SSM Cardinal Glennon Children's Medical Center
(314) 577-5600
www.cardinalglennon.com
 

Inflammatory Bowel Disease

Digestive problems are among the most common conditions affecting Americans today. There are many different types of digestive problems, from gastrointestinal infections that make a person miserable but pass quickly to long-term illnesses like inflammatory bowel disease (IBD). IBD is a general term that refers to illnesses that cause chronic inflammation in the intestines.

If you're having diarrhea, stomach cramps, and other symptoms that make you question your digestion, you might want to learn more about the digestive system and IBD, as well as other digestive conditions.

What Is IBD?

The digestive system is the set of organs that digest food and absorb the important nutrients your body needs to stay healthy and grow. Two of the major parts of the digestive system are the small and large intestines. Just like other organs in your body, the intestines can develop problems or diseases.

IBD (which is not the same thing as irritable bowel syndrome, or IBS), can cause more serious problems than just diarrhea and pain. IBD may also cause a delay in puberty or growth problems for some teens with the condition, because it can interfere with a person getting nutrients from the foods he or she eats.

The two major types of IBD are Crohn's disease and ulcerative colitis.

Crohn's disease occurs when the lining and wall of the intestines become inflamed and ulcers develop. Although Crohn's disease can occur in any part of the digestive system, it often occurs in the lower part of the small intestine where it joins the colon.

The intestine becomes inflamed, meaning the lining of the intestinal wall reddens and swells. It can become irritated, causing it to bleed and preventing it from properly absorbing the nutrients from digested food.

People with Crohn's disease usually have these symptoms:

  • abdominal cramps or pain
  • diarrhea, sometimes with blood in the stool (bowel movements)
  • fever
  • weight loss

These symptoms often cause people with Crohn's disease to feel tired and lose their appetites.

Some people with Crohn's disease have minor symptoms and hardly any discomfort or pain. Their symptoms may only flare a few times. But others may experience frequent diarrhea, intestinal ulcers, and problems in other parts of their bodies, such as inflammation of the joints, skin rashes, and eye problems.

Crohn's disease can cause the intestines to become blocked by swelling and scar tissue. People with the condition may also be more susceptible to infections and developing abscesses in and around their intestines.

In ulcerative colitis, the large intestine becomes inflamed and ulcers may develop. Ulcerative colitis affects only the large intestine. The inflammation begins in the rectum (the last few inches of the large intestine where feces are stored before they leave the body) and can affect only the rectum or the part of the large intestine that joins it. However, most kids and teens who have ulcerative colitis have the condition throughout their large intestines.

The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. But some people also experience these symptoms:

  • tiredness
  • weight loss
  • loss of appetite
  • nausea

Some people with ulcerative colitis may have periods of time when they are free of symptoms (this is called remission) and other times when they feel sick (called relapse).

Like Crohn's disease, ulcerative colitis can be associated with problems in other parts of the body. These problems may include inflammation of the joints, eye problems, and anemia due to blood loss.

Who Gets IBD?

IBD is most likely to occur in people in their late teens and twenties. However, kids as young as 5 years old have been known to develop IBD. It affects both guys and girls.

The exact cause of IBD is not known. Because it often runs in families, genetic factors are probably involved. About 15% to 30% of people with IBD have a relative with the disease. Research is being done to find out if a certain gene (or group of genes) makes a person more likely to get the disease.

What Do Doctors Do?

If you have any of the symptoms of IBD, it's important to see your doctor. In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.

After hearing your symptoms, if your doctor suspects IBD, he or she may suggest certain tests. Blood tests may be done to look for signs of inflammation in your body, which are often present with IBD. The doctor may also check for anemia and for other causes of your symptoms, like infection.

The doctor will examine your stool for the presence of blood, and might look at your 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 your colon.

The doctor may also do a test called an upper endoscopy to check the esophagus, stomach, and upper small intestine for inflammation, bleeding, or ulcers. During either exam, the doctor may perform a biopsy, which involves taking a small sample of tissue from part of the colon so it can be viewed with a microscope or sent to a laboratory for other kinds of analysis. Another test that might be ordered instead of the barium study is an MRI (magnetic resonance imaging) to check whether there may be any abnormality in the part of the intestines not reachable by the endoscopes.

A doctor may also order a barium study of the intestines. This procedure involves drinking a thick white solution called barium, which shows up white on an X-ray film and allows a doctor to get a better look at what's going on in the intestines.

How Is IBD Treated?

Some ways to manage the symptoms of IBD include:

Nutritional Therapy

It is important for people with IBD to eat healthy foods and drink plenty of fluids to replace those lost through diarrhea. They should work with a doctor or a dietitian to come up with an eating plan that's best for their individual situation and symptoms.

For example, some people are told to cut down on the amount of fiber or dairy products in their diets, whereas others find that their symptoms improve if they cut back on foods that are high in fat or sugar. If you've been diagnosed with IBD, your doctor might ask you to keep a food diary so that you can find out which foods make your symptoms worse.

If you're having trouble maintaining or gaining weight, your doctor may recommend that you take nutritional supplements or special drinks or shakes that contain needed vitamins, minerals, and calories.

Some people are placed on an elemental formula and restricted from eating regular food. It has been found that those who have mild Crohn's disease respond to this type of treatment because it removes some proteins in the diet that might cause inflammation of the intestine.

More Sleep and Less Stress

Besides watching the types of foods they eat, people with IBD need to get enough sleep. It's also helpful to manage stress in a positive way. When you get stressed out, your intestinal problems can flare. Some people find that learning breathing and relaxation exercises can help.

Medications

Medications are also used to treat IBD. Anti-inflammatory drugs, including corticosteroids, may be used to decrease the inflammation caused by IBD. If symptoms don't go away after taking anti-inflammatory drugs, your doctor may prescribe other medications called immunosuppressants or immunomodulators to reduce the inflammation. Biologic therapy, which is treatment to stop the body from developing inflammation, may also be used.

Doctors may prescribe antibiotics to prevent or treat bacterial infections associated with Crohn's disease, and antidiarrheal drugs may be prescribed for someone who has diarrhea a lot.

Surgery

Sometimes surgery is necessary to control the symptoms of IBD and to remove damaged sections of the intestines. For people with Crohn's disease, surgery may need to be performed more than once because the disease can involve other parts of the intestine over time.

Removal of the large intestine can cure the bowel problems in people with ulcerative colitis. However, this surgery is usually only done if medicines have failed or if a person develops a perforation (a hole in the intestine), uncontrollable bleeding, or has developed intestinal cancer.

Although it can be challenging and difficult to deal with the symptoms of IBD, many people with IBD find that they're able to feel well and have few symptoms for long periods of time. Talk to your doctor about ways that you can feel better during the times you have flares. If you feel sad or anxious about your symptoms, it may also help to talk to a therapist or other mental health professional.

If you don't get medical treatment, IBD can put a serious cramp in your daily life. The good news? Getting treatment for IBD, managing your symptoms, and keeping a positive attitude can help get you back on the fast track.

Reviewed by: J. Fernando del Rosario, MD
Date reviewed: May 2013