Inflammatory Bowel Disease (IBD)
Chronic inflammatory bowel disease (IBD) affects more than two million Americans and many more worldwide. Inflammation or ulceration in the small and large intestines associated with these diseases impairs patients' quality of life by causing debilitating symptoms ranging from abdominal pain and intestinal bleeding to weight loss, anemia, and nutritional deficiencies. IBD can frequently manifest outside the digestive tract, in places such as the skin, eyes, joints, mouth, and elsewhere.
People are most often diagnosed with IBD in their late teens to early 20s, but may develop the condition at any age. IBD affects women and men equally. The two most common types of IBD are:
- Ulcerative colitis: an inflammation of the innermost lining of the large intestine (colon or bowel) and/or rectum.
- Crohn's disease: an inflammation that usually involves the lining and walls of the small intestine, most often the lower part called the "ileum." It may also affect the large intestine and other parts of the digestive system and can spread deep into the tissue.
Care for patients with IBD at the Center for Advanced Digestive Care of NewYork-Presbyterian/Weill Cornell Medical Center is delivered through The Jill Roberts Center for Inflammatory Bowel Disease. Our goal is to help patients achieve wellness and a high quality of life while living with IBD.
Patients can receive comprehensive assessment, education, psychosocial support, and a personalized treatment plan that may include a combination of lifestyle changes and medication. Our surgeons are highly skilled at performing the techniques needed to help patients with IBD who cannot achieve adequate relief of their symptoms through nonsurgical approaches.
The Center also offers support groups to help patients cope with this very difficult disease. Patients can also participate in clinical trials, helping to advance our understanding of this difficult disorder.
Inflammatory Bowel Disease Symptoms and Diagnosis
Symptoms of IBD may include frequent diarrhea, abdominal cramps, abdominal pain, rectal bleeding, fever, and weight loss. Related symptoms may appear if the inflammation manifests in other parts of your body, like your joints (arthritis), skin, or eyes. Your physician will ask you to describe your symptoms, when they began, and what makes them better or worse. You will undergo a physical exam to look for any outward signs of IBD, such as pain when your doctor presses on areas of your abdomen, mouth sores, rashes, and abdominal masses. You may also have a blood test and have a sample of your stool examined.
Your doctor may perform the following additional tests to see if you have IBD:
- X-rays: To see what is happening in your gastrointestinal (GI) tract, your doctor may use a series of x-rays called a "GI series." To view the stomach and upper part of the small intestine (upper GI series), your doctor will ask you to drink a liquid containing barium that coats your GI tract, allowing it to be seen on an x-ray. To view the rectum, large intestine, and lower small intestine, you may receive a barium enema, called a lower GI series, which is given through your rectum.
- Upper endoscopy (EGD): We may use a procedure that allows the physician to examine the inside of the esophagus, stomach, or duodenum (upper part of the small intestine).
- Sigmoidoscopy or colonoscopy: Your doctor uses these procedures to view either the lower part of your large intestine (sigmoid colon) or your entire large intestine to look for inflammation or bleeding. Both procedures use a thin flexible tube inserted into your rectum with a camera at the end. If necessary, the doctor may take a small tissue sample (biopsy) from the lining of the intestine to examine under a microscope.
Inflammatory Bowel Disease Treatment
While there is no cure for inflammatory bowel disease (IBD), lifestyle changes, medications, and surgery can reduce patients'' symptoms, achieve a remission (a period of time when symptoms fade), and improve their quality of life.
While foods don’t cause IBD, eating certain foods can make IBD symptoms worse. Our nutrition team, working in close collaboration with your gastroenterologists, can help you modify your diet to reduce your IBD symptoms, and also make sure that you are eating and absorbing enough food to meet your nutritional needs.
Smoking cessation: Smoking may be a cause of IBD and may also worsen symptoms. Speak with your doctor about the various options available to help you stop smoking.
Stress relief: While stress is not a known cause of IBD, it can worsen your symptoms or bring about a relapse. It may be helpful for people with IBD to find effective ways to reduce stress, such as exercise, yoga, meditation, massage, breathing exercises, biofeedback, therapy, and support groups.
If your doctor believes your inflammation is manifesting outside of your gut: Your doctor may recommend you follow up with other specialists, including an ophthalmologist, rheumatologist, and/or dermatologist.
Inflammatory Bowel Disease Medications
Drugs to treat IBD are designed to decrease the inflammation in the lining of the colon. A variety of medications are available to manage the symptoms of IBD and help keep the disease in remission. It is important to work with your doctor to determine what medication is right for you. Examples include:
- Anti-inflammatory agents: Aminosalicylates like 5-ASA are aspirin-like anti-inflammatory agents often used as the first drug therapy for patients with early-stage IBD.
- Steroids such as prednisone are typically used to treat patients with moderate to severe disease and reduce symptoms that have continued despite other treatments. However, because steroids do not maintain remission and have side effects, we discuss strategies with patients to limit or avoid their use.
- Antibiotics and probiotics used to treat Crohn's disease may also have a role in effectively treating some forms of colitis.
- Immunosuppressants help to reduce inflammation and maintain remission by lowering the immune response, which is heightened in patients with IBD.
- Biologic therapies have proven to be effective treatments and include Remicade®, Humira®, and Cimzia®, as well as newer drugs such as Tysabri®.
Promising new medications and therapies are always being investigated by our active research group. Patients may be offered the opportunity to participate in clinical trials.
Patients being treated with intravenous IBD therapies may receive them in The Jill Roberts Outpatient Infusion Center. This comfortable and private in-office setting is staffed by an expert clinical team with special training. In-office infusion allows for close observation and communication between patients and staff members.
