Inflammatory bowel disease (IBD) occurs when the intestines and bowels become swollen and may include Crohn’s and ulcerative colitis.

Crohn's Disease

Crohn’s disease is an autoimmune disorder, the cause of which is unknown. It occurs when your body's immune system mistakenly attacks and destroys healthy body tissue. It also seems to run in some families and most commonly starts between the ages of 13-30. Anything from the mouth to the anus can be affected, including the liver, skin, eyes and joints.

Factors that may play a role in Crohn's disease include:

  • Genes and family history (People of Jewish descent are at higher risk.)
  • Environmental factors (antibiotics, animal fat, red meat, smoking, toxins)
  • Microbes in the stomach
  • Tendency of your body to overreact to normal bacteria in the intestine
Diagnosing Crohn’s can be extremely tricky, due to the facts that symptoms are unreliable and depend on the part of the digestive tract is involved. Symptoms mimicking Crohn’s can be present without the actual disease being active and active disease can be present with no or minimal symptoms.

The most common symptoms are pain in the abdomen and diarrhea. Other common symptoms include:

  • Rectal bleeding and bloody stools
  • Weight loss/loss of appetite
  • Fever
  • Fatigue
  • Feeling that you need to pass stools, even though your bowels are already empty. This may involve straining, pain, and cramping.
  • Watery diarrhea, which may be bloody
  • Constipation
  • Sores or swelling in the eyes
  • Draining of pus, mucus or stools from around the rectum or anus
  • Joint pain and swelling
  • Mouth ulcers
  • Swollen gums
  • Tender, red bumps (nodules) under the skin, which may turn into skin ulcers
Symptoms range from mild to severe, and can come and go with periods of flare-ups. Complications like bowel perforation (fistulas) and bowel blockages may occur.

Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation and sores (ulcers) in the lining of the rectum and colon. UC usually starts between ages 15-30 and tends to run in families. The most common symptoms are pain in the abdomen and bloody stools and diarrhea. Other symptoms may include:

  • Anemia
  • Severe tiredness
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Skin sores
  • Joint pain
  • Growth failure in children
About one third of people with UC have mild symptoms. Some people have long periods of remission, when they are free of symptoms.

Most people with Crohn’s disease and UC never develop colon cancer; however, the duration of the disease, how much of the colon is involved, family history, diet, obesity, smoking and presence of IBD related liver disease may increase the risk.


Diagnosis

A number of conditions can mimic irritable bowel disease. They include:

  • Irritable bowel syndrome (IBS). IBS is also present in nearly half of IBD patients, including those with Crohn’s disease and ulcerative colitis. No one knows the exact cause of IBS and although it can cause a great deal of discomfort, it does not visibly harm the intestines. Symptoms include abdominal cramping, bloating and a change in bowel habits, ranging from diarrhea to constipation and sometimes both. IBS can sometimes be confused with a flare-up or IBD.
  • Infections resulting from bacteria, viruses, fungi or parasites
  • Celiac disease/sensitivity to gluten
  • Reaction to sugars in milk, fruit and vegetables
  • Depression and anxiety
  • Overuse of pain medications

Your doctor will perform a physical exam to look for symptoms of Crohn’s disease and Ulcerative Colitis. Blood and stool studies will be done to rule out other possible causes. Laboratory tests, imaging studies and endoscopic procedures will help provide a precise diagnosis.

Tests that diagnose and monitor flare-ups of Crohn’s and UC and response to treatment of Crohn’s include:

  • Upper endoscopy
  • Enteroscopy
  • Double or single balloon endoscopy
  • Video capsule endoscopy, “pill camera”
  • Colonoscopy or sigmoidoscopy
  • Confocal laser endomicroscopy
  • CT enterography scan of the abdomen
  • MRI enterography of the abdomen
  • Endoscopic rectal ultrasound
  • Surgical exam 
  • Confocal laser endomicroscopy: This relatively new endoscopic technology allows for real-time microscopic views of the bowels. A high-resolution laser probe attached to the endoscope provides a noninvasive “optical biopsy” of nearly any GI surface. In addition to Crohn’s and UC, confocal laser endomicroscopy provides a cellular level diagnosis for a number of conditions, including colon polyps and Barrett’s esophagus. It can also detect and define various types of cancer.


