Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is the name given to a group of medical conditions that cause long-term inflammation of the digestive tract, leading to persistent and severe diarrhea, pain, unintended weight loss and other symptoms.

The two primary types of IBD are Crohn’s disease and ulcerative colitis. While they share common symptoms, each condition affects different areas of the digestive tract and causes varying degrees of inflammation:

• Crohn’s disease causes damaging inflammation to the lining of the digestive tract. This inflammation can occur anywhere from the mouth to the anus, although it commonly affects the small intestine or colon. Sometimes the inflammation occurs in patches, meaning inflamed sections appear in between normal, healthy sections.

• Ulcerative colitis causes chronic inflammation and sores, but unlike Crohn’s disease it occurs only in the colon or rectum. The inflammation associated with ulcerative colitis is usually continuous, meaning there are no patches of healthy tissue within the affected area.

Without proper management, IBD poses the risk of serious complications, including:

• Bowel obstruction
• Malnutrition
• Fistulas, or open sores that are so deep they tunnel through the intestinal wall. A fistula can become infected and form an abscess, which may be life-threatening if not treated.
• Strictures, which occur when portions of the intestine become narrow and reduce or block the passage of food
• A perforated colon

People with Crohn’s disease or ulcerative colitis also have an increased risk of developing colon cancer.

While there is no cure for IBD, the medical community continues to find new and more effective ways to reduce inflammation and control symptoms.

At Scripps, our goal is to help you achieve two kinds of remission:

• We want to successfully manage the inflammation associated with your disease — ultimately reducing your risk of complications and allowing your digestive tract to heal.
• We want you to reach a point where you feel well and enjoy a good quality of life.

We do this by offering the full spectrum of medical and surgical treatment options for IBD and any resulting complications.

Medication therapy is often the first line of defense, and may be used alone or in combination with surgery.

Drug therapy options

• Drugs that reduce inflammation, including steroids.

• Drugs that target the immune system, ranging from commonly used immunosuppressants (such as azathioprine), to biologics reserved for people who don’t respond well to other medications.

• Antibiotics to help reduce the risk of infections and suppress intestinal bacterial growth.

• Drugs that relieve specific symptoms often caused by IBD, including diarrhea, pain and low levels of vitamin B-12, iron and other vitamins and minerals.

Surgery is often reserved for patients with moderate to severe IBD who don’t respond well to drug therapy, or who have developed complications that require surgical treatment.

Surgical options

• Proctocolectomy, or surgery to remove the colon and rectum, for people with ulcerative colitis.

Patients who require a proctocolectomy often undergo a second procedure called ileoanal anastomosis surgery, also known as J-pouch surgery, so they can pass stool normally without the need for a collection bag.

Some patients, however, are not eligible for J-pouch surgery. Instead, their surgeon will likely create a permanent opening in their abdomen, called a stoma, which allows feces to pass into a bag worn on the outside of the body.

• Surgery to remove a diseased portion of the colon or rectum and then reattach the healthy sections. This procedure is typically used to treat patients with Crohn’s disease, who have healthy patches of tissue in between the inflamed portions of their digestive tract.

• Strictureplasty or stricture dilations. These procedures help widen portions of the intestine that have become narrowed due to the inflammation caused by Crohn’s disease.

• Surgery to close fistulas.

• Surgery to drain infected abscesses.

Scripps gastroenterologists also offer many other services designed to help patients manage their conditions, including their risk of complications. These include:

• Chromoendoscopy for ongoing colorectal cancer screening. This endoscopy procedure is often used among high-risk patients because it utilizes a special dye that helps pre-cancerous lesions show up better.

• Pouch surveillance for people with J-pouches or Kock pouches (also known as K-pouches).

• Coordinating referrals to other Scripps specialists, including physicians at Scripps Center for Integrative Medicine who provide complementary and alternative therapies for people with IBD.

• Managing patients who develop short bowel syndrome (also known as short gut syndrome) after part of their small intestine has been removed.

Scripps gastroenterologists actively participate in research designed to find the causes of, and new treatments for, IBD. Their areas of study include:

• Genetic and epigenetic changes that occur during the course of IBD
• Changes that occur in the fecal microbiome as a result of IBD
• Establishing quality measures for IBD
• Exploring the link between diet and IBD symptoms

Learn more about active studies.

Take a look at the following resources for more information on inflammatory bowel disease:

• Crohn's and Colitis Foundation (Diet and Nutrition)
• Crohn's and Colitis Foundation (Gut Friendly Recipes)
• Nutrition Therapy for IBD
• International Foundation for GI Disorders  
• United Ostomy Association of America 

Scripps gastroenterologists offer consultations or care for people with IBD at the following locations:

• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital (San Diego and Chula Vista)
• Scripps Green Hospital
• Scripps Clinic Carmel Valley
• Scripps Clinic Encinitas
• Scripps Clinic Jefferson
• Scripps Clinic Rancho Bernardo
• Scripps Clinic Rancho San Diego