Inflammatory Bowel Disease (IBD)

Approximately one million Americans suffer from inflammatory bowel disease (IBD), a condition that causes the upper (esophagus, stomach and small intestines) or lower (colon) gastrointestinal (GI) tract to become inflamed. People with IBD have symptoms that include diarrhea, abdominal pain, infections and bleeding. There are two main types of IBD: Crohn’s disease and ulcerative colitis. Although there is no cure for IBD, medical and surgical care can minimize symptoms and prevent complications. Learn the myths and facts about IBD.

As the surgical team of the Crohn’s and Colitis Center in the Division of General and Gastrointestinal Surgery at Brigham and Women’s Hospital (BWH), our board certified colorectal surgeons offer the most innovative and effective treatment for patients with IBD conditions, including minimally invasive surgical techniques that improve lives.

Inflammatory Bowel Disease Topics

Crohn’s Disease

Crohn's disease is an inflammatory bowel disease (IBD) that causes inflammation of the lining of your digestive tract. Crohn’s disease most commonly affects the end of the small intestine, or the terminal ileum. Sometimes, the entire digestive tract (regional enteritis) is affected. Crohn’s disease is a chronic condition and can be hereditary. Though painful and, at times, debilitating, the symptoms of Crohn’s disease can be greatly reduced with proper medical and surgical care. Learn more about Crohn’s disease.

Symptoms of Crohn’s Disease

Crohn's disease symptoms can be mild or severe, and symptoms may arise suddenly, without warning. You may also have periods of remission when you have none of the following symptoms:

  • Abdominal pain and cramping
  • Bloating
  • Diarrhea (sometimes bloody)
  • Rectal bleeding
  • Reduced appetite and weight loss
  • Fever
  • Fatigue
  • Joint pain
  • Anal fissures  

Diagnosis of Crohn’s Disease

People who have chronic abdominal pain, diarrhea, fever, weight loss and anemia may be examined for signs of Crohn's disease. In addition to a complete medical history and physical examination, diagnostic procedures may include:

  • Blood tests
  • Stool culture
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
  • Colonoscopy
  • Biopsy
  • Upper GI (gastrointestinal) series (also called barium swallow)
  • Lower GI (gastrointestinal) series (also called barium enema)

Learn more about diagnostic tests and procedures for Crohn’s disease.

Treatment for Crohn’s Disease

There is no cure for Crohn's disease but treatment can help control symptoms. Treatment may include:

Lifestyle and Medical Treatment

  • Drug therapy
  • Diet
  • Supplements
  • Feeding through a vein

Learn more about medical treatment for Crohn’s disease.

Surgical Treatment

Colon and rectal surgeons at BWH have advanced training in diagnosing and treating Crohn’s disease, and use minimally invasive techniques that speed healing and preserve healthy bowels. Our board certified surgeons work closely with a multidisciplinary team of medical colleagues.

Surgical treatment includes:

  • Drainage of abscesses or removal of a section of bowel
  • Ostomy Part of the intestines is removed, and a new method for stool release is created. The surgery to create the new opening is called ostomy, and the new opening is a stoma.
    • Ileostomy The colon and rectum are removed and the bottom part of the small intestine (ileum) is attached to the stoma.
    • Colostomy A surgically-created opening in the abdomen through which a portion of the colon is brought up to the surface of the skin. Sometimes a temporary colostomy may be performed when part of the colon has been removed and the rest of the colon needs to heal.

Learn more about surgical treatment for Crohn’s disease.

Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease that causes inflammation of the inner lining of the large intestine (colon or bowel) and rectum. This inflammation triggers diarrhea, or frequent emptying of the colon. Ulcers (tiny open sores) may also form, producing pus and mucus, in addition to bleeding. Sometimes, the eyes, skin, liver and joints are affected as well. Ulcerative colitis can increase the risk for colon cancer. Learn more about ulcerative colitis.

Symptoms of Ulcerative Colitis

Symptoms of ulcerative colitis vary from person to person. You may have symptoms intermittently or all the time. Ulcerative colitis symptoms include:

  • Abdominal pain with cramping
  • Frequent loose bowel movements
  • Bloody diarrhea, often containing pus or mucus
  • Rectal bleeding
  • Urgency
  • Having to wake from sleep to have bowel movements
  • Weight loss and dehydration
  • Fatigue
  • Anemia

Less common symptoms:

  • Skin lesions
  • Joint pain
  • Inflammation of the eyes
  • Liver disorders
  • Osteoporosis
  • Rashes
  • Kidney stones

Diagnosis of Ulcerative Colitis

A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation) will be done. Diagnostic procedures may also include:

  • Stool culture
  • Colonoscopy
  • Biopsy
  • GI (gastrointestinal) series (also called barium enema)

Learn more about diagnostic tests and procedures for ulcerative colitis.

Treatment for Ulcerative Colitis

Your surgeon will recommend a step by step approach to relieve symptoms of ulcerative colitis. The first course of action may be:

Lifestyle and Medical Treatment

  • Drug therapy
  • Diet: low-fat and low-fiber
  • Supplements
  • Intravenous feedings

Learn more about diet and medical treatment for ulcerative colitis.

Surgical Treatment

Most people with ulcerative colitis do not need surgery. However, twenty-five to forty percent of patients require an operation to remove the colon or rectum because of bleeding, chronic illness, colon perforation or colon cancer. Doing this is often termed “curative,” because the diseased area has been removed. If just the affected area of the colon is removed, it is called a resection. This is usually done in one procedure and is performed as an open surgery, laparoscopic surgery or robotic surgery. Surgical options include:

  • Proctocolectomy with ileostomy involves proctocolectomy (removal of the entire colon and rectum) with ileostomy (creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste).
  • Ileoanal anastomosis (also called a pull-through operation) removes the diseased portion of the colon and preserves the outer muscles of the rectum. The ileum is attached inside the rectum, forming a pouch, or reservoir, that holds waste. This allows the patient to pass stool through the anus in a normal manner, although the bowel movements may be more frequent and watery than usual.
  • Ileoanal J-pouch is done in two or three stages. In the first stage, the colon or the colon and rectum are completely removed. A new rectum called a "J-pouch" is created and "anastomosed,” or hooked up, to the muscles of continence (anal sphincters). Usually a temporary, diverting ileostomy, or bag, is created upstream from this complicated surgery so that it can heal without infection. After six to twelve weeks, the temporary ileostomy is taken away with a smaller operation and the patient can return to evacuating normally.

Learn more about surgical treatment for ulcerative colitis.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have Crohn’s disease or ulcerative colitis and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced colon and rectal surgeon are important to the successful outcome for patients with inflammatory bowel disease (IBD).

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in Crohn’s disease and ulcerative colitis. After surgery you will go to the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.

 Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating inflammatory bowel disease (IBD). In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Our surgeons are an integral part of the Crohn’s and Colitis Center. In addition, patients have full access to BWH’s world-renowned academic medical center in Boston with its diverse clinicians and state-of-the-art facilities.

Resources

Go to our health library to learn more about Crohn’s disease and ulcerative colitis.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

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