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| Diagnosis & Treatment of Inflammatory Bowel Disease |
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Diagnosing inflammatory bowel disease
Since it can be difficult to definitively diagnose IBD, your doctor may recommend a number of different tests in additional to taking a thorough medical history and doing a physical exam. Initial tests may include:
- A CBC (complete blood count) to detect infection, anemia or other abnormalities
- An electrolyte panel to measure potassium and other mineral that may depleted by IBD-associated diarrhea
- Stool studies to detect bacterial infections
- Liver screening for liver and bile duct abnormalities sometimes seen in IBD patients
If your doctor suspects you have IBD, you will most likely undergo more extensive tests, such as the following:
- Endoscopy is used to visually examine your gastrointestinal tract and can also be used to obtain tissue for biopsy . During endoscopy, a thin tube with a light and camera at the tip are inserted into the mouth or through the anus, depending on the area to be viewed, and into the GI tract. The images are magnified and projected onto a screen for viewing. Depending on the type of endoscopy being performed, you may be asked to follow a liquid diet, use enemas or drink special “bowel prep” liquids to cleanse the colon before the test.
- Radiologic tests can include conventional X-rays, contrast X-rays (using an agent such as barium) or CT scans
- MRI (magnetic resonance imaging) can also be used, especially when assessing abcesses and fistulas
Treatment options
While there’s no permanent cure for IBD, treatments are designed to bring about and maintain remission, that is, the absence of symptoms. The two major treatments are medication and surgery, depending on the symptoms, prognosis, and severity of the disease.
Medications
The majority of inflammatory bowel disease cases can be managed with medications in the following five categories:
- Aminosalicylates, or 5-ASA drugs, are anti-inflammatory medicines that can be taken orally or via suppositories to suppress inflammation in the intestine as well as relieve painful symptoms.
- Corticosteroids, such as prednisone, are powerful, fast-acting anti-inflammatory drugs. However, since these drugs trigger extensive side effects, they’re not feasible for long-term maintainance.
- Antibiotics can be used, even though there’s no specific infectious agent associated with IBD, to reduce intestinal bacteria and suppress the intestinal immune system.
- Immunomodulators help to weaken the activity of the immune system, which in turn reduces inflammation. Since they act very slowly, they are often paired with corticosteroids, which act quickly.
- Biologic therapies, a class of medications that includes Remicade, are becoming increasing popular because of their effectiveness in treating inflammation. These drugs are developed to target specific proteins and enzymes and suppress immune response.
Surgery
In the past, surgery has often been considered a last resort because of the risk factors inherent in any surgery. Also, with Crohn’s disease in particular, inflammatory bowel disease tends to recur and after repeated surgeries, patients can develop painful intestinal adhesions, or risk losing enough intestine to cause malnutrition.
However, advances in minimally invasive surgery, including laparascopic and robotically-assisted techniques, have greatly improved surgery as a treatment option. In fact, Dr. Michael Docherty, of UCSD Medical Center, says minimally invasive surgery is the future of IBD treatment. “If we can do these surgeries more easily, with quick recoveries, that becomes a better option," says Docherty, head of UCSD's Inflammatory Bowel Disease Center. "The less trauma for the patient, the better.”
Benefits of minimally invasive surgery include:
- Smaller incisions
- Faster recovery time
- More targeted surgery, which allows more of the intestines to be spared
- Reduced risk of adhesions in the abdominal cavity, which can cause pain and other complications
At UCSD Medical Center, the colorectal surgery team includes Dr. Mark Talamini, a pioneer in the field of robotic and minimally invasive surgeries, and Dr. Sonia Ramamoorthy, a specialist in minimally invasive techniques whose research interests include ulcerative colitis and Crohn’s disease.
Contact us
For an appointment, to refer a patient, or for more information about UCSD Medical Center's Inflammatory Bowel Disease Center, call Jennifer Pulido at (858) 657-8381.
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