Crohn's Disease - Treatment Overview

The main treatment for Crohn's disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery. The type of symptoms you have and how bad they are will determine the treatment you need.

Initial treatment

Your doctor will most likely start with the traditional first-line treatment for Crohn's disease. He or she will then add or change medicines if you are not getting better.

Mild symptoms may respond to an antidiarrheal medicine such as loperamide (Imodium A-D, for example), which slows or stops the painful spasms in your intestines that cause symptoms.

For mild to moderate symptoms, your doctor will probably have you take:

• Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohn's disease.
• Antibiotics such as ciprofloxacin and metronidazole may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon. Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped.²
• Corticosteroids (such as budesonide or prednisone) may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection.
  • Budesonide causes remission in mild or moderate Crohn's disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.
  • Prednisone may help if budesonide does not.
• Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.

If you have tried all the medicines listed above and none of them have worked, your doctor may give you a tumor necrosis factor (TNF) antagonist such as infliximab (Remicade). This drug may work for people who have not had any success with other medicines for Crohn's disease. Infliximab is also used to treat fistulas if antibiotics do not heal them. Another TNF antagonist that may be used to treat Crohn's disease is adalimumab (Humira). It may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.

Severe symptoms may be treated with corticosteroids given through a vein (intravenous, IV) or TNF antagonists. With severe symptoms, the first step is to control the disease. When your symptoms are gone, your doctor will probably have you start taking one of the medicines listed above to keep you symptom-free (in remission).

Ongoing treatment

Ongoing treatment is designed to find a medicine or combination of medicines that keeps Crohn's disease in remission.

If aminosalicylates (such as sulfasalazine or mesalamine) or immune system suppressors (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or methotrexate) keep your disease in remission, you will continue taking the medicines. Your health professional will want to see you about every 6 months if your condition is stable or more frequently if you have flare-ups. You may have laboratory tests every 2 to 3 months.

Corticosteroids (such as budesonide, hydrocortisone, or prednisone) may be given to stop inflammation if you have flare-ups of symptoms. If you need to take corticosteroids for an extended time, you also may receive calcium, vitamin D, and prescription medicine to prevent osteoporosis.

Tumor necrosis factor (TNF) antagonists such as infliximab (Remicade) and adalimumab (Humira) are also used as maintenance medicines.

Treatment if the condition gets worse

If you have severe Crohn's disease, you will most likely be given infliximab (Remicade). This drug may be prescribed if Crohn's disease does not get better with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or methotrexate). Infliximab may also be given if your symptoms come back when you try to stop taking corticosteroids. Infliximab is given in a vein (intravenous, IV).

If infliximab does not work for you, or if you cannot take it because of a serious side effect, you may be given adalimumab (Humira). Adalimumab is given as a shot under the skin (subcutaneous).

If you have a very bad flare-up of Crohn's disease, you will most likely need IV corticosteroids (like hydrocortisone) to get the disease under control.

Some severe cases of Crohn's disease need to be treated in the hospital where you would receive supplemental nutrition through a tube placed in your nose and down into the stomach (enteral nutrition). In other cases, the bowel may need to rest, and you will be fed liquid nutrients in a vein (total parenteral nutrition, TPN). Supplemental nutrition may be necessary if you are malnourished because of severe Crohn's disease in the small intestine. Nutritional support is especially important for children who are not growing normally because of severe disease.

Surgery may be needed if no medicine is effective, you have serious side effects from medicine, your symptoms can be controlled only with long-term use of corticosteroids, or you develop complications such as fistulas, abscesses, or bowel obstructions. Surgery involves removing the affected portion of the intestines, preserving as much of the intestines as possible to maintain normal function. Unfortunately, Crohn's disease tends to return to other areas of the intestines after surgery.
WebMD Medical Reference from Healthwise

Eating plan for inflammatory bowel disease

Crohn’s disease and ulcerative colitis are types of inflammatory bowel disease. They cause inflammation and sores (ulcers) in the digestive tract. This can lead to symptoms such as diarrhea, belly pain, loss of appetite, fever, bloody stools, and weight loss. Often symptoms are worse after eating.

If you have an inflammatory bowel disease, it may be hard to get important nutrients such as vitamins, minerals, and protein. Your intestines may not be able to take all the nutrients from the food you eat. You may lose nutrients through diarrhea. This can lead to problems such as anemia or low levels of vitamins, such as vitamin B12 and folic acid.

