Inflammatory Bowel Disease (IBD) includes two specific conditions: Crohn’s Disease (CD) and Ulcerative Colitis (UC). The exact pathogenesis of Inflammatory Bowel Disease is not entirely understood. It is believed, though, that most cases are due to an imbalance in the immune system’s ability to tolerate commensal native enteric flora and attack pathogenic bacteria. The chronic inflammatory state that ensues damages the gastrointestinal tract as a bystander.
Crohn’s Disease (CD) can affect the entire gastrointestinal tract with the most common area of involvement being the terminal ileum. The inflammation of Crohn’s extends deep into the lining of the GI tract in a skipping fashion. Acute inflammation results in swelling and ulceration which leads to symptoms of fever, abdominal pain, diarrhea, loss of appetite, weight loss, vitamin deficiency and bleeding with anemia. When the inflammation becomes chronic it can scar resulting in eventual bowel obstruction or it can eat through bowel wall resulting in bowel perforation and the formation of fistulas and abscesses.
Ulcerative Colitis (UC) classically affects the distal rectum with progression proximally through the colon as the disease increases in severity. The inflammation of Ulcerative Colitis is localized to the superficial layers of the GI tract in a continuous fashion. Acute inflammation results in swelling and ulceration which leads to symptoms of fever, gastrointestinal bleeding, diarrhea, tenesmus, urgency and abdominal pain. When the inflammation becomes chronic it results in colonic atrophy and the formation of psuedopolyps and strictures.
An interesting and important feature of Inflammatory Bowel Disease is that organ systems outside of the gastrointestinal tract can be affected including the skeletal, cutaneous, ocular, hepatobiliary, renal and hematologic systems. Please visit Dr. Mantas if you feel you have any gastrointestinal or extra-gastrointestinal symptoms suggestive of Inflammatory Bowel Disease.
Inflammatory Bowel Disease afflicts 1 out of 1000 to 3000 people in the United States and tends to have a bimodal age distribution at time of diagnosis: 10-20 years old and 60-70 years old. The predominant patient tends to be a Caucasian who lives in an urban, industrialized setting.
A diagnosis of Inflammatory Bowel Disease begins with a thorough history and physical examination. If there are features suggestive of IBD Dr. Mantas will proceed with a combination of tests to clinch the diagnosis. These tests include blood/stool analysis, radiographic imaging and endoscopy/colonoscopy.
Dr. Mantas utilizes a variety of treatments to suppress the immune system and achieve a state of clinical remission with minimal side effects. Treatments include nutritional modifications (eg. anti-inflammatory diet), complementary alternative therapies (eg. herbals), antibiotics/probiotics (eg. metronidazole), topical/systemic anti-inflammatories (eg. mesalamine), immunomodulators (eg. azathioprine) and biologics (eg. anti-TNF agents). Dr. Mantas has access to the most up-to-date therapies available for IBD. It is important to know that even though IBD exacerbations become less frequent with treatment no cure exists. Patients with IBD require life-long treatment and regular doctor visits, but with close follow up most patients with IBD can live full active lives.
In refractory or complicated cases surgical intervention is sometimes needed. The type of surgery varies based on the location and extent of disease and can range from short bowel resection with direct primary anastomoses to longer bowel resections requiring an ileostomy. Dr. Mantas will guide you through this process and offer referrals to the best surgeons available.
Aside from the acute and chronic symptoms from inflammation noted above, chronic untreated inflammatory bowel disease can increase one’s risk of malignancy. Crohn’s patients are at a high risk of developing lymphoma, small intestine cancer, colon cancer and squamous cell carcinoma. Ulcerative Colitis patients are at high risk of developing of colon cancer.
A variety of other disorders can affect the colon, rectum and anus. Suggestive symptoms include diarrhea, constipation, bleeding, lower abdominal pain, anorectal pain and bowel urgency. Please visit Dr. Mantas if you feel that you have a colo-rectal-anal disorder. Other common colo-rectal-anal disorders include microscopic colitis and fecal incontinence.