Diagnosis and Treatment for inflammatory bowel disease (IBD)

Diagnosis:

Lab Test

tests for an infection or anemia. Your doctor may recommend blood tests to look for bacterial or viral infection symptoms and anemia, a disease in which there aren’t enough red blood cells to supply enough oxygen to your tissues.

Stool Sample. To check for organisms like parasites or concealed (occult) blood in your stool, your doctor may ask for a sample of your feces.

endoscopic techniques

Exam by colonoscopy

Colonoscopy: Through the use of a small, flexible, illuminated tube with a camera at the end, this examination enables your doctor to see your whole colon. Tiny tissue samples (biopsies) may be collected during the operation for laboratory examination. A biopsy is the only method to distinguish IBD from other types of inflammation.

Sigmoidoscopy: Your doctor will inspect the rectum and sigmoid, the last part of your colon, using a thin, flexible, lit tube. A partial colonoscopy may be substituted for this test if your colon is irritated.

Lower endoscopy: Your healthcare professional will examine your esophagus, stomach, and the first segment of your small intestine during this operation (duodenum). Although it is uncommon for these areas to be affected by Crohn’s disease, Your doctor may suggest this test if you are experiencing upper abdominal discomfort, nausea, or vomiting.

Endoscopy of a capsule: This test may occasionally be used to identify Crohn’s disease in your small intestine. You ingest a capsule with a camera inside of it. The capsule leaves your body painlessly in your feces after the photographs are transferred to a recorder you wear on your belt. 

To confirm a Crohn’s disease diagnosis, your doctor may conduct an endoscopy with a biopsy can still required. The doctor should not do capsule endoscopy if a bowel blockage is thought to exist.

A balloon helps with Enteroscopy. A scope and a tool called an overture are utilized for this examination. This permits the technician to see farther into the small bowel than is possible with a regular endoscope. This approach might be helpful when a capsule endoscopy reveals anomalies, but the diagnosis is still in doubt.

Imaging Exams

X-ray. If your symptoms are severe, your doctor may do a routine abdominal X-ray to rule out more serious issues like a megacolon or a ruptured colon.

CT scan for computerized tomography. A CT scan, a specialized X-ray method that offers more information than a regular X-ray does, could be performed on you. In addition to tissues outside the gut, this examination examines the whole colon. Better pictures of the small intestine are produced using CT enterography, a specialized CT scan. Most medical facilities no longer use barium X-rays in favor of this test.

Imaging with magnetic resonance (MRI). MRI scanners employ a magnetic field and radio waves to produce finely detailed pictures of organs and tissues. An MRI is beneficial when examining a fistula in the small intestine or anal region (MR enterography). With MRI, there is no radiation exposure, in contrast to CT.

Treatment

Reducing the inflammation that leads to the signs and symptoms of inflammatory bowel disease is the aim of treatment. In the ideal scenarios, this may result in a lessened risk of complications, long-term remission, and symptom alleviation. In most cases, surgery or medication therapy are used to treat IBD.

Anti-inflammatory medicines

In the case of mild to moderate illness, anti-inflammatory medications are frequently used as the first line of treatment for ulcerative colitis. Aminosalicylates such as mesalamine (Delzicol, Rowasa, and other brands), balsalazide (Colazal), and olsalazine are anti-inflammatories (Dipentum).

Additionally, time-limited corticosteroid treatments are utilized to promote remission. Steroids have anti-inflammatory and immunosuppressive properties. The medication you need to take depends on which part of your colon is ailing.

Immunosuppressive drugs

These medications block the immune response that sends chemicals into the body that cause inflammation in several different ways. These compounds can potentially harm the lining of the digestive system when released.

Azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), and methotrexate are a few examples of immunosuppressant medications (Trexall).

Orally administered drugs, commonly known as “small molecules,” are now available to treat IBD. Ozanimod, upadacitinib, and tofacitinib are a few of them (Zeposia).

Tofacitinib has received a warning from the U.S. Food and Drug Administration (FDA), which noted that early research indicates an elevated risk of major heart-related issues and cancer from using this medication. Do not discontinue taking tofacitinib if you are taking it for ulcerative colitis without consulting your doctor.

Biologics

In a more recent subcategory of therapy known as biologics, inflammation-causing proteins in the body are neutralized. Some are injected, while intravenous (IV) infusions give others. Infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio), ustekinumab (Stelara), and risankizumab are a few examples (Skyrizi).

Antibiotics

In situations of perianal Crohn’s disease, for instance, or where the infection is a risk, antibiotics may be given in addition to other treatments or as a last resort. The antibiotics ciprofloxacin (Cipro) and metronidazole are frequently administered (Flagyl).

Additional drugs and supplements

Some drugs may also reduce inflammation and ease your signs and symptoms, but always see your doctor before using any over-the-counter drugs. Your doctor may advise one or more of the following treatments, depending on the severity of your IBD:

Drugs to treat diarrhea. By giving your stool more volume, a fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), helps ease mild to moderate diarrhea. Loperamide (Imodium A-D) may be useful for cases of more severe diarrhea.

These drugs may be ineffective or harmful in certain patients with strictures or specific infections. Before consuming any medications, please speak with your doctor.

Drugs that reduce pain. Your doctor could prescribe acetaminophen for minor pain (Tylenol, others). Ibuprofen (Advil, Motrin IB, and others), naproxen sodium (Aleve), and diclofenac sodium are likely to exacerbate your symptoms and even worsen your condition.

Supplements and vitamins. Your doctor can suggest vitamins and dietary supplements if you’re not getting enough nutrients.

Nutritional Assistance

Your doctor can suggest a special diet administered through a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your IBD if weight loss is severe. This will enable the bowel to relax while also enhancing your overall nutrition. Short-term inflammation reduction is possible with bowel rest.

Your doctor could advise a low-residue diet if you have stenosis or intestinal stricture. This will lessen the possibility that undigested food may become trapped in the constricted area of the intestine and cause a blockage.

Surgery

Your doctor could advise surgery if diet and lifestyle modifications, medication therapy, or other therapies are ineffective in treating your IBD symptoms.

For ulcerative colitis surgery. To facilitate bowel movements without a bag, the whole colon and rectum are removed during surgery, and an internal pouch attached to the anus is formed.

It might not always be possible to use a pouch. Instead, the surgeons create an ileal stoma, a permanent hole in your abdomen, through which feces are passed and collected in a bag attached to the hole.

Crohn’s disease surgery Up to two-thirds of Crohn’s disease sufferers will need at least one operation throughout their lifespan. Crohn’s disease cannot be cured by surgery.

Your digestive tract’s diseased segment is cut out during surgery, and the healthy pieces are subsequently reconnected. Additionally, surgery may be done to drain abscesses and seal fistulas.

Surgery for Crohn’s disease typically only has short-term advantages. The illness typically reappears close to the rejoined tissue. To reduce the chance of recurrence, the medication should be used after surgery.