Gastroenterology

Inflammatory Bowel Disease (IBD)

An estimated one million American adults suffer from inflammatory bowel disease (IBD), a condition characterized by inflammation of the gastrointestinal (GI) tract. There are two major types of IBD- Crohn's disease and ulcerative colitis. Crohn's disease can occur anywhere in the digestive tract and can spread deep into the layers of affected tissues. Ulcerative colitis is inflammation of the innermost lining of the large intestine and rectum.

Penn Medicine provides evaluation and the latest treatments for Crohn’s disease and ulcerative colitis, as well as refractory inflammatory bowel disease and unexplained diarrhea. The IBD program at Penn is home to one of the largest research groups in the world based at an academic medical center. As the treatment of IBD evolves, Penn is at the forefront of developing new therapies and diagnostic techniques.

Causes of IBD

There is no known cause for inflammatory bowel disease. There is a genetic predisposition to the disease, however the triggering factors have not yet been identified.

Symptoms of IBD

As with other chronic diseases, symptoms may flare up and can be followed by little or no symptoms. The location of the inflammation within the intestinal tract will determine the symptoms, which can range from mild to severe. They include:

  • Abdominal cramps and pain
  • Diarrhea
  • Blood in the stool
  • Severe urgency to have a bowel movement
  • Weight loss
  • Loss of appetite
  • Fever
  • Anemia

IBD Diagnosis

To diagnose IBD, your physician will take your medical history and perform a full medical examination, including blood tests and bowel movement samples. Other tests may include:

  • Flexible sigmoidoscopy or colonoscopy - A small flexible tube is inserted into the anus. The tube is slowly passed into the lower third of the colon (flexible sigmoidoscopy) or through the entire colon (colonoscopy), allowing your physician to see the lining of the colon. If necessary, he or she can take a tissue sample to diagnose your condition.
  • Barium enema – This is an X-ray of the colon. A white substance called barium is put into the colon by an enema. This test may allow your doctor to see areas of the colon that are abnormal.
  • Small bowel x-ray (Crohn's disease only)

In addition to standard testing, the extensive resources at Penn provide physicians with a wide array of tools for diagnosing GI problems, including endoscopic retrograde cholangiopancreatograph, manometry, breath testing and endoscopic ultrasound (EUS).

Treatment for IBD

There are a variety of treatments for IBD. If you are diagnosed with ulcerative colitis or Crohn's disease, your physician will discuss a treatment plan with you that may include medication or surgery, along with nutritional planning and emotional support.

Medication for IBD

Currently, there is no cure for IBD, however, medications are available that decrease the inflammation of the colon lining and control the symptoms of IBD. These medications can relieve diarrhea, rectal bleeding and abdominal pain, and allow the colon to heal.

The main classes of medication used today to treat IBD are:

  • Aminosalicylates (5-ASA) – Effective in treating mild to moderate episodes of ulcerative colitis, these medications are also useful in preventing relapses of this disease. Examples include sulfasalazine and oral formulations of mesalamine (Asacol®, Colazal®, Dipentum®, Pentasa®). 5-ASA drugs also may be administered rectally (Canasa® and Rowasa®).
  • Corticosteroids – Prednisone and methylprednisolone nonspecifically suppress the immune system, meaning they suppress the entire immune system, not one particular area.
  • Immune modifiers – Sometimes called immunomodulators, these medications are used to help decrease corticosteroid dosage and patients' dependence on corticosteroids. They also may help maintain remission in some patients who do not respond to standard medications. Examples include Azathioprine (Imuran®), 6-MP (Purinethol®), and methotrexate Immune modifiers.
  • Antibiotics
  • Biologic therapies (Crohn's disease) – In August 1998, the FDA approved infliximab (Remicade®), the first biologic therapy for Crohn's disease. This medication is used for moderately to severely active Crohn's patients who have not responded adequately to conventional therapy, or for reducing the number of draining enterocutaneous fistulas. This medication can also be used to maintain remission.

IBD Infusion Therapy

IBD infusion therapy is a therapeutic intravenous procedure administered in a comfortable setting by an expert clinical team with special training in infusion therapy.

Infusion therapies may include the following:

  • Remicade® therapy
  • Stem cell infusion therapy
  • Medications for chronic pain
  • Ion infusions
  • Hydration therapy
  • Nutrition therapy

Surgery for IBD

Surgery may be appropriate for patients who do not respond to a treatment plan of medication and nutritional planning. Based on the patient's type of IBD and the extent of disease, options for surgery include:

  • Resection and Anastomosis – The diseased segment of bowel and any associated abscess are removed, and the two ends of healthy bowel are joined together in a procedure called anastomosis.
  • Proctocolectomy – The entire colon and rectum are removed, with the creation of an ileostomy, or external stoma (an opening on the abdomen through which wastes are emptied into a pouch that is attached to the skin with adhesive).
  • Restorative Proctocolectomy – This procedure also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external ostomy appliance.

Locations

This program is available at the following locations:

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