Treatment

Crohn’s Disease

There is no cure for Crohn's. Treatment can help control symptoms and may include medicines, nutrition supplements and/or surgery. Learning how to control and deal with stress also helps. A healthy, well-balanced diet may also help manage Crohn’s.

Steroids may be used during the initial phase of a flare-up. However, while steroids may help you feel better fast, they do not actually heal the bowel and are only short-term solutions that should be replaced by immunosuppressants, which make up the majority of the current therapies. Some are given as oral medications (Azathioprine, 6-MP) others are self-injectable (methotrexate, Humira, Cimzia, Simponi) or infusions (Remicade, Entyvio).

Some people with Crohn's disease may need surgery to remove a damaged or diseased part of the intestine. In some cases, parts of the small bowel and large bowel or even the entire large intestine are removed, with or without the rectum.

Ulcerative Colitis

Treatment for UC depends on the severity of the disease and its symptoms. Treatments include:

Medication therapy: While no medication “cures” UC, many can reduce symptoms. Medication can induce and maintain remission for months or possibly even years and improve quality of life. Many people with UC require medication indefinitely, unless they have their colon and rectum surgically removed. The type of medication prescribed depends on the severity of the condition. In mild cases, your doctor may prescribe products contain the drug mesalamine in the form of pills, enemas or suppositories. All other patients will require treatments similar to Crohn’s disease (see above).

Surgery: Some people may eventually need a proctocolectomy – surgery to remove the rectum and part or all of the colon. Surgery is sometimes recommended if medical treatment fails or if the side effects of medications threaten a person’s health. Other times surgery is performed because of massive bleeding, severe illness, colon rupture or cancer risk.

Crohn's/UC/IBD

A recently implemented treatment, a fecal transplant, uses a donor’s healthy stool sample to relieve serious, recurrent diarrhea in certain IBD cases. On a case-by-case basis and with special approval from the FDA, a fecal transplant may be used for difficult-to-control Crohn’s and ulcerative colitis. In a procedure similar to a colonoscopy, a golf-ball sized stool sample from a healthy donor is diluted with saline and flushed through the scope, covering the lining of the sick patient’s colon with the stool. Fecal transplant recipients usually feel better within days, as the donor’s good bacteria are harnessed to help heal the bowel.

Sometimes symptoms are so severe that hospitalization is required. They may include severe bleeding and/or diarrhea resulting in dehydration. Intravenous fluids will help treat diarrhea and loss of blood, fluids and mineral salts. People with severe symptoms may need a special diet, tube feeding, medications or surgery.

Dietary changes may help reduce symptoms. A recommended diet will depend on your symptoms, medications and reactions to food.

Treating conditions like anxiety, depression, irritable bowel and bowel infections are also part of the treatment for IBD.


Why Choose Ohio State

Why seek treatment at The Ohio State University Wexner Medical Center?

Inflammatory bowel diseases can be particularly tricky to diagnose and treat. At The Ohio State University Wexner Medical Center, we take a multidisciplinary team approach, with several dedicated gastroenterologists, hepatologists, surgeons, radiologists, nutritionists, pathologists and psychologists to assure individualized treatment. We also coordinate with other departments such as Hematology, Endocrinology, Dermatology, Rheumatology, Pulmonary, Obstetrics and The James to assure that all aspects of the disease are addressed. These coordinated efforts, coupled with our emphasis on translational research, help provide a rapid and reliable diagnosis and an effective treatment plan.

We offer single, concentrated care at the Inflammatory Bowel Diseases Center, including unique programs such as dietary interventions, stool transplant and advanced methods of cancer detection. We are also one of the few medical centers to provide confocal laser endomicroscopy for the diagnosis of precancerous lesions. And if regular treatment options are exhausted, additional therapies may be available though clinical trials.

Our surgeons provide minimally invasive surgical procedures that significantly shorten hospitalization, recovery and provide better results. For example, in some cases, bowel blockages that might otherwise lead to surgery can be resolved though endoscopy. We work with high-risk and complicated cases, such as pregnant women with IBD and patients with past current malignant conditions or other issues that require special observation and coordination by multiple specialists.

In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis, and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.

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