Explaining Inflammatory Bowel Disease

We all experience the occasional stomach ache from time to time. Maybe you ate something that didn’t agree with you or caught a stomach bug. While this is often just an unfortunate part of life, frequent and debilitating stomach aches and pain may indicate a more serious illness, such as inflammatory bowel disease (IBD).

IBD is an umbrella term for both Crohn’s disease and ulcerative colitis. Both conditions are characterized by chronic inflammation of the gastrointestinal tract, also known as the GI tract. The GI tract includes the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus. The CDC estimates that 3 million U.S. adults have IBD.

For some, IBD is mild, but for others, it can lead to life-threatening complications.

What is the difference between Crohn’s disease and ulcerative colitis?

While Crohn’s disease and ulcerative colitis cause the same symptoms, each condition affects different parts of the GI tract.

Crohn’s disease can affect the entire GI tract (mouth to anus) but most typically affects the small intestine. When looked at during a colonoscopy or endoscopy, the areas damaged by Crohn’s disease appear patchy, and it causes significant inflammation in the GI tract.

Ulcerative colitis affects the large intestine (also known as the colon) and rectum. When examined, damaged areas are continuous and usually start at the rectum and spread into the colon. Inflammation is only present in the innermost layer of the colon lining.

Causes

Most people with IBD are diagnosed before the age of 30. The exact causes of both IBD conditions are unknown, but IBD often results from a weakened immune system. Many clinicians think that possible triggers are:

• In the past, the immune system responded incorrectly to a virus or bacteria, attacking tissue in the GI tract and causing inflammation
• Gene mutations or a family history of IBD
• Nonsteroidal anti-inflammatory medications (ibuprofen, naproxen sodium), which increase your risk or make the disease worse if you already have it
• Race and ethnicity: white people and Ashkenazi Jews have a higher risk of developing IBD

Symptoms of Chrohn’s Disease and Ulcerative Colitis

Although they affect different parts of your GI tract, both Crohn’s disease and ulcerative colitis cause the same symptoms, including diarrhea, abdominal pain, bleeding ulcers, bowel obstruction, rectal bleeding, bloody stools, loss of appetite, weight loss and malnutrition due to reduced appetite, and fatigue.

Diagnosis

Your provider can help determine whether you have Crohn’s disease or ulcerative colitis by obtaining a thorough medical history, a physical exam, and a review of your symptoms. They may also order diagnostic testing, including blood and stool samples, diagnostic imaging, and an endoscopic procedure.

Treatment Options

The main goal of IBD treatment is to reduce inflammation, relieve symptoms, reduce potential complications, and hopefully lead to remission.

Your clinician might consider several treatment options based on your needs and the severity of your IBD. These include:

• Surgery to remove damaged portions of the GI tract, although this is less effective for Crohn’s disease
• Anti-inflammatory medication
• Short term corticosteroids for ulcerative colitis
• Immune system suppressors, which can suppress the immune response that causes inflammation
• Biologics, which are a new kind of therapy aimed at neutralizing proteins that cause inflammation
• Antibiotics if you’re at risk of infection in the GI tract
• Your provider may also recommend you take:
  • Over-the-counter anti-diarrheal medications like Imodium® or fiber supplements such as Metamucil®
  • Tylenol® or other generic acetaminophen products as anti-inflammatory medications, such as ibuprofen and naproxen, can worsen symptoms

Complications

While some people experience mild IBD symptoms, others might be at risk of complications. Prolonged inflammation damages the GI tract and can cause a variety of health issues, depending on whether you have Crohn’s disease or ulcerative colitis.

If you have either form of IBD, you might be at risk of:

• Colon cancer: You should have regular colon cancer screenings 8-10 years after diagnosis. Ask your Atrius Health provider how often these screenings should be repeated if you’re at risk for colon cancer.
• Skin, eye, and joint inflammation, as well as arthritis
• Blood clots
• Severe dehydration from diarrhea
• Primary sclerosing cholangitis or inflammation in your bile ducts, though this is rare

If you have Crohn’s disease, you might suffer from the following:

• Bowel obstruction
• Malnutrition, anemia, or a B-12 deficiency due to a lack of appetite
• Fistulas (holes between different parts of the GI tract)
• Anal fissures (associated with painful bowel movements)

If you have ulcerative colitis, you might suffer from the following:

• Toxic megacolon, which happens when inflammation causes all or part of your colon to swell wider than normal, which pushes toxic substances around the body
• Perforated colon, when a hole is torn in the wall of the colon, generally caused by a toxic megacolon

IBD can be painful and affect your quality of life, but you are not alone. Atrius Health provides IBD specialty care at our Medford and Dedham locations as well as through virtual visits. Atrius Health providers specializing in IBD include Dr. Razvan Arsenescu, Dr. Michal Tomczak, and Dr. Zhuo Geng. To schedule an appointment, please call 617-657-6440.

About Dr. Razvan Arsenescu

Dr. Razvan Arsenescu is a board-certified gastroenterologist and chief of gastroenterology at Atrius Health. He completed his medical training at SUNY/Stony Brook, his gastroenterology fellowship at the University of Iowa Hospitals & Clinics, and his PhD focused on microbiology, immunology, and genetics at the University of Kentucky College of Medicine. Dr. Arsenescu’s clinical interests include inflammatory bowel disease, Crohn’s disease, ulcerative colitis, celiac sprue, autoimmune digestive disorders, eosinophilic esophagitis, confocal laser endomicroscopy, gut microbiome, and clinical and basic research in mucosal immunology.

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