Inflammatory Bowel Disease
Chrohn’s Disease & Ulcerative Colitis.
Inflammatory bowel diseases (IBD) are a group of diseases that cause lifelong inflammation of the bowel. There are two main groups of IBD diseases: ulcerative colitis, that affects the colon and Crohn’s disease that can affect the GI tract anywhere from the mouth to anus, most commonly the colon and last segment of the small bowel. The incidence of IBD is on the rise in the USA and there are currently 1.6 million Americans affected by Crohn’s and ulcerative colitis.
IBD typically manifests itself with GI symptoms of abdominal pain, diarrhea, blood in stool, but also can present with fever, weight loss, malnutrition, and fatigue. Some patients also develop inflammation in organs outside the GI tract (extra-intestinal manifestations) like the skin, joints, eyes, liver and biliary tree. The disease can affect people at any stage of life, but typically starts between age 15-30 and follows a waxing and waning chronic course, with episodes of flares and remission. In addition to disease symptoms, patients with IBD are at increased risk of complications such as colorectal cancer, bowel obstruction, abdominal abscesses, hospitalization, and surgery.
The diagnosis of IBD is made based on the combination of clinical symptoms, physical findings, lab tests, colonoscopy and endoscopy and imaging (such as CTScan and MRI). The goal of the endoscopy is to exclude other causes of the patient’s symptoms, make the diagnosis of IBD type, assess the extent of the bowel involved and the severity of the disease. Endoscopy can be helpful in treating certain complications of Crohn’s disease, such as dilating a narrowed part of the bowel (stricture) that is causing a bowel blockage. Endoscopy is also essential to screen IBD patient for colon cancer and to monitor disease activity and response to treatment.
Treatment of IBD is complex and aims at achieving several goals to optimize patient’s health and quality of life:
- Control an IBD flare by using medications that can quickly resolve the flare symptoms
- Prevent recurrent flares by choosing a personalized maintenance treatment adapted to the patient’s disease severity and manifestations, and to the patient’s lifestyle and medical history
- Prevent complications of the disease, such as the need for recurrent courses of prednisone, the need for surgery etc..
- Treat the extra-intestinal symptoms, such as joint pains, skin rashes.
- Correct nutrient and vitamin deficiencies and optimize diet to help recover from a flare, and promote a healthy gut in a healthy body
- Improve quality of life by keeping the disease in remission and adopting a healthy lifestyle
- Minimize the risks of medications by taking preventive measures and monitoring for potential side effects
- Provide tools to help manage the psychological and physical stress of the disease
Overall, IBD treatment requires a multidisciplinary approach where gastroenterologists, primary care doctors, surgeons, radiologists, nutritionist and other medical subspecialists working together to help the patient achieve and maintain disease remission