Inflammatory bowel disease (IBD) is an umbrella term used to describe two conditions characterized by chronic inflammation of the gastrointestinal (GI) tract: Crohn’s disease and ulcerative colitis. Over 1.5 million people in the U.S. have IBD, including more than 780,000 patients with Crohn’s disease. 

“I have a particular interest in inflammatory bowel disease, which includes both Crohn’s disease and ulcerative colitis,” says Barry R. Katz, M.D., a board-certified gastroenterologist at Digestive Disease Consultants Orlando.

“These are chronic conditions, which are quite often debilitating.”

Signs and Symptoms of IBD

Although Crohn’s disease and ulcerative colitis cause similar symptoms, they impact different parts of the GI tract. Both ulcerative colitis and Crohn’s disease typically involve severe diarrhea, abdominal pain, fatigue, and weight loss. The conditions can also impact other areas of the body, including the skin, eyes, liver, and joints.

“The symptoms of inflammatory bowel disease are sometimes very nonspecific, which makes it somewhat difficult to make the initial diagnosis,” says Dr. Katz. “The main symptoms are abdominal pain and diarrhea, GI bleeding, and fevers; and several other etiologies can also cause those symptoms.”

Other symptoms typically associated with IBD, include:

  • Reduced appetite
  • Weight loss
  • Rectal bleeding/bloody stools
  • Fatigue
  • Night sweats
  • Irregular menstrual cycles

Crohn’s Disease vs. Ulcerative Colitis

Named after Dr. Burrill B. Crohn, who first documented the disease in 1932, Crohn’s disease is characterized by swelling in the digestive tract that can cause significant abdominal discomfort, extreme diarrhea, and a host of adverse health effects. 

Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucus. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

Crohn’s disease affects the entire thickness of the bowel wall, while ulcerative colitis only involves the innermost lining of the colon. Crohn’s-related inflammation can penetrate deeply into the bowel tissue causing crippling pain, and lead to a disabling loss of function. 

Depending on the individual, inflammation from Crohn’s disease can appear along different areas of the digestive system, from the mouth to the rectum. Moreover, the inflammation can pass over specific regions of the intestine, with healthy patches of the GI tract interspersed with areas of diseased intestine. Ulcerative colitis, on the other hand, is limited to the large intestine.

The symptoms of ulcerative colitis tend to wax and wane, with relatively long periods in between flare-ups where patients may not experience any distress at all. These periods of remission can last months or even years, although symptoms do eventually return. The unpredictable development of ulcerative colitis can make it challenging for physicians to evaluate whether a particular course of treatment has been effective or not.

Causes of Inflammatory Bowel Disease

According to Dr. Katz, the exact cause of IBD is unknown, but it is believed that the condition is the result of a defective immune system. A healthy immune system will only attack foreign organisms, such as viruses and bacteria, to protect the body. 

However, with IBD, the immune system responds incorrectly to environmental triggers; it mistakes food, bacteria, and other materials in the intestine for foreign or invading substances, which causes inflammation of the gastrointestinal tract. There also appears to be a genetic component—someone with a family history of IBD is more likely to develop this inappropriate immune response.

“We don’t really know the cause of inflammatory bowel disease,” says Dr. Katz. “We think it’s an environmental trigger on somebody who’s genetically susceptible. Many times in the last 25 years, I’ve read that we’ve discovered the cure or the cause of inflammatory bowel disease, and I wish that were true, but unfortunately, we have not yet discovered either the cause or a definitive cure for these ailments.”

While both ulcerative colitis and Crohn’s disease are types of inflammatory bowel diseases, they should not be confused with irritable bowel syndrome (IBS), a condition that affects the muscle contractions of the colon. 

Treatment for Inflammatory Bowel Disease

IBD is a complex illness that requires proper examination and testing by a physician to correctly diagnose the condition. Being a chronic condition, patients usually go through periods where their symptoms come and go — Crohn’s disease or ulcerative colitis may flare up for a specific period followed by an almost complete lack of symptoms. Patients with mild ulcerative colitis may need minimal or no treatment and remain well for prolonged periods of time.

Different kinds of medications are employed to treat IBD, including: 

  • Aminosalicylates
  • Corticosteroids
  • Immunomodulators
  • Biologics (specific antibody-based treatments that target a specific part of the immune system)
  • Specific vaccinations may be recommended for individual patients to prevent infection

Roughly 60-75% of patients with Crohn’s disease will need surgery to treat complications and repair damage to their digestive system. Dr. Katz stresses that because of its complex nature, it is critical for patients to work closely with an expert and skilled team.

“It is very important to have a good team approach and collaboration with patients to get them back to their best functioning possible,” he says. “There are a lot of new medicines available for Crohn’s and ulcerative colitis, and in fact, our center has an infusion center within our office for some of the new biologic therapies. With all these new therapies, it has made it somewhat more complicated both on the physician and on the patients; there are now so many more (treatment) choices for everybody.” 

While there’s no known cure for IBD, restoring and maintaining proper nutrition as well as reducing stress are essential for properly managing the illness. Moreover, a patient’s relationship with their healthcare team, and being comfortable with, trusting, and having the full support of one’s physician are perhaps the most vital factors for living well with IBD.

“We spend a lot of time with patients talking about the different options, pros, and cons, and then we try to get a treatment plan together,” says Dr. Katz. “One of the things I like about our practice is that you see the physician each visit as opposed to nurse extenders or PAs. Especially for patients with a chronic disease like inflammatory bowel disease, that’s very important.”For questions or more information about inflammatory bowel disease, please feel free to contact us.