Brief Overview: According to the CDC, “Inflammatory bowel disease (IBD) refers to a group of lifelong diseases affecting the intestines. The main types of IBD are Ulcerative Colitis and Crohn's Disease. IBD symptoms come and go (periods of “flares” and remission). Symptoms can range from mild to severe.” Currently, there is no cure for IBD, but there are medications that can work to help control symptoms. The information below reflects overlapping information for Ulcerative Colitis and Crohn’s Disease. Please refer to the individual resources for more condition-specific information.
Prevalence: According to UpToDate, “In North America, the age-standardized prevalence rate of IBD was 422 cases per 100,000 population.”
Etiology: The exact cause of IBD is not known, but it’s believed to be caused by a combination of genetic, environmental, and gut-immune factors.
Risk Factors:
- NSAID use
- Family history of IBD
- Age 15-30 years old, and 50-80 years old
- Jewish descent
- Dietary emulsifiers and additives
- High-fat diet
Commonly Associated Conditions:
- Primary sclerosing cholangitis
- Osteoporosis
- Anemia
- Arthritis
- Uveitis, episcleritis
- Vitamin D deficiency
Common Medications:
- Glucocorticoids
- 5-aminosalicylates
- Immunomodulators
- JAK inhibitors
- Biologics
Common Labs, Imaging, and Tests:
- Labs: CMP, CBC, CRP, ESR, vitamin levels, iron studies
- Stool studies
- Imaging/other tests: abdominal imaging, endoscopy, colonoscopy, etc.
Common Symptoms:
- Abdominal pain
- Diarrhea
- Fatigue
- Weight loss
Common Treatments:
- Medication (see above)
- Vitamin, nutrient supplementation as needed
- Surgical intervention may be indicated
Physical Findings:
- Typically, normal physical exam
- Abdominal tenderness may be present
Potential Complications and Contraindications:
- Increased risk of colorectal cancer
- Increased risk for bone loss
- Dehydration
- Vitamin, nutrient deficiencies
General Health and Lifestyle Guidance:
- Stay up to date on all age-appropriate vaccinations. Discuss which vaccines are recommended for you with your healthcare provider. Some vaccines are not recommended if you are immunosuppressed.
- Ask your healthcare provider if there are any medications you should avoid (like NSAIDs, opioids).
- Stay adequately hydrated to avoid dehydration associated with diarrhea
- Exercise regularly as tolerated. Speak with your healthcare provider about what exercise regimen is safe for you.
- Annual skin examinations by a dermatologist is recommended for all IBD patients who are taking immunomodulators, anti-TNFs, or small molecules
- Talk to your healthcare provider and/or dietician about any specific dietary modifications that are recommended for you. Keeping a food/symptom diary may be helpful.
Suggested Questions to Ask Patients:
- Are you currently experiencing diarrhea, pain, or fatigue?
- Have you had any weight loss or changes in appetite?
- Are you taking your medications consistently?
- Do you have a history of fistulas, strictures, or past surgeries?
- Have you experienced joint pain, skin rashes, or eye issues?
- Have you had a recent colonoscopy or lab work?
Suggested Talking Points:
- Make sure to report any new, worsening, or persistent symptoms to your healthcare provider
- Make sure to follow up with all healthcare providers as directed. Complete any blood work, imaging, or tests that are ordered.
- Make sure to take all mediations as directed, even when you’re feeling well.
- Make sure to talk to your healthcare provider before taking any supplements
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