Inflammatory Bowel Disease

Presented by: Shamita Shah, MD
Clinical Assistant Professor, Gastroenterology
Clinical Director, Stanford Inflammatory Bowel Disease Program
Stanford University Medical Center
February 24, 2010

Lecture Overview:

• Ulcerative colitis and Crohn’s disease are chronic inflammatory disorders of the gastrointestinal tract known as inflammatory bowel disease (IBD).
• Its cause is unknown and may be a combination of genetic, environmental, and immune system factors.
• Treatment is designed to induce a rapid response and maintain remission.
•  Management of symptoms is individualized for each patient, and compliance to medical treatment is essential.

Inflammatory bowel disease (IBD) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn’s disease. Although the diseases have some features in common, there are some important differences.

It’s estimated that as many as 2 million Americans have inflammatory bowel disease, with 10,000 news cases reported each year. The disease occurs most frequently in young people, age 20 to 30, and may also occur in middle-aged adults, age 50 to 60. It is most common in the industrialized nations of Western Europe and North America; however as nations in Asia, Africa, and South America become more “Westernized”, more cases of IBD are being reported.

“While there’s no test to predict who might develop IBD, people with a family history are 30 to 100 times more likely to develop the condition,” said Shamita Shah, MD, the clinical director of the IBD program at Stanford, who spoke at a presentation sponsored by the Stanford Health Library. “A genetic predisposition coupled with environmental triggers can cause a dysregulation of the immune system, and that imbalance can trigger chronic inflammation.”

Two Different Conditions
Ulcerative colitis is an inflammatory disease in which the lining of the large intestine becomes inflamed, starting in the rectum and then working its way up through the colon.  Symptoms may include bloody diarrhea, rectal bleeding, weight loss and fever.

Crohn’s disease causes inflammation that extends much deeper into the layers of the intestinal wall and tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel. It may affect any part of the gastrointestinal system, from the mouth to the anus. Symptoms may include non-bloody diarrhea, weight loss, abdominal pain, fatigue, and fevers.

Triggers can range from infection to antibiotics, stress, diet, and nonsteroid anti-inflammatory drugs (NSAIDs). Both disorders can be painful, debilitating, and lead to sometimes life-threatening complications.

The two conditions have different characteristics and physicians need to conduct a thorough evaluation to diagnose the disease, which may include endoscopy, tissue biopsy, imaging (X-ray, MRI, or CT), blood and stool tests. “It’s very important to get an accurate diagnosis since some infections can mimic IBD,” said Shah. “Tests can also make sure that there are no complications such as abscess, fistula, or narrowing of the intestine.”

Evaluation for other manifestations of IBD outside of the intestine is also very important because the disease can also affect the eye, skin, joints, liver, and other organs.

Individualized Treatment
“Treatment is designed to induce a rapid response and maintain remission. The goal is to achieve and maintain mucosal healing, avoiding complications and hospitalizations, and improving quality of life,” Shah said.

Physicians can prescribe a variety of medications, including anti-inflammatories such as steroids, and oral or topical mesalamine agents, biologics, and immunomodulators. Some drugs are used to induce remission (induction) and others to maintain remission (maintenance).  For example, steroids are helpful for getting inflammation under control initially but should only be used in the short term and should never be stopped abruptly, she said. Immunomodulators take time to work so they are used for maintenance rather than induction therapy. These medications often have side effects which should be discussed with your physician.

Surgery may be required in advanced cases of ulcerative colitis, when no other treatment helps. “The beauty is, once you remove the part affected part of your colon affected by ulcerative colitis, you’re cured,” said Shah. “That’s not the case in Crohn’s disease: Surgery is not curative and the disease may recur.”

Adherence to treatment, a healthy diet, bone density tests to assess for osteopenia and osteoporosis after prolonged steroid use, and routine vaccinations are essential in staying healthy with IBD.

“It’s important to individualize therapy and understand the disease,” said Shah.  “Ongoing research is improving our understanding and new therapies continue to be developed.”

About the Speaker
Shamita Shah, MD, is a clinical assistant professor of medicine (gastroenterology) and the clinical director of Stanford’s Inflammatory Bowel Disease Program. She is board certified in internal medicine and gastroenterology.  A specialist in Crohn’s disease and inflammatory bowel disease, Shah has a clinical and research focus in treating severe colitis, applying novel diagnostic tools,and preventing post-operative recurrence. Shah joined Stanford in 2008 after completing a fellowship in inflammatory bowel diseases at the University of Chicago.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Shah
http://gastrohep.stanford.edu/profiles/Shamita_Shah/

Gastroenterology at Stanford Hospital
http://stanfordhospital.org/clinicsmedServices/clinics/gastroenterology/

The Division of Gastroenterology and Hepatology
http://gastrohep.stanford.edu/

Crohn’s and Colitis Foundation of America
http://www.ccfa.org/