ibd

There are two types of inflammatory bowel disease (IBD):

  1. Crohn’s disease, and
  2. Ulcerative colitis.

Accurately diagnosing IBD is a multi-step process involving gastroenterology, endoscopy, radiology, pathology, and potentially, surgery.

Treatment

The IBD Program, a part of the University of Utah Health Care Gastroenterology Services, understands that each patient is unique and our IBD treatment team providers work together with our patients to develop a treatment plan that is right for each patient.

Working collaboratively, our IBD providers attend a weekly conference to discuss the individual issues our patients face, reviewing emerging treatment options and the latest research to further the options for our IBD patients.

Our staff will help schedule an appointment at (801) 213-9797.

Crohn's Disease

Illustration of the anatomy of the digestive system, adult

What is Crohn's disease?

Crohn's disease is an inflammatory bowel disease (IBD) that is a chronic condition that may recur at various times over a lifetime. It usually involves the small intestine, most often the lower part called the ileum. However, in some cases, both the small and large intestine are affected. Sometimes, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, or anus.

Crohn's disease affects males and females equally. It appears to run in some families, with about 20 percent of people with Crohn's disease having a blood relative with some form of inflammatory bowel disease.

What are the symptoms of Crohn's disease?

The following are the most common symptoms of Crohn's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Abdominal pain, often in the lower right area

  • Diarrhea, sometimes bloody

  • Rectal bleeding

  • Weight loss

  • Fever

  • Joint pain

  • Rectal fissure

  • Rashes

Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

The symptoms of Crohn's disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What causes Crohn's disease?

There are many theories regarding what causes Crohn's disease. One theory suggests that some agent, perhaps a virus or a bacterium, affects the body's immune system and triggers an inflammatory reaction in the intestinal wall. Although there is a lot of evidence that patients with this disease have abnormalities of the immune system, it is not known whether the immune problems are a cause or a result of the disease. There is no evidence that Crohn's disease is caused by stress.

How is Crohn's disease diagnosed?

People who have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia may be examined for signs of Crohn's disease. In addition to a complete medical history and physical examination, diagnostic procedures for Crohn's disease may include the following:

  • Blood tests. These are done to determine if there is anemia resulting from blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process.

  • Stool culture. Checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by your doctor's office. In two or three days, the test will show whether abnormal bacteria are present, determine if there is blood loss, or if an infection by a parasite or bacteria is causing the symptoms.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). An EGD is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum (the first part of the small intestine where absorption of vitamins, minerals, and other nutrients begins). A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as remove tissue for further examination if necessary.

  • Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine. A colonoscopy can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

  • Biopsy. A procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.

  • Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs. An upper GI with a small bowel follow-through may be used to diagnose Crohn's disease.

  • Lower GI (gastrointestinal) series (also called barium enema). A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

Illustration demonstrating a colonoscopy

What are treatments for Crohn's disease?

Specific treatment for Crohn's disease will be determined by your doctor based on:
  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

At this time there is no cure for Crohn's disease; however, several methods are helpful in controlling it. The usual goals of treatment are to:

  • Correct nutritional deficiencies.

  • Control inflammation.

  • Relieve abdominal pain, diarrhea, and rectal bleeding.

Treatment may include:

  • Drug therapy (anti-inflammatory medications, cortisone or steroids, immune system suppressors, biologic therapies, antibiotics, anti-diarrheal medications, and fluid replacements). Abdominal cramps and diarrhea may be helped by medications, which often lessen the inflammation in the colon. More serious cases may require medications that affect the body's immune system.

  • Diet and supplements. No special diet has been proven effective for preventing or treating Crohn's disease. Some symptoms are made worse by milk, alcohol, hot spices, or fiber, but this may not be true for everyone.

    • Supplements. Nutritional supplements or special high-calorie liquid formulas may sometimes be suggested, especially for children with delayed growth.

    • Feeding through a vein. A small number of patients, who temporarily need extra nutrition, may need periods of feeding by vein (intravenously).

  • Surgery. Crohn's disease may be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return to the areas of the intestine next to the area that has been removed. Surgery may help to either relieve chronic symptoms of active disease that does not respond to medical therapy or to correct complications, such as intestinal blockage, perforation, abscess, or bleeding.
    Types of surgery may include:

    • Drainage of abscesses or removal of a section of bowel (due to blockage, resulting in a shortened bowel).

    • Ostomy. Some people must have part of their intestines removed, and a new method of removing the stool from the body is created. The surgery to create the new opening is called ostomy, and the new opening is called a stoma.

    Different types of ostomy are performed depending on how much and what part of the intestines are removed, and may include the following:

    • Ileostomy. The colon and rectum are removed and the bottom part of the small intestine (ileum) is attached to the stoma.

