Inflammatory bowel disease - IBD
IBD refers to a non-infectious inflammation of the gastrointestinal tract. There are two major types of IBD:
- Ulcerative Colitis: This involves the inner lining (mucosa) of the colon only and begins in the rectum and spreads upwards in some cases to involve other areas in the colon. Thus there can be proctitis (rectal involvement only), left sided colitis and universal colitis (whole colon).
- Crohn’s Disease: This involves any layer of the gut and can involve not only the colon but also the small bowel, stomach etc. Thus can be colitis (colon involvement), enteritis (small bowel involvement) or Ileo-colitis (both small bowel and colon)and gastro-duodenal Crohn’s.
What are the symptoms of IBD?
IBD present in a number of ways that include abdominal pain, diarrhea that can often be bloody and fever. Many patients have extra colonic symptoms such as arthritis, skin rashes or nodules, elevation of liver tests, or eye symptoms.
Complications from IBD include bleeding, perforation, bowel obstruction and fisulae (tracts that lead from the bowel to the skin or other organs).
How is IBD diagnosed?
Endoscopy (Colonoscopy/Ileoscopy/Upper Endoscopy) remains the best method of diagnosing IBD. Biopsies can be obtained to confirm diagnosis. Blood Tests, CT Scans can also be helpful.
Patient with Chronic IBD are a much higher risk for cancer of the colon than the general population and need surveillance colonoscopy at 1-2 year intervals to detect dysplasia that can foretell colon cancer.
How is IBD treated?
There are several drugs that can be used to treat IBD. The treatment depends of the severity of disease, site of involvement and the extent of the disease.
Patients with proctitis (rectal involvement) are best treated with Mesalamine administered as a suppository or enema.
Patients with more extensive disease require oral Mesalamine (Asacol, Pentasa, Apriso, Lialda). In severe cases steroids or immunosuppressive drugs (Immuran, 6-Mercaptopurine) may be required.
The newer class of drugs called Anti-TNF agents (Remicaid, Humira and Cimzia) have made a big dent in IBD especially in those with fistulae and disease not responding to the above agents.