Inflammatory Bowel Disease (IBD) (cont.)
What about Surgery for Inflammatory Bowel Disease (IBD)?
Surgical treatment in persons with inflammatory bowel disease varies, depending upon the disease. Ulcerative colitis is a surgically curable disease because the disease is limited to the colon. However, surgical resection is not curative in persons with Crohn's disease. On the contrary, excessive surgical intervention in persons with Crohn's disease can lead to more problems. Situations arise in Crohn's disease in which surgery without resection can be used. This is done to halt function of the colon in order to possibly allow for healing of the disease away from the site where surgery is done.
- In about 25% to 30% of persons with ulcerative colitis, medical treatment is not completely successful. In such persons and in persons with dysplasia (changes in the cells that are considered a precursor to cancer), surgery may be considered. Unlike Crohn's disease, which can recur after surgery, ulcerative colitis is cured after colectomy (surgical removal of the colon).
- The surgical options for persons with ulcerative colitis depend on a number of factors: the extent of the disease, the person's age, and overall health. The first option involves the removal of the entire colon and rectum (proctocolectomy) with the creation of an opening on the abdomen through which feces is emptied into a pouch (ileostomy). This pouch is attached to the skin with an adhesive.
- The other most commonly used option is a technically demanding surgery and is generally a multistage procedure. The surgeon removes the colon, creates an internal ileal pouch from the small intestine, attaches it to the anal sphincter muscle (ileoanal anastomosis), and creates a temporary ileostomy. After the ileoanal anastomosis heals, the ileostomy is closed and the passage of the feces through the anus is reestablished.
- Even though surgery is not curative in persons with Crohn's disease, approximately 75% of persons will require surgery at some point of time (especially for complications). The most simple surgery for Crohn's disease is the segmental resection, in which a segment of intestine with active disease or a stricture (narrowing) is removed and the remaining bowel is re-anastomosed (two ends of healthy bowel are joined together).
- In persons with a very short stricture, instead of removal of that part of the intestine, a bowel-sparing stricturoplasty (repair) can be performed.
- Ileorectal or ileocolonic anastomosis is an option is some persons who have lower small intestine or upper colon disease.
- In persons with severe perianal fistulae, diverting ileostomy/colostomy is a surgical option. In this procedure, the function of the distal colon and the rectum is halted to allow healing, and then the ileostomy/colostomy is reversed.
What Are the Other Complications of Inflammatory Bowel Disease (IBD)?
- Persons with inflammatory bowel disease are prone to the development of malignancy (cancer). In Crohn's disease, there is a higher rate of small intestinal malignancy. Persons with involvement of the whole colon, particularly ulcerative colitis, are at a higher risk of developing colonic malignancy after 8 to 10 years of the onset of the disease. For cancer prevention, surveillance colonoscopy every 1 to 2 years after 8 years of disease is recommended.
- Use of corticosteroids may lead to debilitating illness, particularly after long-term use. You should consider trying more aggressive therapies rather than remaining on corticosteroids because of the potential for side effects with these drugs.
- Patients taking steroids should undergo a yearly ophthalmologic examination because of the risk of development of cataracts.
- Persons with IBD may have a reduction in bone density, either from decreased calcium absorption (because of the underlying disease process) or because of corticosteroid use. Crippling osteoporosis can be a very serious complication. If you have significantly low bone density, you will be administered bisphosphonates and calcium supplements.
Can Inflammatory Bowel Disease (IBD) Be Prevented?
- No known dietary or lifestyle change prevents the development of inflammatory bowel disease.
- Dietary manipulation may help symptoms in persons with ulcerative colitis, and it actually may help reduce inflammation in Crohn's disease. However, there is no evidence that consuming or avoiding any particular food item causes or avoids flare-ups of IBD.
- Smoking cessation is the only lifestyle change that may benefit persons with Crohn's disease. Smoking has been linked to an increase in the number and severity of flare-ups of Crohn's disease. Quitting smoking occasionally is sufficient to make a person with refractory (not responding to treatment) Crohn's disease go into remission.
Medically Reviewed by a Doctor on 9/11/2017
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