Managing Inflammatory Bowel Disease (video)

IBD is chronic inflammation of the digestive system. It can range from mild to severe, with symptoms that may include abdominal pain, diarrhea that may be bloody, rectal bleeding and unintended weight loss.

“IBD can be different for every patient,” explains Dr. Konijeti. “Some people may have full-blown symptoms without any warning signs. Others may have very mild symptoms at the start that gradually progress.”

The two most common types of IBD are ulcerative colitis and Crohn’s disease. Ulcerative colitis is generally limited to the inner lining of the colon, also called the large intestine. Crohn’s disease can affect any part of the gastrointestinal (GI) tract from the mouth to the rectum, although it is most common in the colon and the end of the small intestine that connects to the colon. Crohn’s disease also tends to affect all four layers of tissue in the GI tract.

The exact cause of IBD is not known, but several factors appear to play a role in who will develop it.

“If a child was breastfed as an infant, they have about a 30 to 40 percent lower risk of developing IBD later in life. If you have had a lot of infections or have taken a lot of antibiotics, you may have a higher risk,” says Dr. Konijeti. “There are genetic factors as well. More than 200 genes are associated with IBD, and the bacteria in our intestines also matters, but research has not determined exactly how.”

IBD can affect people of any age but is most common among those in their 20s to 30s. IBD develops more often in women than men, and Dr. Konijeti often cares for women who have IBD and plan to become pregnant. She recommends women meet with their gastroenterologist before conceiving to check for any vitamin deficiencies that might affect the health of the mother or baby. 

“I tell them that the best way to increase the likelihood of conception, as well as have a healthy pregnancy, is to try and get their IBD under control first,” she says. “If a woman can do that, it’s much more likely that her IBD will stay controlled during pregnancy.”

Symptoms, such as abdominal pain and diarrhea, are common and often go away without treatment. However, if these symptoms last for more than a week or become worse, it’s time to see a physician. 

Symptoms such as blood in your stools, very severe pain, fever, night sweats or unexplained weight loss should be checked out by a professional as soon as possible.

There is no cure for IBD, but treatments can help control the inflammation. Without treatment, patients have a higher risk of developing serious complications, such as fistulas, which are abnormal connections between the intestines or other internal organs. Because IBD also raises the risk of colon cancer, physicians recommend that people with the disease should begin screening exams for colon cancer sooner and more frequently than those without IBD. 

“Treatment depends on several factors, such as the severity of the disease or their medical history,” explains Dr. Konijeti. “For mild cases, we may start with anti-inflammatory medications for the gut. If the disease is more severe, we may use medications such as targeted immunosuppressives that stop inflammation from happening.”

If medications are not effective, surgery may be the next step. Surgical treatments for ulcerative colitis are not the same as those for Crohn’s disease.

“Patients with severe ulcerative colitis that does not improve with treatment, or who develop precancerous lesions that can’t be removed, may need surgery to have their colons removed, which essentially acts as a cure,” says Dr. Konijeti. 

Surgery for Crohn’s disease may be required to remove a fistula. Unfortunately, Crohn’s disease often returns following surgery, so it is not considered a cure.

While IBD risk factors such as genetics cannot be changed, a healthy diet and lifestyle may help reduce the risk. Dr. Konijeti recommends a nutrient-dense diet high in fruits, vegetables, fish and fiber. In addition, she suggests minimizing use of nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, which are associated with an increased risk of IBD.

“One of my interests is looking at how we can use diet or other potential triggers of inflammation to reduce the inflammation itself, rather than focusing on drugs,” she says. “We have done clinical trials looking at the efficacy of various diets to help control the disease.”

If you believe you may have IBD, make an appointment with your physician to evaluate your symptoms and determine whether you need treatment.