Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis)
Inflammatory Bowel Disease (IBD) is comprised of two chronic inflammatory conditions of the GI tract - Crohn’s disease and ulcerative colitis. The symptoms of these two illnesses are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different. In the United States, about 1.4 million individuals have IBD.
Crohn’s disease affects the entire thickness of the bowel wall and most commonly affects the end of the small bowel (the ileum), but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis only involves the innermost lining of the colon and is limited to just the large intestine. The causes of IBD are not well understood. Recent research suggests hereditary, genetics, and/or environmental factors contribute to the development of Crohn’s Disease.
While symptoms vary from patient to patient, some of the more common ones are diarrhea, rectal bleeding, urgency, abdominal pains, and bowel obstruction with vomiting and constipation. Despite the chronic nature of these two diseases, new targeted anti-inflammatory treatments hold great promise in improving the quality of life of individuals with IBD.
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IBD Treatment Options
There are a number of treatment options for Crohn’s Disease and Ulcerative Colitis. These include medications and surgery. Medications for IBD can be administered as pills (tablets and capsules), rectally (suppositories and enemas), injections and as an intravenous infusion. Infusions are performed at BMC in an area adjacent to the outpatient Gastroenterology offices in the Moakley Building.
Surgery can often be performed laparoscopically meaning through tiny incisions in the abdomen. A thin, lighted tube called laparoscope, as well as other surgical tools, are inserted through these incisions to allow the surgeon to work on the small and large intestines. Our surgeons specialize in minimally invasive approaches to all of the operations listed below.
Surgical options include the following:
Patients with an ileostomy have a surgically-created opening in their abdomen referred to as a stoma. The small intestine (ileum) connects to the opening, and stool passes out of this opening into a bag worn outside the body. The bag is periodically emptied or replaced.
Ileal Pouch-Anal Anastomosis (IPAA)
The ileal pouch-anal anastomosis (IPAA) is a procedure developed in the 1980s that eliminates the need for a permanent stoma. During IPAA surgery, the patient's large bowel is removed, and the small bowel is connected to the anus. The last few inches of the small bowel are used to create an internal pouch which serves the function of a rectum. By preserving the anus and creating a new storage place for stool, patients are able to maintain control over their bowel habits and can continue to eliminate waste through the anus.
IPAA is commonly performed in two steps and requires a temporary ileostomy (stoma) for the time between the two separate surgeries.
During the first operation, both the colon and rectum are removed, and a pouch is created by folding back the final segment of the small intestine. After the pouch is created, the patient will have an ileostomy for approximately two months, which allows time for the bowel and newly-formed pouch to heal.
During the second operation the ileostomy is reversed (closed). The pouch will now act as the storage area for stool. Conscious control of the muscles in the anus is retained, allowing the patient to eliminate stool normally. After the IPAA procedure is complete, patient will usually have 4 to 6 bowel movements per day. While this frequency is still more than individuals with a healthy large intestine and rectum, it is manageable and generally does not interfere with daily life.
Over the last 30 years, IPAA has become the surgical treatment of choice for patients with ulcerative colitis and familial adenomatous polyposis. During this time, surgeons at BMC have performed over 850 ileal pouch-anal anastomosis procedures. Most of the IPAA surgeries performed are done in two stages, requiring the use of a temporary diverting loop ileostomy. This allows time for the anastomosis to heal before stool is passed through it.
Partial and Total Colectomy
Patients who are appropriate candidates are candidates for a partial resection of their small bowel or large intestine. Frequently, intestinal continuity can be restored. We commonly perform these operations laparoscopically.