Inflammatory Bowel Disease (IBD)

IBD is not a disease itself, but a group of conditions that cause ongoing (chronic) inflammation in your intestines. Chronic inflammation can lead to complications such as malnutrition and increase your risk of colorectal cancer. To help you get the best treatment and reduce your risk of complications, it is important to know which type of IBD you have.

There are two major types of IBD. Although they have similar symptoms, the most notable difference is that they affect different parts of the digestive tract: 

• Ulcerative colitis affects only the top layer of tissue in the large intestine (colon) and rectum.
• Crohn's disease can affect all layers of tissue in the intestinal wall as well as any part of the digestive tract. Inflammation often occurs in patches, with areas of normal tissue in between.

IBD symptoms may include:

• Severe pain in the abdomen (belly), often on the right side, just after eating
• Diarrhea, with or without blood
• Unexplained weight loss
• Loss of appetite
• Bleeding from the rectum
• Small tears in the lining of the anus (anal fissures)
• Infections around the anus (abscesses or fistulas)

An abnormal immune system response causes IBD. Your immune system's job is to protect you from germs and infection. During an immune response, chemicals are released causing temporary inflammation, which isolates the potential germs so they cannot spread.

Under normal circumstances, the immune system turns itself off after the threat of an infection has passed. With IBD, the immune system gets stuck in attack mode, leaving your intestines in a state of chronic inflammation.

Our team includes a dedicated diagnostic expert (pathologist) who specializes in conditions affecting the digestive system. This level of expertise helps rule out conditions that are similar to IBD, know which form of IBD you have and correctly identify the affected areas of your intestines.

Tests we use to diagnose IBD include:

• Blood tests: We analyze a sample of your blood. Blood tests can identify signs of inflammation or the early warning signs of complications, such as malnutrition.
• Stool test: Examining a sample of your stool helps identify signs of infection.
• Colonoscopy: A colonoscopy works by inserting a thin flexible tube with a tiny camera at the tip (colonoscope) into the anus and gently advancing it up the entire length of the colon. A colonoscopy helps pinpoint areas of inflammation or finds signs of complications, such as bleeding, ulcers or narrowing (strictures). We can also detect early signs of cancer by removing tissue samples and examining them under a microscope (biopsy). Learn more about colonoscopy.
• Flexible sigmoidoscopy: Similar to a colonoscopy, sigmoidoscopy uses a thin flexible tube with a camera at the tip. During this procedure, we can also look for early signs of cancer with the help of a biopsy. However, the test examines only the lower portion of the colon (sigmoid colon). 
• Double contrast barium X-ray: This imaging study is an alternative to colonoscopy. "Double contrast" refers to the two methods used to show the fine details of the digestive tract:      
• Inflating the colon with air makes the shape of the intestines appear dark
• Coating the intestines with a chemical (barium) makes the lining appear white
• Computed tomography (CT) scan: A CT scan takes X-rays from several different angles (slices) to produce images of your intestines. We use this test to look for signs of complications, such as bleeding or swollen pockets of pus (abscesses).
• Magnetic resonance imaging (MRI): MRI uses a powerful magnet and radio waves to capture high-resolution images of your intestines. MRI scans offer precise images, which helps us detect signs of abnormalities in your intestines.
• Enterography: This test shows fine details of the digestive tract with the help of a special liquid (contrast material) and advanced imaging technology, such as a CT scan or MRI. Enterography helps us determine whether medications or surgery will work best for you.

We consider your unique needs and work with a team of experts, including our colleagues in gastroenterology, to develop a personalized treatment plan. Our goal is to use non-surgical treatments whenever possible. If surgery is necessary, we offer minimally invasive procedures that help you recover faster with less pain. Read more about our treatments.

Non-surgical treatments for IBD include:

• Medications: Some people with IBD find lasting relief with the help of one or more medications. These medications include steroids for inflammation, antibiotics to fight infection and special medications to control your immune response (immunosuppressants).
• Changing your diet: Dietary changes do not cure IBD, but they can make your symptoms less severe. We help you avoid foods that cause inflammation and offer helpful tips such as eating smaller, more frequent meals, which can be easier on your intestines.
• Nutritional supplements: Taking nutritional supplements can help you get all of the vitamins and minerals you need to stay healthy, just in case you are not getting enough from the foods you eat.

We use minimally invasive techniques whenever possible. Minimally invasive techniques for IBD include accessing surgical areas through the abdomen (abdominal procedures) or rectum (anorectal procedures). These techniques use sophisticated technology and smaller incisions that heal quickly and minimize recovery time. Find out more about minimally invasive colorectal surgery. 

Abdominal procedures for IBD:

Minimally invasive abdominal procedures for IBD include:

• Strictureplasty: If chronic inflammation and scar tissue have narrowed your intestines, we use this procedure to open your intestines without removing and shortening them. Strictureplasty offers an alternative to removing and shortening your intestines (resection).
• Resection: During a resection, we remove the diseased portion of the digestive tract. Our colorectal surgeons take special care to remove the smallest necessary amount of tissue, which helps you maintain normal digestive functioning after surgery. If this procedure is right for you, we make every effort to reconnect the remaining intestines, which helps you maintain normal bowel functioning. If we cannot reconnect the intestines, you may need a colostomy or ileostomy.
• Colostomy: A colostomy allows you to eliminate stool from your colon through a bag that attaches to the abdominal wall outside your body. You may need a colostomy if the colon is not healthy enough for a reconnection to your digestive tract after a resection. A colostomy can bring changes to your everyday life, but we help you get back to your favorite activities over time. Learn more about preparing for surgery.
• Ileostomy: An ileostomy allows you to eliminate stool through your small bowel into a bag that attaches to your abdominal wall. You may need an ileostomy if your colon or small bowel needs time to rest and heal after surgery. After you are done healing, we frequently perform an additional procedure to reconnect your intestines (ileostomy reversal). An ileostomy may bring changes to your everyday life, but we let you know what to expect and offer helpful tips and encouragement every step of the way.
• IIeal pouch anal anastomosis (IPAA): If you need to have your entire colon and rectum removed, IPAA can help you avoid a permanent ileostomy. IPAA works by sewing the healthy end of your small bowel directly to the anus. We use the small intestine tissue to create a pouch to collect stool until you eliminate it through a bowel movement. After an IPAA procedure, you may need a temporary ileostomy to allow the best chances for healing and recovery. Learn about sphincter-sparing minimally invasive surgery.

Anorectal procedures for IBD:

These procedures include:

• Draining an abscess: An abscess is an infected pocket of tissue that is full of pus. Abscesses can form in the lining of your intestines when bacteria invade areas of healthy tissue. We often open and drain abscesses near the anus or rectum through an in-office procedure. If the abscess is higher up in the digestive tract (intraabdominal abscess), we drain it using a different technique involving imaging tests, which can help you avoid surgery.
• Repairing a fistula: The goal of a fistula repair is to break up an abnormal connection between the colon and other organs (fistula). Our depth of experience in colorectal surgery helps you avoid complications, so you can return to normal everyday functioning as quickly as possible.