Inflammatory bowel disease (IBD)

Inflammatory bowel disease, or IBD, is a group of conditions in which the immune system causes ongoing inflammation in the digestive tract. The two main types are Crohn's disease and ulcerative colitis. IBD usually comes and goes, with flares (times when symptoms are active) and remission (times when they settle down). It cannot yet be cured, but it can be controlled, and good control protects your bowel for the long run. Dr. Pimienta sees adults with IBD from across Los Angeles County, in English or Spanish.

What is the difference between Crohn's disease and ulcerative colitis?

Sometimes the two cannot be told apart at first, and the picture becomes clearer with time.

What are the symptoms of IBD?

Symptoms depend on which part of the bowel is inflamed and how much. Common ones are:

• Diarrhea that lasts for weeks, often waking you at night
• Blood or mucus in the stool, especially with ulcerative colitis
• An urgent need to go, or feeling you have not fully emptied
• Belly pain or cramping, often in the lower right side with Crohn's disease
• Tiredness, weight loss, low appetite or fever
• Low iron (anemia) found on blood tests

IBD can affect other parts of the body too, such as joint pain, red or painful eyes, skin rashes, mouth sores and, less often, liver problems. Pain or drainage near the anus can be a sign of Crohn's disease.

Is it IBD or IBS?

The names sound alike, but they are very different. Irritable bowel syndrome (IBS) is a common problem with how the gut and brain work together. It can cause real pain, bloating, diarrhea or constipation, but it does not cause inflammation, bleeding or damage to the bowel. IBD does. Blood in the stool, weight loss, fever, symptoms that wake you at night or anemia point away from IBS and call for a closer look. Some people with IBD in remission also have IBS-like symptoms, and it helps to know which is which before changing treatment.

Who gets IBD, and what causes it?

The exact cause is not known. IBD seems to develop when the immune system overreacts to the normal bacteria in the gut in people whose genes make them more likely to have it. Things that raise the chance include:

• A parent, brother, sister or child with IBD
• Age: it often starts between the teens and the 30s, but it can begin at any age
• Smoking, which raises the risk of Crohn's disease and makes it harder to control
• Some medicines, such as frequent use of anti-inflammatory pain relievers (NSAIDs), which can trigger flares

IBD is not caused by stress or by something you ate, although stress and certain foods can make symptoms feel worse.

How is IBD diagnosed?

There is no single test for IBD. Dr. Pimienta starts with a full history and exam, then uses the tests that fit your symptoms:

• Blood tests for anemia, inflammation, nutrition and liver health.
• Stool tests to rule out infection, and a test called fecal calprotectin, which measures a protein released by inflamed bowel. A normal result makes active IBD less likely, and the test is also used later to track how well treatment is working.
• Colonoscopy with biopsies. This is the key test. It shows the pattern and extent of inflammation, and biopsies (small, painless tissue samples) confirm the diagnosis. An upper endoscopy may be added when Crohn's disease could involve the upper digestive tract. Dr. Pimienta performs both at Specialty Surgical Center of Beverly Hills.
• Imaging, such as CT or MRI of the small intestine, may be arranged to look at parts of the bowel a scope cannot reach and to check for strictures or fistulas.

How is IBD treated?

The goal is not just to feel better, but to calm the inflammation itself, so the bowel can heal and complications are less likely. Medicines fall into a few main groups:

• Aminosalicylates (5-ASA), such as mesalamine. Often used for mild to moderate ulcerative colitis, by mouth or as a rectal medicine.
• Corticosteroids, such as prednisone or budesonide. These work quickly to calm a flare, but they are meant for short courses only, because long-term use causes side effects such as bone loss, high blood sugar and infections.
• Immunomodulators, such as azathioprine or methotrexate, which calm the immune system and are sometimes combined with a biologic.
• Biologics, which are targeted medicines given as shots or through an IV. They block specific signals that drive inflammation.
• Small-molecule pills, newer targeted medicines taken by mouth, for some people with moderate to severe disease.

Some people need surgery at some point, for example to remove a narrowed section of bowel or, in ulcerative colitis that does not respond to medicine, the colon. Many people never do. Treatment is chosen around your type of IBD, how active it is, your other health conditions and your preferences. You and Dr. Pimienta decide together; your plan depends on your health, and he will talk with you about what fits you.

What does long-term IBD care look like?

Good IBD care goes beyond the gut. Over the years, Dr. Pimienta also keeps an eye on:

• Colon cancer surveillance. People who have had colitis in more than the rectum for about 8 years or more have a higher risk of colon cancer and usually need colonoscopy every 1 to 3 years.
• Vaccines. Some IBD medicines weaken the immune system, so staying up to date on vaccines such as flu, pneumonia, COVID-19 and shingles matters. Some live vaccines should be avoided on certain medicines.
• Bone health. Steroids and poor absorption can weaken bones. Calcium, vitamin D and sometimes a bone density scan may be recommended.
• Iron and nutrition, since anemia and low vitamin levels are common.
• Skin checks and other screenings that some medicines call for.

Living well with IBD

• Take your medicine even when you feel well. Stopping during remission is a common cause of flares.
• If you smoke, quitting is one of the most helpful things you can do for Crohn's disease.
• Avoid regular use of NSAIDs such as ibuprofen and naproxen unless your doctor says otherwise.
• During a flare, softer, lower-fiber foods may be easier on the gut. There is no single IBD diet, so changes are best made with your care team.
• Rest, sleep and support for stress and mood are part of care, not extras.

Getting seen in Los Angeles

Whether you have new symptoms, a recent diagnosis or long-standing IBD and want a new GI doctor closer to home, Dr. Pimienta can see you at his Wilshire Boulevard office or by secure video if you are in California. He accepts Medicare, and other patients are seen as self-pay. Bring past colonoscopy reports, pathology results and a list of medicines you have tried. Request an appointment or call (424) 281-7392.

Questions patients ask

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Crohn's Disease.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Ulcerative Colitis.
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for Ulcerative Colitis.