Inflammatory Bowel Disease: Treatment, Procedure, Cost and Side Effects

Inflammatory bowel disease is the term used to describe two medical conditions, namely, Crohn's disease and ulcerative colitis

Inflammatory bowel disease (IBD) is a group of intestinal disorders that cause prolonged inflammation of the digestive tract. The two major types of inflammatory bowel disease are ulcerative colitis and Crohn's disease. They cause sores (ulcers) in the digestive tract and also inflammation which causes extreme pain in the patient. Ulcerative colitis disease can cause inflammation and sores (ulcers) which are long lasting in the innermost lining of the large intestine (colon) and rectum. Crohn's disease can cause inflammation of the lining of the digestive tract, which often spreads deep into affected tissues.

Depending on the severity of inflammation and location of occurrence, the symptoms of inflammatory bowel disease can vary a lot. Main symptoms caused by intestinal ulcers are predominantly abdominal pain, cramps, and bleeding. Sometimes, however, ulcers may be present in IBD but are not associated with any symptoms (asymptomatic). In Crohn's disease, the symptoms can be diarrhoea, fever and fatigue, abdominal pain and cramping, blood in the stool, reduced appetite, unintended weight loss.

Treatment for Crohn’s Disease and Ulcerative Colitis in the patients will depend on how severe the symptoms are, and how much of the gut is affected. Inflammatory bowel disease can be treated with medicines and drugs that aim to reduce inflammation in the gut and bring relief from the symptoms. These anti-inflammatory drugs include steroids, 5ASAs, immunosuppressants such as azathioprine, methotrexate and ciclosporin, and biological drugs like infliximab and adalimumab. If the condition does not improve with medicines, then patients may be required to undergo surgeries. Some IBD surgeries include strictureplasty to widen a narrowed bowel, closure or removal of fistulas, removal of affected portions of the intestines for people with Crohn’s disease and removal of the entire colon and rectum for severe cases of ulcerative colitis.

A number of tests are performed in order to diagnose the signs and symptoms of inflammatory bowel disease. The tests include blood tests, endoscopic procedures and imaging tests. Blood tests are done as tests for anemia or infection to detect the amount of red blood cells to carry adequate oxygen to the tissues or to check for signs of infection from bacteria or viruses. Fecal occult blood test is done with a stool sample. Doctors test for hidden blood in the stool. Colonoscopy is an endoscopic exam that allows the doctor to view the entire colon using a thin, flexible, lighted tube with an attached camera. During this procedure, the doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. In other endoscopic exam, called Flexible sigmoidoscopy, the doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid, the last portion of the colon. Upper endoscopy is done if the patient is having nausea and vomiting, difficulty eating or upper abdominal pain. Capsule endoscopy is used to help diagnose Crohn's disease that involves the small intestine. Balloon-assisted enteroscopy enables the doctor to look further into the small bowel where standard endoscopes don't reach. This procedure is very useful when a capsule endoscopy shows abnormalities. Imaging tests like X ray, Computerized tomography (CT scan) and magnetic resonance imaging (MRI) tests are also done to assist the diagnosis of inflammatory bowel disease.

The treatment of inflammatory bowel disease depends on the degree of severity and location of the syndrome. Treatment aims to reduce the inflammation that triggers the signs and symptoms. IBD treatment usually involves either drug therapy or surgery. Anti-inflammatory drugs are used primarily in the treatment of inflammatory bowel disease. Anti-inflammatory drugs include corticosteroids and aminosalicylates, such as mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Prescribed medicine depends on the location of the disease. Immunosuppressant drugs like azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune) and methotrexate (Trexall) suppress the immune response that releases inflammation-inducing chemicals in the intestinal lining. Drugs called tumor necrosis factor (TNF)-alpha inhibitors, or biologics also help to relieve the symptoms of IBD. It works by neutralizing a protein produced by the immune system. Examples of these drugs include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). Other biologic therapies that may be used are natalizumab (Tysabri), vedolizumab (Entyvio) and ustekinumab (Stelara).Apart from these medicines, antibiotics may also be used. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl). In addition to this, some over-the-counter medications may also be used which help to relieve the symptoms. Depending on the severity of the IBD symptoms, doctor may recommend anti-diarrheal medications, pain relievers, iron supplements and Calcium and vitamin D supplements. The doctor may also recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat the symptoms of IBD. Some IBD signs and symptoms are so severe that the doctor may recommend surgery. Surgery can often eliminate ulcerative colitis by removing entire colon and rectum (proctocolectomy). This procedure involves an ileal pouch anal anastomosis. People with Crohn's disease will require at least one surgery. However, surgery is not able to cure Crohn's disease. During surgery, the surgeon removes the damaged portion of the digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.

Medications used in the treatment of inflammatory bowel disease (IBD) have certain side effects. Side effects of the corticosteroids used in the treatment include weight gain, facial swelling, sweating, insomnia etc. Side effects such as nausea, vomiting and loss of appetite, are noted in case of Oral 5-aminosalicylates drugs. Antibiotics can cause upset stomach, loss of appetite, diarrhea and vomiting and also the feel of an urgent need to urinate, as well as vaginal itching and/or discharge. There can be some serious side effects caused by the immunosuppressant. Despite the side effects, these medications are effective in the treatment of IBD.

In general, it takes around 6 weeks to recover from the treatment of inflammatory bowel disease. People should be careful and avoid complications. Medicines and other opinions from the doctor, when followed, can help in speedy recovery.

IBD is an expensive chronic disease without a cure. Patients incur a huge amount for the treatment fo inflammatory bowel disease. Surgical procedures for IBD typically cost about Rs. 600000/- to Rs. 2000000/-. For mild symptoms, doctors may prescribe a number of drugs which can cost about Rs 6000 to Rs 50000/-. Additional costs are needed for the consultation fees, various diagnostic tests etc.

The treatment can be considered permanent only on certain basis. Medications and drugs can help to cure the inflammation and reduce symptoms. However, the benefits of surgery for Crohn's disease are usually temporary. This disease can recur often, and frequently near the reconnected tissue. Patients must take proper medication to minimize the risk of recurrence and cause the treatment be permanent.