What is inflammatory bowel disease?
The term inflammatory bowel disease (IBD) is commonly used to refer to Crohn’s disease and ulcerative colitis. There are also some cases where the colon is inflamed but the diagnosis may be unclear — these cases may be called indeterminate colitis. These chronic diseases cause inflammation and ulceration in the inner lining of the gastrointestinal (GI) tract. It is estimated that more than 1.5 million Americans suffer from IBD. IBD afflicts people of all ages, but up to 25 percent of cases are diagnosed before the age of 20 years old. IBD is actually one of the most significant chronic diseases affecting children and adolescents.
Crohn’s disease can cause inflammation any part of the GI tract from the mouth to the anus. However, the lower part of the small intestine (ileum) and the large intestine (colon) are most often involved. The lining of the intestines becomes raw and ulcerated with inflammation that can extend through the entire thickness of the intestinal wall.
Ulcerative colitis is a disease of the colon. Intestinal inflammation is similar to Crohn’s in that the inside lining of the colon is diseased, but the bowel injury occurs in the inner lining of the colon and does not extend deeper into the intestinal wall.
The actual cause of IBD is unknown but the current scientific evidence suggests that it is the result of a complex interaction of factors involving a person’s genes, their immune system and the environment. The immune system of an individual with IBD can become stimulated by something in the environment or by the microorganisms within the gastrointestinal tract. Once the immune system is stimulated or “turned on,” it often does not know how to turn itself off. The resulting inflammation leads to damage in the GI tract that then leads to symptoms.
IBD symptoms (which are similar for both Crohn’s disease and ulcerative colitis) can develop gradually or suddenly.
The symptoms of Crohn’s disease vary depending on the severity and location of the inflammation and include:
Ulcerative colitis symptoms often include:
Some children with Crohn’s disease and ulcerative colitis may also experience rashes, mouth sores, joint pain and growth failure.
In addition to a thorough medical history and physical examination, three tests are used to identify IBD:
Often, the same drugs are used to treat Crohn’s disease and ulcerative colitis. The main focus of therapy is to help the person’s immune system control itself and stop the inflammation that is causing damage to the intestines.
These medications include:
Drugs containing mesalamine, or 5-aminosalicylic acid (5-ASA) (e.g., Azulfidine®, Pentasa®, Asacol®, Colazal®, Dipentum®, Lialda®, Apriso®)
Corticosteroids (e.g., prednisone, budesonide)
Immunosuppressive agents (e.g., 6-Mercaptopurine®, Imuran®, methotrexate, Remicade®, Humira®, Cimzia®)
Antibiotics (e.g., metronidazole, ciprofloxacin, rifaxamin)
Dietary therapy at times can have the similar effects as drug therapy. IBD dietary therapy may include consumption of predigested formula by mouth or feeding tube. It may also involve not eating food but receiving nutrition through an intravenous line (total parenteral nutrition/TPN). Dietary therapies are often used to complement some of the medication therapies.
Surgery may be necessary in Crohn’s disease when medications no longer control symptoms or when an intestinal obstruction or other complication arises. In most cases, surgery involves removing the irreversibly diseased segment of the bowel and then rejoining the two ends of the healthy bowel together. For ulcerative colitis, surgically removing the entire colon and rectum is considered a permanent cure. A small opening called an ileostomy is created in the front of the abdomen, where the remaining small intestine is attached, to drain liquid waste into a small bag attached to the skin. Later, the lowest part of the small intestine may be reattached to the anal opening. Once healed, the ileostomy is closed and feces will move normally through the anus.
The IBD Center offers a multidisciplinary approach to the diagnosis and management of Crohn’s disease and ulcerative colitis from infancy to adulthood. We work with the referring health care provider to help children with these digestive diseases lead healthy and productive lives. We provide the highest quality medical and surgical care.
The IBD Team
Our multidisciplinary team includes gastroenterologists, nutritionists, surgeons and nurses. In addition, many other pediatric specialists provide services as needed.
More Information About Conditions of the Colon in the Health Library