To control their symptoms, some people eat only bland foods, like pasta, and they avoid fruits and vegetables. But you need to eat a variety of foods to get the nutrients you need for good health. This Actionset can help you learn more about how to eat so you can manage your symptoms but still get the nutrition you need.

Key Points

• Inflammatory bowel disease can make it hard to get the nutrients you need.
• It is important to eat a healthy, varied diet to help you keep your weight up and stay strong.
• Some foods can make symptoms worse. Avoiding these foods may help reduce your symptoms.
• No one diet is right for everyone with an inflammatory bowel disease. Keep a food diary to find out which foods cause problems for you. Then you can avoid those foods but choose others that supply the same nutrients.
• Because you may not be absorbing all the nutrients from the food you eat, you will need to eat a high-calorie, high-protein diet. This may be easier to do if you eat regular meals plus 2 or 3 snacks each day.
• You may need to take vitamin and mineral supplements to help you get the nutrients you need.

• Crohn's Disease
• Ulcerative Colitis

What are some common problem foods?

Some foods may make your symptoms worse, especially during a flare-up. For many people, common problem foods include:

• Dairy products for people who are lactose-intolerant.
• High-fiber foods, such as raw fruits and vegetables, and whole grains. Often people have the most problems with gas-producing foods, such as beans, cabbage, broccoli, and onions, or foods with hulls, such as seeds, nuts, and corn.
• High-fat foods, such as fried foods, butter and margarine, mayonnaise, peanut butter, nuts, ice cream, and fatty cuts of red meat.
• Spicy foods.
• Foods with caffeine, such as chocolate and coffee.
• Carbonated drinks.
• Alcohol.

Test Your Knowledge

Dairy foods are a problem for everyone with inflammatory bowel disease.

True
False

This answer is incorrect.
Some people with inflammatory bowel disease are lactose-intolerant and will do better if they avoid dairy products. If you think they make your symptoms worse, you may want to work with your doctor to find out if you are lactose-intolerant. If you aren't, you may be able to have dairy products when your disease is under control. Dairy products are a good source of calcium and protein.

This answer is correct.
Some people with inflammatory bowel disease are lactose-intolerant and will do better if they avoid dairy products. If you think they make your symptoms worse, you may want to work with your doctor to find out if you are lactose-intolerant. If you aren't, you may be able to have dairy products when your disease is under control. Dairy products are a good source of calcium and protein.

Why is it important to pay attention to what you eat?

What you eat does not increase the inflammation that causes your disease. But some types of foods, such as high-fiber fruits and vegetables, may make your symptoms worse. This is especially true during a flare-up. As a result, you may be tempted not to eat these foods at all. But that can make it hard to get the nutrients you need to stay healthy.

A better idea is to keep a food diary to find out which foods cause problems for you. Then you can avoid those foods but choose others that supply the same nutrients. Foods that cause symptoms during a flare-up may not bother you at other times.

To learn more about nutrients and the types and amounts of food you need to be healthy, see the topic Healthy Eating.

Test Your Knowledge

Eating foods that make my symptoms worse also makes my disease worse.

True
False

This answer is incorrect.
Certain foods may make your symptoms worse, but they do not increase the inflammation that is causing your disease.

This answer is correct.
Certain foods may make your symptoms worse, but they do not increase the inflammation that is causing your disease.

How to eat when you have inflammatory bowel disease

No one diet is right for everyone with an inflammatory bowel disease. Foods that bother one person may not bother another. Your diet has to be tailored for you. But the following basic ideas can help you feel better and get the nutrition you need.

Find your problem foods

Find out your problem foods by keeping a food diary. As soon as you know what foods make your symptoms worse, your doctor or dietitian can help you plan a diet that avoids problem foods but gives you plenty of nutrients and enough calories to keep you at a healthy weight.

To make a food diary, get a small notebook and keep it with you. Make notes after each meal or snack.

• On the left side of the page, write down what you ate, about how much of each food you had, and what time you ate. Be honest-write down everything.
• On the right side of the page, note any symptoms you had and what time they occurred.

If you notice certain foods make your symptoms worse, talk to your doctor about these foods at your next visit.

