Inflammatory Bowel Disease

Understanding Inflammatory Bowel Disease

Inflammatory Bowel Disease Types

Two forms of IBD exist, including:

• Crohn's disease
• Ulcerative colitis

Both types of IBD are chronic or lifelong and characterized by flare-ups followed by periods of remission that can last months or even years. Crohn’s disease and ulcerative colitis tend to appear in your teens or early adulthood.

The conditions can also affect children, and it affects men and women equally. Inflammatory bowel disease also tends to run in families.

Physicians do not know the exact cause of either condition, but patients with IBD have abnormal immune systems. IBD is not the same as irritable bowel syndrome (IBS).

Crohn's disease most often involves inflammation in the ileum, the part of your small intestine that connects to the colon. Crohn’s disease can impact your entire digestive tract, from your mouth to your anus. Inflammation from Crohn’s disease penetrates the full thickness of your intestinal wall. This can cause perforations, strictures and abscesses that cause pain and complications

Ulcerative colitis is inflammation in the bowel and involves only the colon. It often begins in the rectum and travels part or all of the length of the colon. This condition affects the mucus lining of your colon but does not go into the colon wall.

Symptoms

Symptoms of inflammatory bowel disease include:

• Diarrhea
• Abdominal pain
• Ulcers in the intestinal lining
• Inflammation of the eyes, joints and skin

How We Can Help

At IU Health, our physicians will use a collaborative approach to diagnosing and treating inflammatory bowel disease. Gastrointestinal pathologists, gastrointestinal radiologists, gastrointestinal psychologists, dietitians and colorectal surgeons will work together for your care.

Your physicians will use the latest techniques for evaluating your intestines, making a diagnosis and delivering treatment. IU Health has the only group in Indiana with a team of gastroenterologists dedicated to the evaluation and treatment of inflammatory bowel disease.

IU Health’s affiliation with the IU School of Medicine and the Division of Gastroenterology/Hepatology will give you access to experts and many endoscopic procedures used to diagnose and treat IBD. These include:

• Colonoscopy
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound (EUS)

The EUS program at IU Health has one of the highest volume centers in the country, with more than 2,500 investigations performed each year. IU Health physicians are also the only ones in Indiana who offer double balloon endoscopy, a procedure that allows us to examine the entire intestine.

IU Health research efforts put us at the forefront of new therapies, including biologic medicines and fecal transplants.

Diagnosis

When you receive a diagnosis of inflammatory bowel disease, you want to feel better. IU Health will offer you the latest medicines and treatments to manage your symptoms, keep you healthy and maintain remission so you can enjoy your regular activities.

Diagnosis

Your physician will use a variety of tests to check for anemia, abnormal bacteria and infection, and to visualize all or part of your digestive tract, from your mouth to your rectum. These tests involve many digestive diagnostic procedures and include:

• Blood tests count the red and white blood cells and platelets as well as other materials in your blood, including electrolytes. These tests monitor your blood's ability to clot, your nutritional state and the amount of oxygen your blood is carrying.
• Stool cultures detect the presence of bacteria to diagnose an infection of the digestive tract.
• Barium X-rays help your physician visualize and diagnose problems in your gastrointestinal tract. You may undergo an upper gastrointestinal series, a lower gastrointestinal series (Barium Enema) or both. For both procedures you ingest a barium liquid, which coats the inside of your digestive tract. This makes abnormalities stand out on the X-ray image.

Endoscopic procedures

We use many types of advanced endoscopic procedures to diagnose and treat inflammatory bowel disease. Some of those procedures are:

• Colonoscopy. A colonoscopy views the inside of your colon and looks for abnormalities, including bleeding, inflammation, ulcers, polyps and tumors. An advanced form of this test, called chromocolonoscopy, uses dyes to further enhance tissue differentiations and characteristics. Chromocolonoscopy helps take targeted biopsies in patients with long-term ulcerative colitis who have higher risk of precancerous polyps.
• Video capsule endoscopy. Your physician may prescribe a video capsule endoscopy to find the source of bleeding from your small intestine. You swallow a pill equipped with a tiny camera that transmits pictures of your intestinal tract as it travels through your digestive system and exits your body. Endoscopic ultrasound (EUS). EUS lets your physician obtain better images of the walls of the digestive tract, including your small intestine, colon and rectum. EUS uses sounds waves to create high quality images of your digestive tract and nearby organs. EUS can also be used to obtain cells for a biopsy study or to induce drainage from a duct or abnormal growth (cannulation).
• Double balloon enteroscopy: Balloon enteroscopy uses a push-pull method to move scopes all the way through your intestines. The procedure alternately inflates and deflates balloons inside your intestines. This lets the scope device grab or pull the intestinal wall while pushing the scope through. During a double balloon enteroscopy, samples can be taken from tissues, tumors and polyps. The procedure also allows your physician to treat and cauterize bleeding lesions in your small intestine.
• Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope is guided down your throat, into your esophagus, through your stomach and positioned in the small intestine where the bile ducts and pancreas drain. Learn more about ERCP.
• Stricture dilation: Many of our endoscopic procedures can be used to open or stretch a narrowed or partially blocked part of your intestines, bile or pancreatic ducts. A balloon is inflated inside the affected passageway. The balloon stretches and expands the duct. Your physician can also achieve dilation with a graduated catheter that is passed over a guide wire.

Treatment

• Medicines. Many different types of medicines treat the symptoms of IBD such as nausea and diarrhea, as well as suppress to your immune system to reduce attacks on healthy intestinal cells. A combination of medicines put you into remission and keep you there. These types of therapies include anti-inflammatories, corticosteroids, antibiotics, immunomodulators and biologics.
• Nutrition. When you have inflammatory bowel disease, you must eat a healthy diet and maintain your weight. Some foods can make symptoms worse. Our gastrointestinal dietitians will work with you to create a proper eating plan.
• GI psychology. IU Health has the only GI group in Indiana with three full-time gastrointestinal psychologists on faculty. Living with IBD, like living with any chronic medical condition, can cause anxiety, depression or stress. Our GI psychologists will help you manage the emotional stress that accompanies this condition.
• Surgery. When complications of IBD cannot be handled medically, surgery can bring relief, but not a cure. GI surgeons will help you decide the best surgery for your specific symptoms. For Crohn’s disease, surgeries may include abscess drainage, opening of strictures, bowel resections or creation of an ostomy.
• Research. IU Health researchers test new medicines, endoscopic procedures and other therapies, such as fecal transplants to treat inflammatory bowel disease or complications such as C difficile infection. Clinical trials at IU Health tested any of the new biologic medicines now available.