Crohn's Disease |
Ulcerative Colitis |
Medical Treatments |
Surgery for IBD |
Diet and Nutrition
The term inflammatory bowel disease (IBD) encompasses a spectrum of inflammatory diseases that includes both Crohn’s disease and ulcerative colitis. These diseases stem from an overly active immune system that attacks and damages the intestine. Approximately 1.4 million people in North America are affected by IBD. The cause of these diseases is not known, but both genetic and environmental factors are implicated. Many patients with IBD have a family member who is also affected by the disease. However, the majority of patients do not have a family history of IBD. Although the disease can have onset at any age, patients typically develop symptoms in their teenage or early adult years.
Crohn’s disease is a chronic inflammatory condition of the bowel in which the body’s immune system becomes improperly regulated, resulting in destruction and injury to the intestine. Crohn’s disease may affect any part of the intestinal tract, and the symptoms depend on which part of the intestine is involved. The most commonly involved segment of the bowel is the small intestine, and patients with inflammation in this area typically have symptoms of diarrhea and abdominal pain, and may have nausea and vomiting as well.
Patients with Crohn’s disease involving the colon (large intestine) often describe diarrhea, urgency to use the bathroom and blood in the stool. Occasionally, the inflammation from Crohn’s disease can extend through the wall of the intestine and erode into adjacent structures, creating a hole or connection called a fistula. Children with Crohn’s disease may present with failure to properly gain weight or grow. Crohn’s disease has fluctuating disease activity with periods of symptom exacerbation and periods of quiet disease (called remission).
Although Crohn’s disease is a lifelong condition, there are many safe and effective treatments available that can extinguish the inflammation and maintain the disease in remission. Treatment is not the same for each patient, and we work with each person to develop an individualized approach to therapy. Our goal and expectation is to control the inflammation of Crohn’s disease in order to avoid the need for surgery due to complications, such as a blockage or hole in the bowel, or cancer.
Ulcerative colitis is a chronic disease that involves inflammation of the colon and rectum (large intestine). Patients experience frequent loose stools, urgency to use the bathroom, nighttime bowel movements, blood in the stool, and inability to distinguish gas from stool. This is a chronic condition that typically has alternating periods of increased symptoms and periods of inactive disease. The cornerstone of treatment is medication to control inflammation and improve symptoms and quality of life. However, approximately one fourth of patients with ulcerative colitis will ultimately require a curative surgery for their disease. Patients with ulcerative colitis should expect to live a normal length and quality of life.
Establishing an accurate diagnosis is fundamental to selecting appropriate treatment for patients with IBD. However, making the diagnosis of IBD can be challenging since there is no single test that can conclusively establish the diagnosis. Physicians use a combination of blood tests, stool studies, x-rays and endoscopic techniques to determine the diagnosis, distribution and severity of IBD. The physicians at UW have extensive experience performing and interpreting these tests.
Colonoscopy is an examination of the colon using a flexible tube with a lighted camera at the tip that is inserted into the rectum. This procedure is essential to inspect the lining of the colon and to obtain small pieces of tissue (biopsies) to review under a microscope. At the UW IBD center, physicians also use non-invasive technology such as capsule endoscopy. This procedure involves swallowing a small (pill-sized) camera that takes over 50,000 pictures as it passes through the small intestine. Additionally we offer balloon enteroscopy, a state-of-the-art technique that is only available at a few centers and allows us to directly visualize and sample tissue from the small intestine.
Our radiologists use advanced imaging technology such as CT enterography that provides very detailed pictures of the abdomen and intestine. A newer method of looking at the intestine using MRI is also available and has the advantage of avoiding exposure to radiation from conventional x-rays.
Medical Treatments for IBD
The goals of therapy in IBD are to quiet the inflammation in the intestine, control symptoms, avoid complications, reduce the need for surgery, prevent relapses and improve quality of life. Achieving these goals involves first getting the inflammation under control with medication. Currently there are no medications that cure Crohn’s disease or ulcerative colitis, so we recommend continuing medication even when the disease is in remission in order to prevent relapses and future complications. The benefits of treatment must always be weighed against the short term and long term side effects of medication. Several of the common medications used to treat IBD include:
- Aminosalicylates (mesalamine, balsalazide, sulfasalazine)
- Corticosteroids (prednisone, prednisolone, budesonide)
- Immunomodulators (6-mercaptopurine, azathioprine, methotrexate)
- TNF-alpha antagonists (infliximab, adalimumab, certolizumab)
- Selective adhesion molecule inhibitors (natalizumab)
- Antibiotics (ciprofloxacin, metronidazole, rifaximin)
- Probiotics (Saccharomyces, VSL#s, lactobacillus GG)
Treatment is not the same for all patients. The best therapy to prescribe for an individual patient depends on the type of IBD (Crohn’s or ulcerative colitis), the distribution of disease involvement in the intestine, the severity of disease, and the patient’s individual response and tolerance to medication. We work with each patient to develop a customized treatment plan.
Surgery for IBD
Although medications work very well for many patients, some patients will require surgery to remove the affected segment of their bowel. The type of surgery performed depends on many factors, including the disease type and distribution.
Surgery is indicated for patients with Crohn's disease who have developed bowel obstruction or perforation, or for patients with inflammation or fistulas that cannot be controlled with medications. Surgery is not a cure for Crohn’s disease and the inflammation can recur after an operation. At the University of Washington, we offer minimally-invasive laparoscopic surgery that results in smaller scars and shorter recovery time after surgery. Additionally, we specialize in bowel-sparing surgical techniques designed to preserve as much healthy bowel as possible. Occasionally, patients with Crohn’s disease require a surgery in which the intestine is brought through a small opening in the abdominal wall called an “ostomy”. Patients with an ostomy must wear a bag over the opening to collect the intestinal waste contents.
For patients with ulcerative colitis, surgery is indicated when the disease cannot be controlled with medications or in patients who develop cancer or pre-cancerous changes in the colon. The surgical treatment for ulcerative colitis requires 2 or 3 separate operations to remove the entire colon and rectum, and to create a new rectum using the small intestine. This new rectum is shaped like the letter "J" and is often referred to as a J-pouch. Patients who have had a J-pouch procedure typically have 5-6 loose bowel movements per day, with full control of their bowels. This surgery is considered curative for ulcerative colitis and most patients live a normal quality of life without any further need for medications.
Diet and Nutrition
A focus on nutrition is an integral part of the patient-centered comprehensive approach to IBD management at the UW IBD Center. Patients with inflammatory bowel disease are at risk for nutritional problems related to poor absorption from chronic diarrhea. It is important to recognize and treat nutritional deficiencies if they exist in order to promote intestinal healing, facilitate growth and development in children, increase energy levels, improve quality of life and avoid complications of anemia or low bone density. Adequate nutrition is also essential to support healing after an operation. Although there is no conclusive evidence that things you eat can cause IBD, certain foods can worsen symptoms and specific diets are recommended to patients in particular situations in order to help control these symptoms.