Medical Mondays: Inflammatory Bowel Disease (IBD)

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Inflammatory bowel disease, or IBD, is an inflammatory condition that affects the digestive tract. Two types of IBD are Crohn’s disease and ulcerative colitis.

Living with inflammatory bowel disease can be scary, but there are treatment options available. Here you will learn about:

• The symptoms, causes of, and treatments for Crohn’s disease
• How celiac disease, Crohn’s disease, and ulcerative colitis are alike and how they are different
• Common causes of stomach pain, and when to talk to your doctor
• The symptoms, causes, and treatments for ulcerative colitis
• IBD and pregnancy

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    string(4663) "Nearly 1.5 million Americans currently suffer from inflammatory bowel disease (IBD), with an estimated 30,000 new cases each year. Many people don't realize that IBD is a collection of chronic conditions that include Crohn's disease and ulcerative colitis.

Crohn's disease differs from person to person, as do the symptoms. Some sufferers may have certain symptoms that others will not. Similarly, different foods may trigger a flare-up of Crohn's disease. Each person should understand their trigger foods to learn how to cope with the illness and prevent flare-ups.
What Is Crohn's Disease?
Crohn's disease is a severe, chronic inflammatory bowel disease that can cause inflammation, ulcers, and bleeding in the digestive tract. While Crohn's disease often affects the end portion of the small intestine, it can also affect any part of the digestive tract.

The cause of this disease is not known, but like other inflammatory bowel diseases, it seems to run in families.

Some research links Crohn's disease to an overactive and inappropriate immune response to the bacteria that normally reside in the intestine, causing damage to the intestines.

    
            

        
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Symptoms of Crohn's Disease
Common symptoms of Crohn's disease include:

 	
Diarrhea
 	
Abdominal cramps and pain
 	
Rectal bleeding
 	
Anemia
 	
Weight loss
 	
Fatigue, weakness
 	
Nausea
 	
Fever
 	
Mouth sores
 	
Skin rash
 	
Joint pain
 	
Abscesses in the abdomen and perianal area

Diagnosing Crohn's Disease: What You Need to Know
To diagnose Crohn's disease, your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

 	
Blood tests
 	
Stool examination
 	
Computed tomography (CT) or magnetic resonance imaging (MRI) scans to identify abnormalities in the gastrointestinal tract or internal organs
 	
Colonoscopy or flexible sigmoidoscopy to examine the lining of the colon and the small intestine
 	
Upper endoscopy/enteroscopy to examine the esophagus, stomach, and upper part of the small intestine
 	
Biopsy to test a small sample of the gastrointestinal lining

Treatment Options for Crohn's Disease
Medicines
Many types of medicines are available for treatment, such as:

 	
Aminosalicylate medicines
 	
Antibiotics/probiotics
 	
Corticosteroids
 	
Immunomodulators
 	
TNF-inhibitors
 	
Other biologic treatments

Dietary Changes
Your doctor may recommend that you avoid foods that provoke symptoms. Those foods are different for each person, but may include:

 	
Dairy foods (due to lactose intolerance)
 	
Highly seasoned foods
 	
High fiber foods

Surgery
Very severe cases of Crohn's disease may not improve with medicines and can even cause added complications such as:

 	
A narrowing of the intestines
 	
A bowel obstruction
 	
Fistula (abnormal connections between the intestine and other organs or tissue)

In these cases, surgery to remove the diseased section of your intestine and join the two remaining healthier ends together may be an option.
New Cutting-Edge Therapy
Groundbreaking research from the UPMC Inflammatory Bowel Disease Center, part of the UPMC Digestive Disorders Center, has shown that treating patients with very specific medicines following bowel resection surgery can keep Crohn's disease from recurring.

For more information about Crohn's disease, visit the UPMC Digestive Disorders Center online or call 1-866-4GASTRO (442-7876) to schedule an appointment.

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• Crohn’s Disease Symptoms, Causes, and Treatment

  Crohn’s disease is a severe type of IBD that can cause ulcers, inflammation, and bleeding in your digestive tract. Treatment for Crohn’s disease can range depending on how serious it. Learn about the causes, symptoms, and treatment options for living with Crohn’s disease.Read More

  

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    string(4932) "Celiac Disease, Crohn's Disease, and Irritable Bowel Syndrome are among the most common digestive disorders. In all three cases, the cause is unknown and, if diagnosed, they often require lifestyle changes. The best way to manage these digestive disorders is to be aware of the symptoms and factors that may put you at risk. If you are experiencing the symptoms below, schedule an appointment with your doctor to discuss your options.