Make smart food choices

During a flare-up, avoid or reduce foods that make symptoms worse. But instead of cutting out a whole group of high-nutrient foods, try replacing them with healthy choices.

• Choose dairy products that are low in lactose, such as yogurt or hard cheeses like cheddar. Or try drinking lactose-reduced milk.
• If you are having fat in your stools, choose low-fat foods instead of high-fat ones. For instance, some cuts of red meat have a lot of fat. A low-fat choice would be lean beef (such as sirloin, top and bottom round, chuck or diet lean hamburger), poultry, or fish, such as cod. Instead of frying foods, try baking or broiling them.
• Cook fruits and vegetables without hulls, skins, or seeds. Try different ways of preparing them, such as steaming, stewing, or baking. Peel and seed fresh fruits and vegetables if these bother you, or choose canned varieties.

Get the calories and nutrients you need

Your body may not be able to absorb all the nutrients it needs from the food you eat. To stay as healthy as you can:

• Eat a varied, nutritious diet that is high in calories and protein.
• Try eating 3 meals plus 2 or 3 snacks a day. It may be easier to get more calories if you spread your food intake throughout the day.
• Take vitamin and mineral supplements if your doctor recommends them.
• Try adding high-calorie liquid supplements, such as Ensure Plus or Boost Plus, if you have trouble keeping your weight up.
• Drink plenty of fluids. This can help you avoid dehydration, kidney problems, and gallstones.
• See your doctor or dietitian if your diet feels too limited or you are losing weight.

Test Your Knowledge

I need to eat a high-calorie, high-protein diet.

True
False

This answer is correct.
You may not be absorbing all the nutrients from the food you eat, so you need to eat a high-calorie, high-protein diet. This may be easier to do if you eat 3 meals plus 2 or 3 snacks each day.

This answer is incorrect.
You may not be absorbing all the nutrients from the food you eat, so you need to eat a high-calorie, high-protein diet. This may be easier to do if you eat 3 meals plus 2 or 3 snacks each day.

Where to go from here

Now that you have read this information, you are ready to follow an eating plan for inflammatory bowel disease.

Talk with your doctor

If you have questions about this information, take it with you when you visit your doctor or dietitian. You may want to mark areas or make notes in the margins where you have questions.

For more information on nutrition, see the topic Healthy Eating.

Organizations

Crohn's and Colitis Foundation of America (CCFA), Inc., National Headquarters
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone:	1-800-932-2423 (212) 685-3440
Fax:	(212) 779-4098
E-mail:	info@ccfa.org
Web Address:	http://www.ccfa.org
Crohn's and Colitis Foundation of America (CCFA) is a nonprofit, voluntary organization dedicated to finding the cure for Crohn's disease and ulcerative colitis. This organization sponsors basic and clinical research, offers educational programs for patients and health professionals, and provides supportive services.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892-2560
Phone:	1-800-860-8747 (301) 496-3583
Web Address:	www.niddk.nih.gov
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides information and conducts research on a wide variety of diseases as well as issues such as weight control and nutrition. WebMD Medical Reference from Healthwise

New Drug May Help Treat Crohn's Disease

Experimental Drug, Called Cimzia, May Reduce Crohn's Symptoms

By Miranda Hitti
WebMD Medical News

Reviewed by Louise Chang, MD

July 18, 2007 -- Two new studies show that a new drug called Cimzia may ease symptoms of Crohn's disease.

Cimzia hasn't been approved by the FDA yet. Patients would give themselves injections of the drug, which targets an inflammatory chemical called tumor necrosis factor (TNF) alpha.

The two new studies, published in The New England Journal of Medicine, highlight Cimzia's clinical trials in Crohn's disease patients.

Cimzia vs. Placebo

The first study included 662 people with moderate to severe Crohn's disease. Half of the patients got Cimzia shots every two weeks for the first month, and then one shot per month for the rest of the six-month study.

For comparison, the other patients got sham shots (placebo) on the same dosing schedule. Patients in both groups kept diaries about their Crohn's symptoms and got regular checkups.

At the end of the study, Crohn's symptoms had eased for 23% of the Cimzia group, compared with 16% of those in the placebo group.

Cimzia had a "modest improvement in the response rate, as compared with the placebo," write the researchers. They included William Sandborn, MD, of the gastroenterology and hepatology division of the Mayo Clinic in Rochester, Minn.

