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Last Updated: Nov 01, 2019
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Inflammatory Bowel Disease: Treatment, Procedure, Cost and Side Effects

What is Inflammatory Bowel Disease? How is the treatment done? Are there any side effects? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent?

What is Inflammatory Bowel Disease?

Inflammatory bowel disease is the term used to describe two medical conditions, namely, Crohn's disease and ulcerative colitis

Inflammatory bowel disease (IBD) is a group of intestinal disorders that cause prolonged inflammation of the digestive tract. The two major types of inflammatory bowel disease are ulcerative colitis and Crohn's disease. They cause sores (ulcers) in the digestive tract and also inflammation which causes extreme pain in the patient. Ulcerative colitis disease can cause inflammation and sores (ulcers) which are long lasting in the innermost lining of the large intestine (colon) and rectum. Crohn's disease can cause inflammation of the lining of the digestive tract, which often spreads deep into affected tissues.

Depending on the severity of inflammation and location of occurrence, the symptoms of inflammatory bowel disease can vary a lot. Main symptoms caused by intestinal ulcers are predominantly abdominal pain, cramps, and bleeding. Sometimes, however, ulcers may be present in IBD but are not associated with any symptoms (asymptomatic). In Crohn's disease, the symptoms can be diarrhoea, fever and fatigue, abdominal pain and cramping, blood in the stool, reduced appetite, unintended weight loss.

Treatment for Crohn’s Disease and Ulcerative Colitis in the patients will depend on how severe the symptoms are, and how much of the gut is affected. Inflammatory bowel disease can be treated with medicines and drugs that aim to reduce inflammation in the gut and bring relief from the symptoms. These anti-inflammatory drugs include steroids, 5ASAs, immunosuppressants such as azathioprine, methotrexate and ciclosporin, and biological drugs like infliximab and adalimumab. If the condition does not improve with medicines, then patients may be required to undergo surgeries. Some IBD surgeries include strictureplasty to widen a narrowed bowel, closure or removal of fistulas, removal of affected portions of the intestines for people with Crohn’s disease and removal of the entire colon and rectum for severe cases of ulcerative colitis.

How is the treatment done?

A number of tests are performed in order to diagnose the signs and symptoms of inflammatory bowel disease. The tests include blood tests, endoscopic procedures and imaging tests. Blood tests are done as tests for anemia or infection to detect the amount of red blood cells to carry adequate oxygen to the tissues or to check for signs of infection from bacteria or viruses. Fecal occult blood test is done with a stool sample. Doctors test for hidden blood in the stool. Colonoscopy is an endoscopic exam that allows the doctor to view the entire colon using a thin, flexible, lighted tube with an attached camera. During this procedure, the doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. In other endoscopic exam, called Flexible sigmoidoscopy, the doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid, the last portion of the colon. Upper endoscopy is done if the patient is having nausea and vomiting, difficulty eating or upper abdominal pain. Capsule endoscopy is used to help diagnose Crohn's disease that involves the small intestine. Balloon-assisted enteroscopy enables the doctor to look further into the small bowel where standard endoscopes don't reach. This procedure is very useful when a capsule endoscopy shows abnormalities. Imaging tests like X ray, Computerized tomography (CT scan) and magnetic resonance imaging (MRI) tests are also done to assist the diagnosis of inflammatory bowel disease.

The treatment of inflammatory bowel disease depends on the degree of severity and location of the syndrome. Treatment aims to reduce the inflammation that triggers the signs and symptoms. IBD treatment usually involves either drug therapy or surgery. Anti-inflammatory drugs are used primarily in the treatment of inflammatory bowel disease. Anti-inflammatory drugs include corticosteroids and aminosalicylates, such as mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Prescribed medicine depends on the location of the disease. Immunosuppressant drugs like azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune) and methotrexate (Trexall) suppress the immune response that releases inflammation-inducing chemicals in the intestinal lining. Drugs called tumor necrosis factor (TNF)-alpha inhibitors, or biologics also help to relieve the symptoms of IBD. It works by neutralizing a protein produced by the immune system. Examples of these drugs include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). Other biologic therapies that may be used are natalizumab (Tysabri), vedolizumab (Entyvio) and ustekinumab (Stelara).Apart from these medicines, antibiotics may also be used. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl). In addition to this, some over-the-counter medications may also be used which help to relieve the symptoms. Depending on the severity of the IBD symptoms, doctor may recommend anti-diarrheal medications, pain relievers, iron supplements and Calcium and vitamin D supplements. The doctor may also recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat the symptoms of IBD. Some IBD signs and symptoms are so severe that the doctor may recommend surgery. Surgery can often eliminate ulcerative colitis by removing entire colon and rectum (proctocolectomy). This procedure involves an ileal pouch anal anastomosis. People with Crohn's disease will require at least one surgery. However, surgery is not able to cure Crohn's disease. During surgery, the surgeon removes the damaged portion of the digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.

Who is eligible for the treatment?

People should consult a doctor when they experience a persistent change in their bowel habits. They may have any of the signs and symptoms of inflammatory bowel disease and pain which they have not experienced before. Inflammatory bowel disease usually is not fatal, but it can be a serious disease and in some cases, may cause life-threatening complications. It is always advisable to consult a doctor and seek medical assistance and care.

Who is not eligible for the treatment?

