Treatments available for IBD
If you or a family member is diagnosed as having IBD, both medical and surgical treatment options should be explained. The goal of treatment is to reduce symptoms and enable the intestines to absorb adequate nutrients.
Medications.
While there is no medical cure for IBD, several medications including sulfa drugs, corticosteroids, immunosuppressive agents and antibiotics are used to reduce inflammation of the bowel tissue, permitting healing of the bowel and relief of symptoms. As inflammation subsides and symptoms resolve, a person with IBD may enter a period of remission that can last from weeks to years. Promising new drugs are often being evaluated in clinical trials conducted at certain medical centers.
Nutrition.
Many patients with IBD need specialized nutritional care. Without it, some risk becoming malnourished because they may be unable to absorb sufficient nutrients from their food. Total parenteral nutrition or hyperalimentation, which supply nutrients intravenously, can ensure that a person receives adequate nutrition. And giving the bowel a rest may alleviate some symptoms of IBD.
Surgery.
When medical treatment does not control the disease, or when the side effects of steroids or other drugs threaten a persons health, surgery may be the treatment of choice.
Surgery for Crohns disease offers temporary relief; it is not a permanent cure because the disease is likely to recur. Narrowed areas called strictures cause special problems in Crohns disease, especially when they occur in the small intestine, because they can lead to partial or complete blockages in the bowel. For ulcerative colitis, surgery to remove the entire large intestine (colon), called a colectomy, or both the colon and rectum, called a proctocolectomy, is a permanent cure.
Resection.
With this traditional procedure for Crohns, the diseased bowel segment is removed. But some people have several strictures during their lifetime or many strictures at one time. This may lead to a condition called short-bowel syndrome, in which not enough bowel is left to absorb adequate nutrients from food.
Strictureplasty.
In a relatively new procedure to treat Crohns called strictureplasty, the surgeon cuts and stitches the narrowed area in a way that widens it without removing any of the bowel. Reserved for people with extensive Crohns disease, it avoids short-bowel syndrome.
Permanent ileostomy.
This procedure for ulcerative colitis involves removing the entire large intestine, rectum and anus. An opening, called a stoma, is made in the abdominal wall. The tip of the lower small intestine (ileum) is then brought through. Stools pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times. This procedure is also sometimes used to treat people with Crohns disease.
Pelvic pouch, or ileal pouch anal anastomosis (IPAA).
This newer operation avoids the stoma and the external pouch. The colon and rectum are removed. The small intestine is used to form an internal pouch or reservoir that will serve as a new rectum. This pouch is stitched to the anus, allowing for nearly normal bowel movements. Depending on the shape, the reservoir is called a J-, S-, or W-pouch. This procedure is frequently done in two operations and requires a temporary ileostomy in between. People with Crohns disease dont qualify for the IPAA or the continent ileostomy (described below) because the disease is likely to recur.
Continent ileostomy (Kock Pouch).
This is an option for people who would like their old-style ileostomy converted to an internal pouch and for people who dont qualify for the new IPAA procedures because their anal sphincter muscles are weak. In this procedure, there is a stoma but no bag. The colon and rectum are removed. An internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the internal reservoir is then joined to the skin with a nipple valve. The patient inserts a catheter through the valve into the internal reservoir to drain the pouch.
Laparoscopy.
These procedures are being further refined through the use, in appropriate cases, of keyhole, or laparoscopic, surgery. This technique, which uses a tiny (one-quarter-inch long) incision in the abdomen, reduces pain, speeds recovery and improves the cosmetic result of surgery.
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Modified August 2003
