Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) refers to certain chronic diseases that cause inflammation (painful swelling, usually with heat) of the intestines.
Crohn's disease and ulcerative colitis are the two terms most often assigned to the different types of IBD. Although they are different diseases with a variety of forms, each causes the digestive system to be destroyed and produces symptoms that can affect people emotionally as well as physically.
The most common symptom is diarrhea, sometimes severe enough to require up to 20 trips or more to a toilet a day. Other symptoms include:
- Abdominal cramps
- Bloody stool
- Blocked bowels
- Loss of body fluids
- Loss of appetite
- Extreme weight loss
Many people with IBD also experience such conditions as arthritis and inflammation of the eye, skin and liver. IBD is also considered a major risk factor for developing colorectal cancer.
Children with IBD often suffer from retarded growth and delays in the onset of puberty. The struggle continues into adulthood as patients suffer new bouts with the disease. Once IBD has taken hold, symptoms can flare up without warning. Sufferers constantly worry over when the next episode will strike, how severe it will be and how long it will last.
Causes and Risk Factors
IBD tends to strike early in life, most commonly between the ages of 15 and 25.
About 25% of IBD sufferers have a direct relative who also has the disease.
Jewish Americans are four to five times more likely to develop IBD than the population as a whole.
Diagnosing inflammatory bowel disease is complex and can take months or even years. After collecting a patient's medical and family history, the doctor does a physical examination, including laboratory tests, endoscopy (use of an instrument to look inside the body) and imaging (pictures of the affected areas). Once inflammatory bowel disease has been confirmed, the doctor decides whether the patient has ulcerative colitis or Crohn's disease.
In recent years, the IBD Center has pioneered efforts to develop new diagnostic tests for IBD. Certain patterns of markers in the blood have been proven to be associated with various types of ulcerative colitis and Crohn's disease. The IBD Center uses these blood tests to speed up the diagnostic process and to limit the need for invasive procedures like endoscopy.
IBD may be treated with drug therapy, surgery or a combination thereof.
Drug therapy can include aspirin products (e.g., sulfasalazine, Asacol®, Dipentum® and Rowasa®), steroids (e.g., prednisone and prednisolone) and agents to modify the immune system (e.g., azathioprine, Immuran®, 6-MP, cyclosporine, methotrexate and tacrolimus). Each has side effects that can complicate treatment plans for some patients.
The IBD Center at Cedars-Sinai has experience in using drugs without specific FDA indications for IBD, such as thalidomide, as well as ones that are currently undergoing study by researchers. Another important strategy our specialists use is developing treatment plans with several drugs at a time that can more aggressively treat complex cases. Unfortunately, the medications used to treat IBD may have side effects as bad or worse than the disease itself.
Sometimes patients with IBD must have surgery to remove the affected area. The IBD Center's surgeons are skilled in advanced techniques that preserve continence for patients who are facing colon removal. Removing only the diseased portion of the bowel helps relieve symptoms, but often the disease will recur in areas close to the surgery.
Although the condition can be severe and require surgery and long-term drug use, the physicians at the IBD Center are experts in planning treatments that limit the use of steroids and possibly find ways to avoid surgery.
IBD currently has no cure, but dedicated researchers are making steady progress in unraveling secrets of the disease.