What Is Celiac Disease?
Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine.
Causes of Celiac Disease
Those suffering from the disease cannot tolerate gluten, a protein found in wheat, rye, barley, and some oats. When people with Celiac disease consume gluten, their immune systems attack the small intestine and damage the inner lining which is used to absorb nutrients from food.
Celiac Disease Symptoms

 	
Abdominal pain
 	
Diarrhea
 	
Constipation
 	
Weight loss
 	
Nausea
 	
Fatigue

Treating Celiac Disease
Celiac disease is chronic and there is no known cure. People living with Celiac disease must consume a gluten-free diet in order to eliminate symptoms. Gluten is sometimes hidden in processed foods so those with Celiac are advised to always check nutrition labels and ingredients. However, a person should not begin a gluten-free diet without being diagnosed.
RELATED: Infographic: Managing Celiac Disease With a Gluten-Free Diet
What Is Crohn's Disease?
Crohn's disease is a severe, chronic inflammatory bowel disease. It causes inflammation, ulcers, and bleeding in the digestive tract.
Causes of Crohn's Disease
The cause of Crohn's disease is unknown, but like other inflammatory bowel diseases, it seems to run in some families. Some research links Crohn's disease to an overactive and inappropriate immune response to the bacteria that normally reside in the intestine, causing damage to the intestines.
Crohn's Disease Symptoms

 	
Diarrhea
 	
Abdominal cramps and pain
 	
Rectal bleeding
 	
Anemia
 	
Weight loss
 	
Fatigue, weakness
 	
Nausea
 	
Fever
 	
Mouth sores
 	
Sores, abscesses in the anal area

Did You Know?
There are about 700,000 people currently living with Crohn's Disease.
Crohn's Disease Treatment
Your doctor may recommend that you avoid foods that provoke symptoms, including:

 	
Dairy foods (due to lactose intolerance)
 	
Highly seasoned foods
 	
High-fiber foods
 	
Other biologic treatments

Medication or surgery may also be an option.
RELATED: Crohn's Disease: Symptoms, Causes, and Treatment
What Is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a digestive disorder that leads to abdominal pain and bowel changes. It is the most common intestinal problem that causes patients to be referred to a bowel specialist (gastroenterologist).
Causes of Irritable Bowel Syndrome
The reasons why IBS develops are not clear, but it can occur after an infection of the intestines. Another trigger may be stress. Signals go back and forth between the bowel and brain, which affect bowel function and symptoms. The nerves can become more active during stress, which can cause the intestines to be more sensitive and contract more.

IBS is twice as common in women, affecting 1 in 6 women.
Irritable Bowl Syndrome Symptoms

 	
Abdominal pain
 	
Gas
 	
Fullness
 	
Bloating

Treating Irritable Bowel Syndrome
Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.

The following dietary changes may help:

 	
Avoid foods and drinks that stimulate the intestines, such as caffeine, tea, or cola
 	
Eat smaller meals
 	
Increase fiber in the diet – this may improve constipation, but make bloating worse.

Talk with your doctor before taking over-the-counter medications.

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• Infographic: Comparing 3 Common Digestive Disorders

  Not all digestive disorders are the same. Celiac disease, Crohn’s disease, and irritable bowel syndrome are three types of common disorders and each needs to be treated differently. It’s important to understand your symptoms and how diet, lifestyle, and genetics play a role in how your disease affects you.View Infographic

  

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    string(9033) "Updated Dec. 9, 2019

Everyone gets a stomach ache — or abdominal pain — from time to time. Usually, stomach pains are harmless conditions caused by overeating, gas, or indigestion. Frequent or recurring sharp stomach pain is often due to stress and worry, even in child care. But it can point to more serious medical problems like pancreatic diseases.

“When I hear about abdominal pain, I am interested to hear about the details of how a patient experiences the pain,” says Michael Kingsley, MD, a gastroenterologist at UPMC.

Dr. Kingsley says to pay attention to when the pain occurs and what makes it better or worse and provide that information to your doctor.
Common Causes of Stomach Pain
Harmless abdominal pain usually subsides or goes away within two hours.

