Inflammatory Bowel Disease Explained

When it comes to gastrointestinal diseases, you may hear a lot of acronyms, such as IBD and IBS, among others. Inflammatory bowel disease (IBD) is a broad term that refers to chronic swelling, or inflammation, of the intestines. IBD is often confused with the non-inflammatory condition irritable bowel syndrome (IBS), which is one of the most common conditions diagnosed by gastroenterologists. While both IBD and IBS have similar names, affect the gut, often cause similar symptoms, and can affect a person’s quality of life, they have underlying causes that are quite different and require very different treatments.

UT Health Austin gastroenterologist Linda A. Feagins, MD is the Director of the Inflammatory Bowel Disease clinical practice within Digestive Health, the clinical partnership between UT Health Austin and Ascension Seton. Dr. Feagins specializes in IBD and provides care for patients with Crohn’s disease, ulcerative colitis, and indeterminate colitis. She is passionate about giving patients the care and treatment they deserve to live their best quality of life. Below, Dr. Feagins provides an in-depth explanation of IBD, including the types, common symptoms, and causes as well as the treatment approach taken by the IBD clinical practice within Digestive Health and more.

What is inflammatory bowel disease?

“IBD represents a group of chronic intestinal disorders that cause inflammation of the digestive tract, which can disrupt the normal digestive process,” says Dr. Feagins. “IBD can be very troublesome and in some cases life-threatening if left untreated. Once patients are diagnosed with IBD they are usually treated for it for the rest of their lives.”

The exact cause of IBD is unknown; however, genetics, environmental factors, and problems with the immune system are common risk factors for the disease. People with a parent or a sibling with IBD may be more likely to develop IBD, but most patients diagnosed with IBD often do not have a family history of the disease.

Defects in the immune system also play a role in developing IBD. Inflammation in the digestive tract often occurs as a normal process, such as when your body is fighting off an infection. However, in IBD, the inflammation that should resolve itself after it has served its purpose does not go away, leading to long-term inflammation. The reason this occurs remains unclear.

“Another component is the environment,” says Dr. Feagins. “For example, in animal models that are predisposed to getting IBD, inflammation won’t occur if there are no bugs or germs in the gut, but as soon as you introduce these organisms into the system, the animal models will develop IBD. So, we know there is a correlation between what goes into our bodies and the bugs that exist in our gut that triggers or perpetuates this inflammatory disease.”

There are two main types of IBD:

“When discussing IBD, traditionally we are referring to ulcerative colitis and Crohn’s disease. In some patients, when the disease involves the colon and it has some characteristics of both ulcerative colitis and Crohn’s disease, we may refer to it as indeterminate colitis if we aren’t sure which one it is, but this is less common,” says Dr. Feagins.

1. Crohn’s disease can cause inflammation in the lining of any part of the digestive tract, which includes the mouth, esophagus, stomach, small intestine, large intestine, and anus, but it mostly commonly affects the tail end of the small intestine and the colon.

“Patients with Crohn’s disease can experience inflammation anywhere between the anus and the mouth, and the inflammation is usually inconsistent, affecting patches of the digestive tract,” says Dr. Feagins. “Most commonly, Crohn’s disease inflammation occurs in the colon and the terminal ileum, which is the end part of the small bowel right before the colon.”

2. Ulcerative colitis involves inflammation and sores along the superficial lining of the colon that starts in the rectum.

“Ulcerative colitis is a disease that only involves the colon, typically starting in the rectum and causing continuous inflammation up into the colon. Some patients may have just the bottom part of their colon inflamed, while other patients may have their whole colon inflamed, but the distinguishing factor is that ulcerative colitis causes continuous inflammation throughout the colon,” Dr. Feagins explains.

What are the symptoms of inflammatory bowel disease?

Symptoms of IBD vary depending on the location and severity of the disease and can range from mild to severe. Patients with IBD may experience periods of active illness followed by periods of remission. Signs and symptoms that are common to both Crohn’s disease and ulcerative colitis may include:

• Diarrhea
• Fatigue
• Bleeding ulcers, which may cause blood in the stool
• Stomach pain, abdominal cramping, and bloating
• Reduced appetite
• Unintended weight loss and anemia

People with Crohn’s disease may also get canker sores in their mouths. Sometimes ulcers and fissures will appear around the genital area or anus.

“If not detected and treated early, IBD can cause bowel perforations, fistulas, and lead to colon cancer. IBD can also be associated with problems outside of the digestive system, such as eye inflammation, skin disorders, and arthritis,” says Dr. Feagins.

How is inflammatory bowel disease diagnosed?

“IBD is a clinical diagnosis, meaning patients don’t just have one test done to determine the diagnosis. It’s diagnosed by a combination of information, including the right symptoms and findings on clinical tests, such as colonoscopy and imaging tests,” says Dr. Feagins.

An endoscopy or colonoscopy, including a biopsy, are typically performed to determine where the disease is occurring in the digestive tract as well as the severity of the disease. In some cases where the areas of inflammation may be more difficult to reach, such as in the small intestine, imaging, including an MRI or CT scan, can also be helpful in reaching a diagnosis.

“I find that most of my patients are extremely relieved and thankful to finally understand what is causing their symptoms. IBD is very treatable and patients can start feeling better as soon as we begin an appropriate treatment plan,” says Dr. Feagins.

How is IBD treated at the IBD clinical practice within Digestive Health?

Once a proper diagnosis is determined, several types of medications can be used to reduce inflammation caused by IBD. Immune suppressants (biologics and/or immunomodulators) are commonly used to prevent the immune system from attacking the bowel and causing inflammation. Additionally, antibiotics may help kill bacteria that can trigger or aggravate IBD, and lifestyle modifications and supplements can help address symptoms of IBD.

In patients with severe cases of IBD, surgery may be necessary to remove damaged parts of the small or large intestine, to widen a narrowed section of the bowel, or to close or remove fistulas. In addition to assessing the degree and locations of inflammation, routine colonoscopy is also used to monitor for colon cancer, since patients with IBD affecting the colon are at a higher risk for developing colon cancer.

“Here in the Inflammatory Bowel Disease clinical practice, we have a specialized, multidisciplinary team dedicated to treating patients with IBD. When patients come in to see us, they aren’t going to only see a gastroenterologist, because for patients with IBD, it’s more than just their bowel that can be affected, which is why patients really benefit from our whole-person care model,” says Dr. Feagins.

“We have a dedicated physician assistant to assist with patient care, a clinical social worker to help patients manage the mental and behavioral health components that may come with having a chronic illness, and an IBD dietitian to help with nutritional care, which is extremely important” Dr. Feagins adds.

Dr. Feagins is also working on getting different types of clinical trials started that will be available for patients who qualify for and are interested in trying new treatments for their IBD. She is also conducting clinical research that assesses the needs of GI patients here in Austin in comparison to the rest of the country in order to better tailor treatment options for patients in Austin, across Texas, and beyond.

“I’m really excited to have the opportunity to be here and be a part of this team, and I hope to make a long-standing difference in patients’ lives here in Austin,” says Dr. Feagins.

For more information about the Inflammatory Bowel Disease clinic click here. For more about information about additional services offered in Digestive Health or to schedule an appointment, visit here or call 1-844-GI-AUSTIN (1-844-442-8784).