Inflammatory Bowel Disease Program

An estimated one million American men and women currently suffer from inflammatory bowel disease (IBD), a condition characterized by inflammation of the gastrointestinal (GI) tract.

Penn provides evaluation and state-of-the-art treatment for two major types of IBD, 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 groups in the world based at an academic medical center focused on the care and research of IBD. As the treatment of IBD evolves, Penn is at the forefront of developing new therapies and diagnostic techniques.

Diagnosis
To diagnose IBD, your physician takes your medical history and performs a full medical examination, including blood tests and bowel movement samples. Other tests may include:

• Flexible Sigmoidoscopy or Colonoscopy – Your physician inserts a small flexible tube 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
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 nutrition planning and emotional support.

Medication
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.

Four major classes of medication are used today to treat ulcerative colitis:

• 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. 

Surgery
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:

Perelman Center for Advanced Medicine
Fourth Level, Suite 4-370S
3400 Civic Center Boulevard
Philadelphia, PA 19104
Driving Directions

Penn Presbyterian Medical Center
51 N. 39th Street
Wright-Saunders Building, Suite 218
Philadelphia, PA 19104
Driving Directions

Penn Medicine Radnor
250 King of Prussia Road
Radnor, PA 19087
Driving Directions

Sources:

• Crohn's and Colitis Foundation of America
• American Gastroenterological Association

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.

Digestive System Illustration Copyright A.D.A.M., Inc.