal inflammation in ulcerative colitis is confined to the inner lining (mucosa) of the colon. Accordingly, in chronic ulcerative colitis, benign (not malignant) strictures of the colon occur only rarely.
In fact, a narrowed segment of the colon in ulcerative colitis may well be caused by a colon cancer rather than by a benign (non-cancerous), chronic inflammatory stricture.
Symptoms of internal strictures in IBD
Individuals may not know that they have an intestinal stricture. The stricture may not cause symptoms if it is not causing significant blockage (obstruction) of the bowel.
If a stricture is narrow enough to hinder the smooth passage of the bowel contents, however, it may cause abdominal pain, cramps, and bloating (distention).
If the stricture causes an even more complete obstruction of the bowel, patients may experience more severe pain, nausea, vomiting, and an inability to pass stools.
An intestinal obstruction that is caused by a stricture can also lead to perforation of the bowel. The bowel must increase the strength of its contractions to push the intestinal contents through a narrowing in the bowel.
The contracting segment of the intestine above the stricture, therefore, may experience increased pressure. This pressure sometimes weakens the bowel wall in that area, thereby causing the intestines to become abnormally wide (dilated).
If the pressure becomes too high, the bowel wall may then rupture (perforate).
This perforation can result in a severe infection of the abdominal cavity (peritonitis), abscesses (collections of infection and pus), and fistulas (tubular passageways originating from the bowel wall and connecting to other organs or the skin). Strictures of the small bowel also can lead to bacterial overgrowth, which is yet another intestinal complication of IBD.
Internal strictures diagnosis in IBD
Intestinal strictures of the small intestine may be diagnosed with a small bowel follow-through (SBFT) X-ray. For this study, the patient swallows barium, which outlines the inner lining of the small intestine.
Thus, the X-ray can show the width of the passageway, or lumen, of the intestine. Upper GI endoscopy (EGD) and enteroscopy are also used for locating strictures in the small intestine.
For suspected strictures in the colon, barium can be inserted into the colon (barium enema), followed by an X-ray to locate the strictures. Colonoscopy is another diagnostic option.
Treatment of strictures in IBD
Intestinal strictures may be composed of a combination of scar tissue (fibrosis) and tissue that is inflamed and, therefore, swollen. A logical and sometimes effective treatment for these strictures, therefore, is medication to decrease the inflammation. Some medications for IBD, such as infliximab, however, may make some strictures worse.
The reason is that these medications may actually promote the formation of scar tissue during the healing process. If the stricture is predominantly scar tissue and is only causing a mild narrowing, symptoms may be controlled simply by changes in the diet.
For example, the patient should avoid high fiber foods, such as raw carrots, celery, beans, seeds, nuts, fiber, bran, and dried fruit.
If the stricture is more severe and can be reached and examined with an endoscope, it may be treated by stretching (dilation) during the endoscopy.
In this procedure, special instruments are used through the endoscope to stretch open the stricture, usually with a balloon thatis passed through an endoscope.
Once the balloon traverses the stricture, it is inflated and the force of the balloon dilates the stricture to a bigger size, thus opening the lumen to make it wider. If that doesn't work, some patients will require surgery. Typically, this procedure does not produce long-lasting results.
Surgery sometimes is needed to treat intestinal strictures. The operation may involve cutting out (resecting) the entire narrowed segment of bowel, especially if it is a long stricture. More recently, a more limited operation, called stricturoplasty, has been devised.
In this procedure, the surgeon simply cuts open the strictured segment lengthwise and then sews the tissue closed crosswise so as to enlarge the width of the bowel's passageway (lumen).
After surgery in Crohn's disease patients, medication still should be taken to prevent inflammation from recurring, especially at the site of the stricture. The reason for this recommendation is that after abdominal operations, recurrent intestinal inflammation is a common problem in Crohn's disease.
Furthermore, the risk of post-operative intestinal fistulas and abscesses is increased in Crohn's disease patients. Therefore, only abdominal surgery that is absolutely necessary should be done in patients with Crohn's disease.