The Jill Roberts Center provides the latest intravenous therapies, including:
- Biologic therapies such as Remicade
- Ion infusions for IBD-associated anemia
- Stem cell infusion therapy
- Medications for controlling chronic pain
- Intravenous hydration therapy
- Nutrition therapy
While surgery is not the first approach physicians use to treat Crohn's disease or ulcerative colitis, it can often be used to greatly restore quality of life in people who are struggling to get well despite medical treatment. Some surgeries control symptoms, while others are more curative.
The majority of elective colon and rectal IBD surgeries are performed laparoscopically. Laparoscopic surgery is performed through a small incision rather than larger incisions made in traditional open surgery, significantly reducing healing time, pain, scarring, and hospital stay.
Surgery for Crohn's disease is offered when medications are no longer effective or may even be harmful. More than half of people with Crohn's disease will eventually need an operation during their lifetime. When surgery is needed, our surgeons aim to preserve as much of the bowel as possible. Surgery for Crohn's disease may include:
- Resection: Removal of diseased tissue, typically for patients with isolated disease that affects only a small area of the intestine. This can be achieved through open, laparoscopic, or robotic techniques based on the situational details of the diseased tissue and the judgment of the surgeon.
- Strictureplasty: Short areas of disease and narrowing caused by scar tissue are often treated with a bowel-sparing procedure called strictureplasty. A strictureplasty does not remove the diseased segment of the bowel, but opens the narrowing in a way that restores the flow of intestinal contents and allows nutrients to be absorbed. Sometimes the surgeon needs to perform multiple strictureplasties in a single operation if several areas of the small intestine are diseased.
- Post-operative therapies: After an initial resection, many patients require additional surgery for inflammation in new areas of the bowel. Our gastroenterologists use early intervention, including postoperative therapies to prevent recurrence.
Surgery to treat ulcerative colitis usually involves removal of the entire colon and rectum, a procedure called "proctocolectomy." Since ulcerative colitis involves only the large bowel, this operation is considered curative. Patients then need one of the following:
- Ileostomy: The end of the small intestine is surgically disconnected from the large intestine and then used to create an opening, or stoma, on the surface of the abdomen, through which waste is emptied. The patient wears an external bag over the opening.
- Ileoanal pouch procedure (ileoanal anastomosis or J-pouch): This procedure creates an internal pouch from part of the small intestine which provides a storage place for stool in the absence of the large intestine, allowing the patient to pass waste through the anus in a normal manner and avoiding the need for an external bag. Some studies suggest that fertility may be decreased after an ileoanal pouch procedure, possibly as a result of internal scarring. However, women of child-bearing age have spontaneously conceived and given birth successfully after this procedure. The laparoscopic techniques used by surgeons at NewYork-Presbyterian/Weill Cornell reduce the amount of internal scarring.
UIcerative Colitis and C.Difficile
Clostridium difficile (C. difficile) is a common bacterium that can cause infection in the intestines. The intestines have healthy bacteria with a variety of useful functions in the body. But in some patients using antibiotics, especially those on long-term therapy, the antibiotics can disrupt the balance of healthy bacteria and make the intestines susceptible to infection with C. difficile. Symptoms of C. difficile infection include diarrhea, cramping, abdominal pain, and colitis. Handwashing is very important to prevent infection with C. difficile.
CADC researchers are evaluating fecal transplant, a novel approach to the treatment of patients with ulcerative colitis who have C. difficile, which may also prove useful for patients with ulcerative colitis who don't have this infection. Studies have shown that introducing bacteria from the stool of a healthy individual into the intestines of someone with ulcerative colitis and C. difficile can restore the normal diversity of intestinal bacteria, relieving colitis symptoms and even curing the disease in some patients. This approach shows great promise and requires further evaluation in clinical trials to see if it can be used to effectively treat inflammatory bowel disease.
Follow-up Care for IBD
The Jill Roberts Center provides early detection and screening for the long-term complications of IBD, including colorectal cancer and osteoporosis. We also work closely with other investigators to explore the overlap between Crohn's disease and celiac disease.
Our team emphasizes the importance of IBD annual checkups and frequent visits to maintain control of inflammation that causes symptoms. In addition, we use biomarkers to assess the optimal healing and maintenance of remission, as well as endoscopy, imaging, and diagnostic testing to monitor how each patient's disease is progressing.
Support groups, guest speakers, and seminars that help patients cope with the day-to-day challenges of living with IBD are available through the Jill Roberts Center for Inflammatory Bowel Disease. Support groups address practical and emotional issues such as body image, family issues, how to speak with your doctor, and employment concerns. Guest speakers address topics such as breathing, meditation, complementary medicine, and pain management.
The CADC also offers a range of clinical support and wellness services to its patients, including social work consultations and genetic counseling. For IBD patients who have any type of ostomy, the Center for Advanced Digestive Care has specialized wound, ostomy and continence nurses, and hosts a free support group for patients living with an ostomy.
Further offerings by the Integrative Health and Wellbeing Program include mind-body instruction, acupuncture and more
Because the abdominal pain and inflammation associated with IBD can affect your appetite and ability to digest and absorb food, nutritional health is often compromised. We encourage regular follow-up visits to enable us to observe you closely and make sure your nutritional needs are being addressed.
The CADC also offers short-term nutritional guidance. We offer most of these services at no cost to those who see a CADC physician. Patients seeking further offerings additional nutrition counseling can utilize the following NYP resources:
The CADC's approach to IBD care extends to other medical specialties beyond gastroenterology. Our doctors pay close attention to other parts of the body where IBD inflammation may show up, including the skin, eyes, and joints. Our physicians will recommend visits to specialists for these areas as needed.