 	
Gas: Formed in the stomach and intestines as your body breaks down food, this can cause general stomach pain and cramps. This often can be indicated by belching or flatulence.
 	
Bloating: Related to gas, this occurs when excessive gas builds up in your digestive tract. Your stomach will usually feel full, and you may experience cramps.
 	
Constipation: This occurs when you are having difficulty making bowel movements. If you are having two or fewer bowel movements a week, constipation is the likely cause. In addition to feeling bloated and nauseous, you may experience cramping and pain in your rectum.
 	
Indigestion: You typically experience this as an upset stomach, burning, or belly pain after eating.
 	
Stomach flu: Your stomach may hurt before each episode of vomiting or diarrhea.

Severe Stomach Pain
In serious cases, the stomach pain gets worse or becomes constant. This may be an indication of a more severe condition, such as:

 	
Appendicitis: This happens when the appendix, which is part of the large intestine, becomes infected and inflamed. If the appendix ruptures, it can become life-threatening. Surgery to remove the appendix, an appendectomy, is the usual treatment.
 	
Stomach (peptic) ulcers: Crater-like sores in the lining of the stomach and small intestine. These can bleed or burst and be life-threatening if not treated. Medication to reduce your stomach acid can help treat them.
 	
Gallstones: Hard stones, made up of cholesterol and other materials, that form in the gallbladder, which is just below the liver. They can cause inflammation of the gallbladder, which can lead to inflammation – known as acute cholecystitis. Treatment for these problems includes removal of the gallbladder.
 	
Kidney stones: Crystals of varying sizes that form in your urine and build up in your kidneys. The pain can be severe. You can pass some on your own through urination, or doctors may remove them surgically.
 	
Inflammatory bowel disease (IBD): A chronic inflammation in the digestive tract that can cause severe abdominal pain, vomiting, diarrhea, weight loss, and rectal bleeding. Examples of IBD include Crohn’s disease and ulcerative colitis.
 	
Pancreatitis: The pancreas produces insulin and glucagon – the two hormones that manage how your body processes sugar – and aids in digestion. Inflammation of the pancreas is called pancreatitis, which can affect its performance and cause severe stomach pain.
 	
Hernia: Tissue from inside the abdomen that bulges out through a weak point in the abdominal wall. There are several different types depending on where the bulge appears.

The location of the pain in your stomach can determine the potential cause:

 	
Upper right: Gallstones, cholecystitis, stomach ulcer, duodenal ulcer, hepatitis
 	
Upper center: Heartburn/indigestion, hiatal hernia, epigastric hernia, stomach ulcer, duodenal ulcer, hepatitis
 	
Upper left: Functional dyspepsia, stomach ulcer, gastritis, pancreatitis
 	
Middle right: Kidney stones, kidney infection, inflammatory bowel disease, constipation
 	
Middle center: Umbilical hernia, appendicitis, stomach ulcer, inflammatory bowel disease, pancreatitis
 	
Middle left: Kidney stones, kidney infection, inflammatory bowel disease, constipation
 	
Lower right: Appendicitis, inflammatory bowel disease, constipation, pelvic pain
 	
Lower center: Bladder infection, prostatitis, inflammatory bowel disease, inguinal hernia, pelvic pain
 	
Lower left: Constipation, diverticulitis, irritable bowel syndrome, inflammatory bowel disease, pelvic pain, inguinal hernia

This diagram illustrates the types of abdominal conditions you may have based on the location of the pain.


When to Seek Medical Help
According to Dr. Kingsley at UPMC, you should call your primary care physician if mild pain lasts more than a couple of days, or if the severe stomach pain is accompanied by other symptoms.
When to seek immediate medical attention
Get medical help immediately if:

 	
You have abdominal pain that is very sharp, severe, and sudden.
 	
You also have pain in the chest, neck, or shoulder.
 	
You’re vomiting blood, have bloody diarrhea, or have black, tarry stools (melena)
 	
You have a high fever.
 	
You’re having difficulty breathing.
 	
You develop consistent nausea and/or vomiting.
 	
Your abdomen is stiff, hard, and tender to the touch.
 	
You can’t move your bowels, especially if you’re also vomiting

When to make an appointment to see your doctor
Schedule an appointment to see your doctor if:

 	
Your stomach pain doesn’t go away within a couple of days.
 	
