Inflammatory Bowel Disease (IBD)

Diagnosis

You will require a combination of examinations and procedures to help support an IBD diagnosis:

Laboratory examinations

• Blood examination. Healthcare providers may recommend blood tests to assess the presence of anemia, a condition characterized by insufficient red blood cells to adequately transport oxygen to body tissues. Additionally, these tests can help detect signs of bacterial or viral infections.
• Stool examination. A stool sample may be required by your healthcare provider for testing hidden (occult) blood or organisms, such as parasites, present in the stool.

Endoscopic tests

• Upper endoscopy. In this procedure, a medical professional utilizes a slender, flexible, lighted tube to examine the esophagus, stomach, and the initial segment of the small intestine known as the duodenum. Although it is uncommon for Crohn’s disease to affect these areas, this test might be suggested if an individual experiences symptoms such as nausea, vomiting, difficulties with eating, or upper abdominal pain.
• Flexible sigmoidoscopy. A healthcare provider utilizes a slender, flexible, lighted tube to conduct an examination of the rectum and sigmoid, which is the final section of the colon. In cases where the colon is significantly inflamed, the healthcare provider may opt for this test instead of a complete colonoscopy.
• Colonoscopy. This procedure enables medical professionals to visualize the entire colon using a thin, flexible tube that has a camera attached to the end. Throughout the process, small samples of tissue, known as biopsies, may be taken for analysis in a laboratory. Biopsies are crucial in differentiating IBD from other types of inflammation and establishing a precise diagnosis.
• Capsule endoscopy.  The test used to aid in the diagnosis of Crohn’s disease affecting the small intestine involves swallowing a capsule equipped with a camera. The camera captures images which are then transmitted to a recorder worn on the belt. Eventually, the capsule is safely eliminated through the stool without causing any discomfort. However, it is important to note that a confirmation of Crohn’s disease may still require an endoscopy with a biopsy. If there is a suspicion of bowel obstruction, capsule endoscopy should not be conducted.
• Balloon-assisted enteroscopy. In this procedure, a scope is utilized along with an overtube to extend the visual examination into the small bowel, which cannot be reached by conventional endoscopes. This combination allows technicians to investigate abnormalities detected through capsule endoscopy, particularly when there is uncertainty regarding the diagnosis.

Imaging tests

• X-ray. If your symptoms are severe, your doctor may perform a routine abdominal X-ray to rule out more serious issues like megacolon or a ruptured colon.
• Computerized Tomography (CT) scan. A CT scan, a specialized X-ray method that offers more detail than a regular X-ray does, might be performed on you. In addition to tissues outside the gut, this examination examines the entire bowel. Better images of the small intestine are produced using CT enterography, a specialized CT scan. Most medical facilities no longer use barium X-rays in favor of this test.
• Magnetic Resonance Imaging (MRI). To produce finely detailed images of organs and tissues, MRI scanners use a magnetic field and radio waves. When examining a fistula in the small intestine or around the anal area, an MRI is especially helpful (MR enterography). With MRI, there is no radiation exposure, in contrast to CT.

Treatment

The goal of inflammatory bowel disease treatment is to decrease inflammation and alleviate the associated signs and symptoms. Ideally, this approach can not only provide relief from symptoms but also achieve long-term remission and minimize the risk of complications. The treatment of IBD typically consists of drug therapy or surgical intervention.

Anti-inflammatory drugs

The initial approach to treating ulcerative colitis, particularly for mild to moderate cases, often involves the use of anti-inflammatory drugs. A group of medications known as aminosalicylates, which include mesalamine, balsalazide, and olsalazine, are commonly prescribed for this purpose. These medications help reduce inflammation in the colon.

For inducing remission, time-limited courses of corticosteroids are also employed. Apart from their anti-inflammatory properties, steroids act as immunosuppressants. The choice of medication depends on the specific location in the colon that is affected by the disease.

Immune system suppressors

There are different types of drugs that are used to suppress the immune response, which can release chemicals causing inflammation in the body. These chemicals have the potential to harm the lining of the digestive tract.
Several examples of immunosuppressant drugs are azathioprine mercaptopurine, and methotrexate.
More recently, there have been orally administered drugs called “small molecules” that have become available for treating IBD. These include tofacitinib, upadacitinib, and ozanimod.
The U.S. Food and Drug Administration (FDA) has recently issued a warning about tofacitinib, indicating that preliminary studies have shown an increased risk of serious heart-related problems and cancer associated with this drug. If you are currently taking tofacitinib for ulcerative colitis, it is important not to discontinue the medication without first consulting your doctor.

Biologics

Biologics represent a modern form of therapy aimed at countering the inflammatory effects caused by certain proteins in the body. They are available in different administration methods, including intravenous (IV) infusions or self-administered injections. Notable examples of biologics include infliximab, adalimumab , golimumab, certolizumab, vedolizumab, ustekinumab, and risankizumab .

Antibiotics

Antibiotics such as ciprofloxacin and metronidazole are commonly prescribed alongside other medications or when there is a risk of infection, particularly for conditions like perianal Crohn’s disease. These medications may be utilized to address concerns related to infection in such cases.

Other medicine or supplements

It is important to consult with your doctor before using any over-the-counter medications to relieve symptoms or manage inflammatory bowel disease (IBD). Depending on the severity of your condition, your doctor may suggest the following options:

• Anti-diarrheal medications: To address mild to moderate diarrhea, you may benefit from fiber supplements like psyllium powder or methylcellulose which add bulk to your stool. However, individuals with strictures or certain infections should consult their doctor before using these medications. In cases of more severe diarrhea, loperamide may be effective.
• Pain relievers: Acetaminophen may be recommended by your doctor for mild pain. However, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen sodium, and diclofenac sodium should be avoided as they can worsen your symptoms and the underlying disease.
• Vitamins and supplements: If you are experiencing nutrient deficiencies due to poor absorption, your doctor may suggest vitamins and nutritional supplements to address these deficiencies.

Dietary support

In cases of severe weight loss due to inflammatory bowel disease (IBD), doctors may suggest specialized dietary interventions to improve nutrition and give the bowel a chance to rest. This can be achieved through enteral nutrition, where a special diet is administered via a feeding tube, or parenteral nutrition, where nutrients are injected directly into a vein. These approaches can enhance overall nutrition and temporarily reduce inflammation.
If you have a stenosis or stricture in your bowel, a low-residue diet might be recommended by your doctor. This dietary approach aims to minimize the risk of undigested food getting trapped in the narrowed part of the bowel, which could potentially cause a blockage.

Surgical management

If signs and symptoms of your inflammatory bowel disease (IBD) persist despite diet and lifestyle changes, drug therapy, or other treatments, your healthcare provider may advise surgical intervention as an option.

• Surgery for ulcerative colitis. The surgical procedure entails the complete removal of the colon and rectum. In cases where it is not feasible to create an internal pouch connected to the anus for bowel movements without a bag, surgeons opt for an alternative approach. They create a permanent opening in the abdomen known as an ileal stoma. This opening serves as a passage through which stool is expelled and collected in a bag attached externally.
• Surgery for Crohn’s disease. Surgery is a common necessity for up to two-thirds of individuals with Crohn’s disease, although it does not provide a cure for the condition. The surgical procedure involves the removal of the affected portion of the digestive tract, followed by the reconnection of the healthy sections. Additionally, surgery can be employed to close fistulas and drain abscesses associated with Crohn’s disease. However, the benefits of surgery are typically temporary, as the disease tends to recur, often in proximity to the reconnected tissues. Therefore, the recommended approach is to combine surgery with medication in order to minimize the risk of disease recurrence.