However, patients taking Cimzia weren't more likely to achieve remission from Crohn's disease than those taking the placebo.

Cimzia: Maintaining Results

The second study focused on maintaining improvements in Crohn's disease symptoms over six months.

The researchers included Stefan Schreiber, MD, of the Hospital for General Internal Medicine at Christian Albrechts University in Kiel, Germany.

They studied 668 people with moderate to severe Crohn's disease.

The study lasted for six months. For the first month, all of the patients got Cimzia shots every other week. During that time, Crohn's symptoms improved for nearly two-thirds of the patients.

After that, Schreiber's team focused only on the patients who had shown improvement with Cimzia treatment.

The researchers put the patients on a maintenance plan -- a monthly shot of Cimzia or a placebo.

Patients taking Cimzia were more likely to maintain their improvement in Crohn's symptoms during the six-month study, compared with those taking the placebo.

Cimzia Side Effects

Infection risk may be higher with anti-TNF drugs.

In Schreiber's study, serious infections (including one case of tuberculosis) occurred in 3% of the Cimzia group, compared with less than 1% of the placebo group.

In Sandborn's study, serious infections were reported in 2% of Cimzia patients and less than 1% of those taking the placebo shots.

Both studies were funded by UCB Pharma, which makes Cimzia. Both sets of researchers note financial ties to various drug companies, including UCB Pharma.

Cimzia: Second Opinion

"If the drug is ultimately approved, where will it fit into current treatment strategies?" asks editorialist James Lewis, MD, MSCE, in The New England Journal of Medicine.

Lewis works at the University of Pennsylvania's medical school. He writes that ideally, researchers would do studies that directly compare anti-TNF drugs for Crohn's disease.

"Unfortunately, it is unlikely that such comparative trials will be conducted," writes Lewis.

Lewis notes financial ties to various drug companies, but not to UCB Pharma.

• If you or a loved one is living with Crohn’s, find help and support on WebMD’s Crohn’s and Colitis Support Group message board.

Via: http://www.webmd.com

Upper Gastrointestinal (UGI) Series

An upper gastrointestinal (UGI) series looks the upper and middle sections of the gastrointestinal tract (intestines). The test uses barium contrast material, fluoroscopy, and X-ray. Before the test, you drink a mix of barium (barium contrast material) and water. The barium is often combined with gas-making crystals. Your doctor watches the movement of the barium through your esophagus, stomach, and the first part of the small intestine (duodenum) on a video screen. Several X-ray pictures are taken at different times and from different views.

A small bowel follow-through may be done immediately after a UGI to look at the rest of the small intestine. If just the throat and esophagus are looked at, it is called an esophagram (or barium swallow). See barium swallow images.

Upper endoscopy is done instead of a UGI in certain cases. Endoscopy uses a thin, flexible tube (endoscope) to look at the lining of the esophagus, stomach, and upper small intestine (duodenum).

Why It Is Done

An upper gastrointestinal (UGI) series is done to:

• Find the cause of gastrointestinal symptoms, such as difficulty swallowing, vomiting, burping up food, belly pain (including a burning or gnawing pain in the center of the stomach, or indigestion. These may be caused by conditions such as hiatal hernia.
• Find narrow spots (strictures) in the upper intestinal tract, ulcers, tumors, polyps, or pyloric stenosis.
• Find inflamed areas of the intestine, malabsorption syndrome, or problems with the squeezing motion that moves food through the intestines (motility disorders).
• Find swallowed objects.

Generally, a UGI series is not used if you do not have symptoms of a gastrointestinal problem. A UGI series is done most often for people who have:

• A hard time swallowing.
• A history of Crohn's disease.
• A possible blocked intestine (obstruction).
• Belly pain that is relieved or gets worse while eating.
• Severe heartburn or heartburn that occurs often.

How To Prepare

Tell your doctor if you:

• Are taking any medicine.
• Are allergic to any medicines, barium, or any other X-ray contrast material.
• Are or might be pregnant. This test is not done during pregnancy because of the risk of radiation to the developing baby (fetus).

You may be asked to eat a low-fiber diet for 2 or 3 days before the test. You may also be asked to stop eating for 12 hours before the test. Your doctor will tell you if you need to stop taking certain medicines before the test.

