The Basics of IBD

Like our other Expert Jennifer, I too listened to the Children’s Digestive Health & Nutrition Foundation web cast last month. While she has already given a good overview of the discussions that took place I thought it worth going over some of the basics about IBD diagnosis and treatment options that were discussed. 

Dr. Maria Oliva-Hemker (Johns Hopkins University) works mainly with children who have IBD and Dr. Joshua Korzemik (Harvard Medical School) works primarily with adults. Both physicians agreed that today there are about 1 million adults who have been diagnosed with IBD and approximately 100,000 children. 

To properly understand IBD – Inflammatory Bowel Disease – you need to know that it is comprised of two illnesses, Ulcerative Colitis (UC) and Crohn’s disease, with some people now being diagnosed with Crohn’s colitis. Patients diagnosed with UC typically present with diarrhea, often with blood in the stool. UC affects only the colon, or parts of the colon, and not the small intestine. UC is typically found to be left-sided, in the rectum, or in the entire colon (called pan-colitis). Crohn’s disease, on the other hand, can affect any part of the digestive tract. In patients who are diagnosed with Crohn’s there is not as much blood or diarrhea present as in UC patients but they do tend to have more problems with low energy, anal abscesses, and fistulas, which are not found in UC patients. Today, Crohn’s disease is more commonly found in children than adults. 

In children who are diagnosed with IBD, they typically present with only one symptom, abdominal pain (or a chronic tummy ache). In other children the only symptom they have could be a failure to thrive and grow. In both children and adults, other symptoms that can point to IBD beyond the gastrointestinal tract include: joint pain, skin rashes, mouth sores, low-grade fever, liver inflammation, irritated or red eyes, and weight loss.  

Both Dr. Oliva-Hemker and Dr. Korzemik agreed that other diseases can mimic IBD, making a complete history and tests necessary for a doctor to come to a proper diagnosis. Tests should include a medical history, a physical exam, lab and blood studies, an endoscopic study, colonoscopy, and radiologic studies as deemed necessary.

Treatment options for children and adults are similar. Today, doctors are seeing the efficacy of combining medication with nutrition (in my personal experience this was not the case 10 years or more ago and I’m glad to hear that the medical community is embracing the idea that diet and nutrition play a role in treating IBD). In severe cases of IBD surgery also becomes a viable treatment option. 

Medications used in treating IBD include the following:

For Mild IBD - 
- 5-ASA drugs are typically used to treat Ulcerative Colitis and include prescription medications such as: Asacol, Pentasa, Canasa, Rowasa, and Azulfidine. 
- Antibiotics like Metronidazole are typically used to treat Crohn’s colitis, but not colitis.