Physicians’ Review: Managing Inflammatory Bowel Disease

DANBURY — Inflammatory bowel disease (IBD) is broken into two forms: ulcerative colitis (UC) and Crohn’s disease. Although treatments are readily available, early detection and prevention are key to long-term colon health. At a recent medical town meeting at Danbury Hospital, physicians Steve Brandwein and Christopher Foglia addressed IBD. The program was part of a free health and wellness series conducted by the hospital.

Among the information provided was the fact that ten to 20 percent of UC sufferers have an affected family member, and that smoking increases the chance to develop UC, while, surprisingly, those who have had their appendixes removed are at a lower risk. Fifty percent of patients experience no symptoms one year after treatment. Those who do can expect a mild to moderate range of rectal bleeding, diarrhea, and abdominal pain.

One out of every five patients who have Crohn’s disease has an affected relative. Some factors that can increase the risk of developing Crohn’s include smoking, stress, intestinal bacteria, and residing in northern latitudes.

Common complications that accompany Crohn’s are fistulas, strictures in locations that can make treatment more difficult.

Common symptoms that accompany IBD in general are arthritis, eye problems, and liver disease.

Dr Brandwein noted that the ultimate goals for the treatment of IBD include induced and sustain remission, restore nutrition, decrease numbness, and maintain quality of life.

Most IBD sufferers have mild cases that can be treated successfully with topical medicine. Fewer IBD sufferers have a moderate severity and can be adequately treated with steroids.

The fewest group is the most severe and requires surgery to treat IBD. Probiotics, which contain “good bacteria,” can be used in combination with a healthy lifestyle to reduce the risk of IBD.

Dr Foglia, physician specialist in colon and rectal surgery, highlighted one of the differences between ulcerative colitis and Crohn’s disease. UC starts at the anus and works its way up. Crohn’s, conversely, can attack anywhere in the GI tract and skip around.

Pharmacological treatments are based on severity and include antibodies, steroids, antibiotics, and immune modulators. Methods of treatment are available in oral, intravenous, and enema forms.

When pharmacological treatments are administered, medicines must possess low pH levels to pass through the stomach and reach the small intestine.

Surgery is typically required when medications fail to address the problem. Various surgeries that are used to treat ulcerative colitis include total abdominal colectomy (TAC), total proctal collectomy (TPC), and loop ileostomy.

A majority of these surgeries will require either temporary or permanent ileostomy bags. This decreases risk of complications and allows time for healing. Complications for UC surgeries can include the need for a stoma, leaks, ongoing risk for cancer, and pouch problems such as frequent bowel movements. 

Surgical treatment for Crohn’s disease is required due to the failure of all previous medical treatments and includes resection strictureplasty and diversion. Preoperative procedures such as endoscopies, radiological screening, and symptom evaluations provide the surgeon with valuable information he/she might need to effectively correct the problem.

Laparoscopy, a newer, more commonly practiced minimally invasive surgical procedure, allows for faster recovery, smaller incisions, and performed with similar outcomes of traditional surgery but is less traumatic and faster recovery time.

In the area of gastrointestinal care, Danbury Hospital is ranked in the top five percent nationally for overall gastrointestinal services and gastrointestinal surgery by HealthGrades. This is the second consecutive year for the national award.