The evening before the test, you may be asked to take a laxative to help clean out your intestines. If your stomach cannot empty well on its own, you may have a special tube put through your nose and down into your stomach just before the test begins. A gentle suction on the tube will drain the stomach contents.

If you are having the small bowel follow-through after the UGI series, you will need to wait between X-rays. The entire small bowel follow-through exam takes up to 6 hours, so bring along a book to read or some other quiet activity.

You may be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

A UGI series is usually done in your doctor's office, clinic, or X-ray department of a hospital. You do not need to stay overnight in the hospital. The test is done by a radiologist and a radiology technologist.

You will need to take off your clothes and put on a hospital gown. You will need to take out any dentures and take off any jewelry. You may not smoke or chew gum during the test, since the stomach will respond by making more gastric juices and this will slow the movement of the barium through the intestines.

You will lie on your back on an X-ray table. The table is tilted to bring you to an upright position with the X-ray machine in front of you. Straps may be used to keep you safely on the table. The technologist will make sure you are comfortable during changes in table position.

You will have one X-ray taken before you drink the barium mix. Then you will take small swallows repeatedly during the series of X-rays that follow. The radiologist will tell you when and how much to drink. By the end of the test, you may have swallowed 1 cup to 2.5 cups of the barium mixture. See an illustration of a barium swallow test.

How It Is Done continued...

The radiologist watches the barium pass through your gastrointestinal tract using fluoroscopy and X-ray pictures. The table is tilted at different positions and you may change positions to help spread the barium. Some gentle pressure is put on your belly with a belt or by the technologist's gloved hand. You may be asked to cough so that the radiologist can see how that changes the barium flow. See a photograph of a barium swallow.

If you are having an air-contrast study, you will sip the barium liquid through a straw with a hole in it or take pills that make gas in your stomach. The air or gas that you take in helps show the lining of the stomach and intestines in greater detail.

If you are also having a small bowel study, the radiologist watches as the barium passes through your small intestine into your large intestine. X-ray pictures are taken every 30 minutes.

The UGI series 30 to 40 minutes. The UGI series with a small bowel study takes 2 to 6 hours. In some cases, you may be asked to return after 24 hours to have more X-ray pictures taken.

When the UGI series is done, you may eat and drink whatever you like, unless your doctor tells you not to.

You may be given a laxative or enema to flush the barium out of your intestines after the test to prevent constipation. Drink a lot of fluids for a few days to flush out the barium.

How It Feels

The barium liquid is thick and chalky, and some people find it hard to swallow. A sweet flavor, like chocolate or strawberry, is used to make it easier to drink. Some people do not like it when the X-ray table tilts. You may find that pressure on your belly is uncomfortable. After the test, many people feel bloated and a little nauseated.

For 1 to 3 days after the test, your stool (feces) will look white from the barium. Call your doctor if you are not able to have a bowel movement in 2 to 3 days after the test. If the barium stays in your intestine, it can harden and cause a blockage. If you become constipated, you may need to use a laxative to pass a stool.

Risks

Barium does not move into the blood, so allergic reactions are very rare.

Some people gag while drinking the barium fluid. In rare cases, a person may choke and inhale (aspirate) some of the liquid into the lungs.

There is a small chance that the barium will block the intestine or leak into the belly through a perforated ulcer. A special type of contrast material (Gastrografin) can be used if you have a blockage or an ulcer.

There is always a small chance of damage to cells or tissue from being exposed to any radiation, even the low level of radioactive tracer used for this test.

Results

An upper gastrointestinal (UGI) series looks at the upper and middle sections of the gastrointestinal tract (intestines). Results are usually ready in 1 to 3 days.

Upper gastrointestinal (UGI) series

Normal:	The esophagus, stomach, and small intestine all look normal.
Abnormal:	A narrowing (stricture), inflammation, a mass, a hiatal hernia, or enlarged veins (varices) may be seen. Spasms of the esophagus or a backward flow (reflux) of barium from the stomach may occur.
	The UGI series may show a stomach (gastric) or intestinal (duodenal) ulcer, a tumor, or something pushing on the intestines from outside the gastrointestinal tract. Narrowing of the opening between the stomach and the small intestine (pyloric stenosis) may be seen.
	The small bowel follow-through may show inflammation or changes in the lining that may explain poor absorption of food. This may be caused by Crohn's diseaseceliac disease). or

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Eating before or during the test.
• Too much air in the small intestine.