    • Colostomy. A surgically-created opening in the abdomen through which a small portion of the colon is brought up to the surface of the skin. Sometimes, a temporary colostomy may be performed when part of the colon has been removed and the rest of the colon needs to heal.

    • Ileoanal reservoir surgery. An alternative to a permanent ileostomy, this procedure is completed in two surgeries. First, the colon and rectum are removed and a temporary ileostomy is performed. Second, the ileostomy is closed and part of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.

Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower (sigmoid) intestine and spreads upward to the entire colon. Ulcerative colitis rarely affects the small intestine, except for the lower section, the ileum.

The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form and may cause the discharge of pus and mucus, in addition to bleeding.

Although children and older people sometimes develop ulcerative colitis, it most often starts between the ages of 15 and 30. It affects males and females equally and appears to run in some families.

Ulcerative colitis requires long-term medical care. There may be remissions--periods when the symptoms go away--that last for months or even years. However, symptoms eventually return.

Only in rare cases, when complications occur, is the disease fatal. If only the rectum and lower colon are involved, the risk of cancer is not higher than normal. However, the risk of colon cancer is greater than normal in patients with widespread ulcerative colitis.

What are the symptoms of ulcerative colitis?

The following are the most common symptoms of ulcerative colitis. However, each individual may experience symptoms differently. Symptoms may include:

  • Abdominal pain

  • Bloody diarrhea

  • Fatigue

  • Weight loss

  • Loss of appetite

  • Rectal bleeding

  • Loss of body fluids and nutrients

  • Anemia caused by severe bleeding

Sometimes, symptoms may also include:

  • Skin lesions

  • Joint pain

  • Inflammation of the eyes

  • Liver disorders

  • Osteoporosis

  • Rashes

  • Kidney stones

The symptoms of ulcerative colitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What causes ulcerative colitis?

Although many theories exist regarding the cause of ulcerative colitis, none has been proven. The cause of ulcerative colitis is unknown, and currently there is no cure, except through surgical removal of the colon. One theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.

Although much scientific evidence shows that people with ulcerative colitis have abnormalities of the immune system, physicians do not know whether these abnormalities are a cause or result of the disease.

There is little proof that ulcerative colitis is caused by emotional distress or sensitivity to certain foods or food products.

How is ulcerative colitis diagnosed?

A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. In addition, diagnostic procedures for ulcerative colitis may include the following:

  • Stool culture. Checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by your doctor's office. In two or three days, the test will show whether abnormal bacteria, bleeding, or infection are present.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum (the first part of the small intestine where the absorption of vitamins, minerals, and other nutrients begins). A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

  • Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

  • Biopsy. A procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.

  • Lower GI (gastrointestinal) series (also called barium enema). A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

What is the treatment for ulcerative colitis?

Specific treatment for ulcerative colitis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

While there is no special diet for ulcerative colitis, patients may be able to control mild symptoms simply by avoiding foods that seem to upset their intestines.

When treatment is necessary, it must be tailored for each case, as what may help one patient may not help another. Patients are also given needed emotional and psychological support. Treatment may include:

  • Drug therapy (aminosalicylates, corticosteroids, or immunomodulators). Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. More serious cases may require steroid medications, antibiotics, or medications that affect the body's immune system.

  • Hospitalization. Patients with ulcerative colitis occasionally have symptoms severe enough to require hospitalization to correct malnutrition and to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, intravenous (IV) feedings, medications, or, sometimes, surgery.

  • Surgery. Most people with ulcerative colitis do not need surgery. However, about 25 to 40 percent of ulcerative colitis patients eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer. Sometimes, removing the colon is suggested when medical treatment fails, or the side effects of steroids or other drugs threaten the patient's health.

There are several surgical options, including the following:

  • Proctocolectomy with ileostomy. This is the most common surgery and involves proctocolectomy (removal of the entire colon and rectum) with ileostomy (creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste).

  • Ileoanal anastomosis. Sometimes, ileoanal anastomosis (also called a pull-through operation), an operation that avoids the use of a pouch, can be performed. The diseased portion of the colon is removed and the outer muscles of the rectum are preserved. The ileum is attached inside the rectum, forming a pouch, or reservoir, that holds waste. This allows the patient to pass stool through the anus in a normal manner, although the bowel movements may be more frequent and watery than usual.

Kathleen K. Boynton, M.D.

Kathleen Boynton, M.D. received her medical degree from the University of Florida. She also served as an Intern, Resident, and Chief Resident while in Florida. Dr. Boynton then came to Utah, and completed her Fellowship at the University of Utah. Her clinical interests include immune related disorders of the ... Read More

Specialties:

Endoscopy, GI Motility, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
(801) 213-9797
University Hospital
Gastroenterology Endoscopy Center
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797

Ann Flynn, M.D.

