Inflammatory Bowel Disease (IBD)

Introduction

Inflammatory bowel disease (IBD) is a group of intestinal disorders that causes chronic inflammation of the digestive tract. Ulcerative colitis and Crohn’s disease are the two kinds of inflammatory bowel diseases.
Ulcerative colitis: When the innermost lining of the large intestine and rectum are inflamed for a long period of time and develop sores which are also known as ulcers, the condition is called ulcerative colitis.
Crohn’s disease: Crohn's disease is different from ulcerative colitis by site and depth of involvement. Crohn's disease can affect any part of the intestinal tract and involves all the layers of the intestine. It has the tendency to form fistula (abnormal passage/communication) and strictures (narrowing of the intestine). Crohn’s disease mimics like tuberculosis of intestine thus posing diagnostic challenges.
Inflammatory bowel disease can predispose to cancers later in the course of the disease.

Treatment

Inflammatory bowel disease is usually a chronic disease. A cure is rare but we can keep the disease under control with medications. The treatment path advised by the gastroenterologist can help reduce symptoms, avoid complications and ensure the patient achieves remission.

Medical treatment

Anti-inflammatory drugs:
Drugs such as 5-ASA medications are the first medications prescribed to help reduce the inflammation of the digestive tract.
Immunosuppressants:
Also known as immunomodulators, these drugs stop the immune system from attacking the bowel cells thereby reducing the inflammation.
Antibiotics:
The gastroenterologist may prescribe antibiotics to fight off the inflammation caused by bacteria, which prompt and intensify the symptoms for Inflammatory bowel disease.

Surgery

Surgery is usually required in complicated disease. Ulcerative colitis patients who develop medications related side effects can undergo total removal of colon and rectum. Normal passage of stool in ensured by reconstructing the native passage using the small intestine. This procedure is called total proctocolectomy and ileal pouch-anal anastomosis. The procedure may be done in multiple stages (resection at one sitting and reconstruction at later late after optimization). Patients may require stoma (ileostomy) during treatment. After surgery, medications can be stopped in ulcerative colitis.

Unlike ulcerative colitis, Crohn's disease will have a high recurrence after surgery affecting some other portion of the intestine. Repeated surgery is required in a significant number of patients. Hence the principle of surgery is to preserve as much intestine as possible rather than disease clearance. Medications should be continued for a longer duration, sometimes lifelong in Crohn's disease.