What To Think About

• A gastrointestinal (GI) motility study may be done if the squeezing motions of the small intestine are not normal during the UGI series and small bowel follow-through. The movement of the barium through the lower intestinal tract is recorded every few hours for up to 24 hours. A barium enema or colonoscopy may be needed to confirm the diagnosis.
• Upper endoscopy is done instead of a UGI test in certain cases. Endoscopy uses a thin, flexible tube (endoscope) to look at the lining of the esophagus, stomach, and upper small intestine (duodenum). For more information, see the medical test Upper Gastrointestinal Endoscopy.
• The UGI series test:
  • Cannot show irritation of the stomach lining (gastritis) or esophagus (esophagitis) or ulcers that are smaller than about 0.25 in. in diameter.
  • Cannot show an infection with the bacteria Helicobacter pylori, which may be a cause of stomach ulcers.
• A biopsy cannot be done during the UGI if a problem is found.

WebMD Medical Reference from Healthwise

Frequently Asked Questions About Inflammatory Bowel Disease (IBD)

• What is inflammatory bowel disease (IBD)?
• Answer:

  Inflammatory bowel disease is a group of two diseases: ulcerative colitis and Crohn's disease. These chronic illnesses can inflame the gastrointestinal tract, causing bloody diarrhea, abdominal pain, and weight loss. Ulcerative colitis can affect the entire large intestine or the rectum. Crohn's disease mainly affects short segments of both the small and large intestine.
• What is Crohn’s disease?
• Answer:

  Crohn’s disease is an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.
• Who gets Crohn’s disease?
• Answer:

  Crohn’s disease affects men and women equally and seems to run in some families. About 20% of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but it is more often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohn’s disease, and blacks are at decreased risk for developing Crohn’s disease.
• What causes inflammatory bowel disease?
• Answer:

  The cause(s) of inflammatory bowel disease is not known. However people believe that it may be genetically linked since IBD is known to run in families.

  An environmental cause is also believed to play a role in developing Crohn's disease because it is most often occurs in people who smoke, are residents of Northern European countries and live in urban areas.

  Other researchers speculate that the disease may be caused by an infection or virus.

  Still others believe that the body's immune system is reacting to unidentified or unknown antigens. This antigen would cause the immune system to respond inappropriately against normal intestinal tissue, resulting in chronic inflammation.
• What diseases/infections or vaccines are thought to be linked to the development of IBD?
• Answer:

  Measles, mumps, or rubella virus infection is not known to cause IBD. The virus that causes measles infects the respiratory system and then spreads to lymphatic tissue (an important part of the immune system). During the acute infection, lymph cells in the gastrointestinal tract are infected, but whether this causes chronic inflammation is highly questionable.

  One theory speculates that measles virus may persist in the intestine in certain individuals and later trigger a chronic inflammatory infection; however, this has not been proven. Because the measles, mumps, and rubella (MMR) vaccine contains a very weak live measles virus it has been suggested that the vaccine could cause an inflammatory process in the intestine. This theory has not been proven and is speculative.
• What are the symptoms?
• Answer:

  The most common symptoms of Crohn’s disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn’s disease may suffer delayed development and stunted growth. The range and severity of symptoms varies.
• How are Crohn's disease and ulcerative colitis diagnosed?
• Answer:

  A thorough physical exam and a series of tests may be required to diagnose Crohn’s disease or ulcerative colitis.

  The doctor may do an upper GI series to look at the small intestine. For this test, the person drinks barium, a chalky solution that coats the lining of the small intestine, before X-rays are taken.
  

  The doctor may also do a visual exam of the colon by performing either a sigmoidoscopy or a colonoscopy. For both of these tests, the doctor inserts a long, flexible, lighted tube linked to a computer and TV monitor into the anus.
  

  The doctor may also do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope.
• What are the complications of Crohn's disease?
• Answer:

  The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage.

  Crohn’s disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues, such as the bladder, vagina, or skin.
  

  Nutritional complications are common in Crohn’s disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption, also referred to as malabsorption.
  