Dr. Flynn attended medical school at New York Medical College. She completed internal medicine residency training at the University of Colorado School of Medicine and gastroenterology fellowship training at the Indiana University School of Medicine, where she served as Chief Fellow. She received additional tra... Read More

Specialties:

Gastroenterology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis

Locations:

South Jordan Health Center (801) 213-9797
University Hospital
Gastroenterology Endoscopy Center
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797
Veterans Administration Medical Center
Gastroenterology Lab
(801) 584-1236

Stephen L. Guthery, M.D., M.S.

Dr. Guthery received his medical degree from the Oregon Health Sciences University and completed his pediatric residency at Cincinnati Children’s Hospital Medical Center. He subsequently completed his fellowship in pediatric gastroenterology at Cincinnati Children’s Hospital Medical Center.
... Read More

Keisa M. Lynch, APRN, FNP-C, DNP

Keisa M. Lynch, DNP, APRN, FNP is a family nurse practitioner in the department of Gastroenterology and Hepatology at the University of Utah School of Medicine. Her clinical interests include treatment, diagnosis and continuing care for gastrointestinal diseases and hepatology.
... Read More

Specialties:

Constipation, Diarrhea, Eosinophilic Esophagitis, Esophageal Diseases, Family Nurse Practitioner, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Hepatology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Irritable Bowel Syndrome, Liver Disease, Women's GI Health, Women's Health

Locations:

Redwood Health Center
Gastroenterology
(801) 213-9797
University Hospital
Kidney and Liver Clinic
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797

Whitney Mentaberry, APRN, NP-C

Whitney J. Mentaberry NP-C, BSN-RN, is a family Nurse Practitioner in the department of Gastroenterology, Hepatology, and Nutrition at the University of Utah School of Medicine. Whitney specializes in the diagnosis and continuing care for gastrointestinal diseases. Whitney received her Master of Science in Nursi... Read More

Specialties:

Barrett's Esophagus, Constipation, Diarrhea, Eosinophilic Esophagitis, Esophageal Diseases, Esophageal Motility Disorders, Fecal Incontinence, GI Motility, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Hepatology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Irritable Bowel Syndrome, Liver Biopsies, Liver Disease, Women's GI Health

Locations:

Redwood Health Center
Gastroenterology
(801) 213-9797
Redwood Health Center
Redwood Urgent Care
(801) 213-9797
University Hospital
Kidney and Liver Clinic
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797

Kathryn A. Peterson, M.D.

Kathryn Peterson, MD is an Associate Professor in the Department of Medicine at the University Of Utah School Of Medicine and a Huntsman Cancer Institute investigator. She is certified by the American Board of Internal Medicine.

... Read More

Specialties:

Barrett's Esophagus, Endoscopy, Eosinophilic Esophagitis, Esophageal Diseases, GI Motility, Gastroenterology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Women's GI Health

Locations:

University Hospital
Gastroenterology Endoscopy Center
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797

John F. Valentine, M.D.

John F. Valentine, MD, is a Professor of Medicine at the University of Utah School of Medicine in the Division of Gastroenterology, Hepatology and Nutrition and specializes in ulcerative colitis and Crohn’s disease. His clinical interests and expertise are in inflammatory diseases of the intestinal tract that i... Read More

Specialties:

Gastroenterology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis

Locations:

University Hospital
Gastroenterology, Clinic 3
(801) 213-9797
University Hospital
Gastroenterology Endoscopy Center
(801) 213-9797

Michael J. Walker, M.D.

Dr. Michael Walker received his medical degree from the Chicago Medical School at Rosalind Franklin University of Medicine and Science and completed an Internal Medicine residency at the University of Utah. He then served as chief medical resident in the Department of Medicine. Following this time, he complete... Read More

Specialties:

Barrett's Esophagus, Colon Cancer, Constipation, Diarrhea, Endoscopy, Eosinophilic Esophagitis, Esophageal Diseases, Fecal Incontinence, Gastroenterology, Gastroesophageal Reflux Disease (GERD), Hepatology, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Irritable Bowel Syndrome, Liver Disease, Women's GI Health

Locations:

Farmington Health Center (801) 213-9797
Redwood Health Center (801) 213-9797
South Jordan Health Center (801) 213-9797
University Hospital
Clinic 3
50 North Medical Drive
Salt Lake City, UT 84132
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Appointments
(801) 213-9797
  • MERIT-UC
    Keywords: Ulcerative Colitis, Methotrexate
    Status: Recruiting