The pain comes back after going away.
 	
Symptoms like diarrhea don’t go away within a couple of days.
 	
You’re urinating more or less often, and/or it’s painful.
 	
You have unintended weight loss.

“Know your body,” Dr. Kingsley says. “If you start having pain that you have not had before and does not go away, you should contact your doctor to be evaluated further.”

Bottom line: Trust your gut! Contact your doctor if you’re concerned about lingering or unusual stomach pain.

Sources

National Health Service, Stomach Ache (https://www.nhs.uk/conditions/stomach-ache/)

National Health Service Inform, Stomach Ache and Abdominal Pain (https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/stomach-ache-and-abdominal-pain)

U.S. National Library of Medicine, Abdominal Pain (https://medlineplus.gov/ency/article/003120.htm)"
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  string(329) "Stomach aches are common – especially after a big meal.  But when is a stomach pain something to worry about?  Harmless aches and pains usually fade within a few hours, but pain that lasts more than a few days could be something more serious. Learn more about the many types of stomach conditions and when to call your doctor. "
}

• Stomach Pain: When to Worry About Stomach Ache

  Stomach aches are common – especially after a big meal. But when is a stomach pain something to worry about? Harmless aches and pains usually fade within a few hours, but pain that lasts more than a few days could be something more serious. Learn more about the many types of stomach conditions and when to call your doctor.Read More

  

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    ["post_content"]=>
    string(5994) "Ulcerative colitis (UC) is one type of inflammatory bowel diseases (IBD), which also includes Crohn's disease. IBD affects about 1.3 million individuals in the US.

As the name indicates, UC is characterized by ulcers that involve the rectum and other areas of the colon. In some instances, the whole colon is ulcerated and inflamed. Sometimes, the inflammation in subjects with UC is not only limited to the guts, but can extend to affect the skin, joints, eyes, and liver.

Ulcerative Colitis can be tough to live with and is characterized by flares and remission patterns (waxing and waning course). If left untreated, UC can lead to significant symptoms, disability, and even death. Therefore, public awareness, as well as early diagnosis and treatment are vital to avoid complications and disability.
What Causes Ulcerative Colitis?
While we do not know exactly what causes UC, the immune system in subjects with UC becomes abnormally activated (dysregulated) leading to excessive and unwanted inflammation. Genetics are believed to play a very important role. If you have a relative with UC, you are at a higher risk for UC. About 20 percent of people with the condition have a close family member who also has it.

Food, bacteria, environmental exposures and antigens, and other unknown factors are also believed to play a role in activating the immune system.
What Are the Symptoms of Ulcerative Colitis?
Ulcerative colitis almost always affects the rectum. It can also affect any part of the colon and/or the whole colon. Common symptoms include:

 	
Diarrhea
 	
Loose, bloody stool
 	
Cramping stomach pains

Sometimes people with ulcerative colitis can have a fever or become anemic. You can develop ulcerative colitis at any age, but it's usually diagnosed before age 30.

If you have these symptoms:

 	
See your primary care doctor who will review your medical and family history.
 	
If he/she suspects UC, you will need to see a gastroenterologist.
 	
To diagnose UC, a colonoscopy with biopsies of inflamed colon is often needed.

How Is Ulcerative Colitis Treated?
Treatment focuses on regulating your immune system by suppressing its strong activity. Medications that suppress the immune system are the primary treatments options. Choice of medications varies depending on severity of symptoms, the severity of disease on inspection of your colon during colonoscopy, and your doctor's experience.
Ulcerative colitis medication
These medications include:

 	
Aminosalicylate medicine
 	
Corticosteroids (should be used for short term only given the significant side effects)
 	
Immunomodulators
 	
TNF-inhibitors
 	
Other biologic medications

While some dietary supplements including Probiotics and herbs such as turmeric are popular, limited data and studies are available to support a strong role in treating UC.

Some patients with UC can have severe inflammation, causing their colon to be very sensitive to food. Such typical foods include:

 	
Diary products
 	
Spicy food
 	
High roughage
 	
Vegetables
 	
Foods rich in fructose

If you feel food is making your symptoms worse, keep a food diary and avoid foods that cause your symptoms.
RELATED: 5 Foods to Avoid if You Have Troubles with Your Digestive System
Do not forget that non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can worsen UC. Finally, do not forget that UC is a life-long disease that can often be complicated. Please consult with an experienced GI specialist.
Living With Ulcerative Colitis
It's important to follow your treatment regimen and stay on top of your symptoms to help lessen flare-ups. Sometimes people with ulcerative colitis feel embarrassed or worried about going out with friends when having symptoms.