  Other complications associated with Crohn’s disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.
• What is ulcerative colitis?
• Answer:

  Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.
• Who gets ulcerative colitis?
• Answer:

  Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20% of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. A higher incidence of ulcerative colitis is seen in whites and people of Jewish descent.
  
• What are the symptoms of ulcerative colitis?
• Answer:

  The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. Patients also may experience

  • anemia
  • fatigue
  • weight loss
  • loss of appetite
  • rectal bleeding
  • loss of body fluids and nutrients
  • skin lesions
  • joint pain
  • growth failure (specifically in children)

  About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps.
• What are the other complications associated with ulcerative colitis?
• Answer:

  Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.
• What causes ulcerative colitis?
• Answer:

  Many theories exist about what causes ulcerative colitis. People with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or a result of the disease. The body’s immune system is believed to react abnormally to the bacteria in the digestive tract.

  Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms.

  Answer:
• Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. Treatment for Crohn’s disease depends on the location and severity of disease, complications, and the person’s response to previous medical treatments when treated for reoccurring symptoms. Many of the treatments are used for both conditions.

  Someone with inflammatory bowel disease may need medical care for a long time, with regular doctor visits to monitor the condition.
• What drug therapies are available?
• Answer:

  Anti-Inflammation Drugs. Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine-containing drugs include nausea, vomiting, heartburn, diarrhea, and headache.

  Cortisone or Steroids. Cortisone drugs and steroids—called corticosteriods—provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered once symptoms have been controlled. These drugs can cause serious side effects, including greater susceptibility to infection.

  Immune System Suppressors. Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s resistance to infection.

  Infliximab (Remicade). This drug is the first of a group of medications that blocks the body’s inflammation response. The FDA approved the drug for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically for Crohn’s disease, is a TNF substance.

  Antibiotics. In inflammatory bowel disease antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

  Anti-Diarrheal and Fluid Replacements. Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.
• What type of nutrition supplementation is needed?
• Answer:

  The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose.
• Is surgery ever required to treat or cure this condition? And why do some people with the condition require surgery while others do not?
• Answer:

  Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point in their lives. About 25% to 40% of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer.

  Surgery becomes necessary when medications can no longer control symptoms. Surgery is used either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine. Surgery to remove part of the intestine can help people with Crohn’s disease, but it is not a cure. Surgery does not eliminate the disease as inflammation tends to return to the area next to where the diseased intestine was removed.

  In ulcerative colitis, surgery maybe needed to remove the colon and/or rectum.
• Is colon cancer a concern with ulcerative colitis?
• Answer:

  About 5% of people with ulcerative colitis develop colon cancer. The risk of cancer increases with the duration of the disease and how much the colon has been damaged. For example, if only the lower colon and rectum are involved, the risk of cancer is no higher than normal. However, if the entire colon is involved, the risk of cancer may be as much as 32 times the normal rate.
  

  Sometimes precancerous changes occur in the cells lining the colon. These changes are called "dysplasia." People who have dysplasia are more likely to develop cancer than those who do not. Doctors look for signs of dysplasia when doing a colonoscopy or sigmoidoscopy and when examining tissue removed during these tests.
  

  According to the 2002 updated guidelines for colon cancer screening, people who have had IBD throughout their colon for at least eight years and those who have had IBD in only the left colon for 12 to 15 years should have a colonoscopy with biopsies every 1 to 2 years to check for dysplasia. Such screening has not been proven to reduce the risk of colon cancer, but it may help identify cancer early. These guidelines were produced by an independent expert panel and endorsed by numerous organizations, including the American Cancer Society, the American College of Gastroenterology, the American Society of Colon and Rectal Surgeons, and the Crohn’s & Colitis Foundation of America.

Ask Your Question

IBD versus IBS

Is inflammatory bowel disease (IBD) the same thing as Irritable Bowel Syndrome (IBS)?

No. Inflammatory bowel disease, including UC and CD, is different from irritable bowel syndrome (IBS). Unlike IBD, IBS does not cause inflammation, ulcers or other damage to the bowel. Instead, IBS is a much less serious problem called a functional disorder. This means that the digestive system looks normal but doesn't work as it should. Symptoms of IBS may include crampy pain, bloating, gas, mucus in the stool, diarrhea and constipation. IBS has also been called spastic colon or spastic bowel.