Be open with friends and family about the condition and how you feel. Support groups can also help you connect with other people who have the same struggles. The UPMC Inflammatory Bowel Disease (IBD) Center has a comprehensive team of gastroenterologists, surgeons, psychiatrists, dietitians, social workers, nurses, and more, that are dedicated to treating all aspects of IBD.

To learn more, visit the Digestive Disorders Center website, call 1-866-4GASTRO (427876) or email DigestiveDisorders@upmc.edu.

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• What Is Ulcerative Colitis?

  Ulcerative Colitis (UC) is a type of inflammatory bowel disease that can be tough to live with and embarrassing to talk about. Causes of UC can include the environment, food, and genetics, but there are treatments available. Learn more about UC symptoms and treatments.Read More

  

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    ["post_content"]=>
    string(3318) "It's common to feel concerned about becoming pregnant when you have inflammatory bowel disease (IBD). However, you can have a safe pregnancy despite your condition. The key is to become pregnant while your disease is in remission.

IBD consists of a group of conditions that includes Crohn's disease and ulcerative colitis. These conditions cause inflammation in the intestines at any place along the digestive tract. It causes painful stomach cramping and diarrhea among other symptoms. The disease usually flares up for a time and then goes into remission.
Risks During Pregnancy
Most women who get pregnant while their ulcerative colitis or Crohn's is in remission, stay in remission throughout pregnancy. Even if you're not having symptoms, it's important to stay in close contact with your gastroenterologist as well as your obstetrician.

When planning pregnancy, talk to your gastroenterologist first if possible. If you get pregnant during a flare-up, there is a risk of complications. These include:

	
Premature delivery
	
Miscarriage
	
Low birth weight

IBD medications during and prior to pregnancy
Many medications for Crohn's and ulcerative colitis are safe during pregnancy. Your doctor will work with you to alter any medications that pose risks to you or your baby, while still keeping your symptoms under control.

Methotrexate is not safe during pregnancy. It's best that you stop taking methotrexate before trying to conceive. This drug can also pose risks if the baby's father is taking methotrexate. For the safest pregnancy, he should talk to his doctor about alternative medications while you are attempting to get pregnant.
After Pregnancy
Moms with IBD may feel conflicted about whether to breastfeed after the baby is born. It is possible to breastfeed, even when you are on medications to manage your symptoms.

Aminosalicylates are considered safe during pregnancy and while breastfeeding. Many antibiotics are also safe, but some can pose serious risks, so be sure to let your doctor know if you want to breastfeed.

Breastfeeding offers great benefits to your baby, but it will require that you stay on top of your symptoms and your medications. Talk with your doctor about your decision so that you can find the combination with the least risks.

You may also be worried about passing along IBD to your child. When only one parent has IBD, there's very little increased risk of developing ulcerative colitis or Crohn's over someone whose parent doesn't have either disease. The risk is a bit higher if both parents have some form of IBD.

Overall, you can feel comfortable having a safe pregnancy despite your IBD, especially when in remission.

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    string(146) "It's common to feel concerned about becoming pregnant when you have IBD. You can have a safe, healthy pregnancy when your disease is in remission."
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  ["medical_description"]=>
  string(438) "If you’re hoping to become pregnant but have inflammatory bowel disease, you might wonder how your condition could affect your baby, and how your baby could affect your condition.  There are ways to stay safe and healthy, and it’s important to find out what is best for you.  Planning your pregnancy, keeping in close contact with your gastroenterologist, and knowing what to do after pregnancy are some key steps to lowering risks.  "
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• Inflammatory Bowel Disease (IBD) and Pregnancy

  If you’re hoping to become pregnant but have inflammatory bowel disease, you might wonder how your condition could affect your baby, and how your baby could affect your condition. There are ways to stay safe and healthy, and it’s important to find out what is best for you. Planning your pregnancy, keeping in close contact with your gastroenterologist, and knowing what to do after pregnancy are some key steps to lowering risks.Read More

  

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