People with normal bowel movement and no signs and symptoms of inflammation do not need to undergo medical treatment. Many times, the bowels become inflated and cause pain but this can be cured with home remedies. If the symptoms are not chronic and do not cause hamper in the daily lives of the people, they do not need to undergo medical treatment.

Are there any side effects?

Medications used in the treatment of inflammatory bowel disease (IBD) have certain side effects. Side effects of the corticosteroids used in the treatment include weight gain, facial swelling, sweating, insomnia etc. Side effects such as nausea, vomiting and loss of appetite, are noted in case of Oral 5-aminosalicylates drugs. Antibiotics can cause upset stomach, loss of appetite, diarrhea and vomiting and also the feel of an urgent need to urinate, as well as vaginal itching and/or discharge. There can be some serious side effects caused by the immunosuppressant. Despite the side effects, these medications are effective in the treatment of IBD.

What are the post-treatment guidelines?

After treatment, people need to follow certain rules to prevent relapse of the disease and also cut down the risk of developing inflammatory bowel disease. They need to maintain a healthy diet, take proper medicines and exercise regularly. They should also quit smoking and avoid taking stress in order to prevent the recurrence of the disease even after treatment.

How long does it take to recover?

In general, it takes around 6 weeks to recover from the treatment of inflammatory bowel disease. People should be careful and avoid complications. Medicines and other opinions from the doctor, when followed, can help in speedy recovery.

What is the price of the treatment in India?

IBD is an expensive chronic disease without a cure. Patients incur a huge amount for the treatment fo inflammatory bowel disease. Surgical procedures for IBD typically cost about Rs. 600000/- to Rs. 2000000/-. For mild symptoms, doctors may prescribe a number of drugs which can cost about Rs 6000 to Rs 50000/-. Additional costs are needed for the consultation fees, various diagnostic tests etc.

Are the results of the treatment permanent?

The treatment can be considered permanent only on certain basis. Medications and drugs can help to cure the inflammation and reduce symptoms. However, the benefits of surgery for Crohn's disease are usually temporary. This disease can recur often, and frequently near the reconnected tissue. Patients must take proper medication to minimize the risk of recurrence and cause the treatment be permanent.

Popular Questions & Answers

Hi my son is having some issue with digestion. His age is 7 years old. 3-4 times he goes for poo in a day. Most of the time I found he goes for poo after drinking milk. Same milk my younger son drinks but he do not face any problem of digestion. Please suggest me which doctor should I consult. Also provide me any treatment so that my son could digest things what he eat.

MS - Obstetrics and Gynaecology, MBBS Bachelor of Medicine and Bachelor of Surgery
Gynaecologist, Shimla
I am sorry to hear about your concern but will be happy to assist you. Such problems can be the result of bacteria in food, infection, stress, certain medications, or chronic medical conditions such as colitis, crohn's disease, and ibs. Let's conn...

My mother is a ibs d patient, age 58. She goes for stool every day for 10-12 times. She is under medication and have a sedentary life style. She regularly takes loperamide, inset, librax and rifaxcin for 2 months. Alternatively she is taking this treatment for 2 years. She used to have leg swelling since then which occurs but automatically gets cured. 1 year before her kidney and liver profile test were ok. But during this 1 month her swelling of leg have increased. So her liver function and kidney profile test have been done. Her albumin level is 3.2,24 hour urine protein test- 324 mg/day, urine protein -18 mg/dl, esr-20, crp-.04, urea-9.87, creatine-0.57. Her weight is 26 kg since childhood she suffers from digestive problems and her weight was 32 kg. She cannot digest protein, diary products hence her diet is low in protein .her stool frequency is not getting low even after taking so many medications also. She regularly goes to toilet for 10-12 and it is more after eating anything. Recently it has increased as during night time before going to bed she is also going for stool. Previously before 6 months she only use to go for stool in the morning till 11 am. After that it gets stopped. Her colonoscopy and endoscopy reports done 1 year before were ok. Due to her increased frequency of stool during this 1 month she took kutsjghsn vati from dabur and stooped the allopathy. She got relaxed from it. But suddenly drop in albumin and excretion of protein from urine is whether the side effects of kutajghanvati?/ loperamide 2 tablets she takes in a week interval of 4 days. Is the reports of the recent blood test and urine test anything serious. Kindly suggest for any medicine or remedy during this covid period as we are not able to go to hospital.

DM - Gastroenterology, MD - Medicine, MRCP (UK), DNB ( Med)
Gastroenterologist, Trivandrum
1. Is she passing loose stools or formed stools? 2. Any associated diseases like diabetes, heart diseases will have to do more tests and have to optimise medicines.
1 person found this helpful

I have ulcerative colitis from past 10 yrs. I am on mesacol 400 mg 4 tabs per day. Can I take celin ,vitamin c 500 mg one per day? Or can you prescribe vitamin c tablet.

DM - Gastroenterology, MD - Medicine, MRCP (UK), DNB ( Med)
Gastroenterologist, Trivandrum
If you are a diagnosed case of ulcerative colitis since 10 years, blood tests have to be done and medications have to be reviewed. However you can take vitamin c.
2 people found this helpful

Hello Dr. i’m suffering from irritable bowel syndromes inflammation in the intestines associated with loose stools kindly advise me a best medicine which can cure my problem permanently someone refers me a mesacol but I really want to know.

MBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)
General Physician, Delhi
I am sorry to hear about your concern but will be happy to assist you. Irritable bowel syndrome (ibs) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or consti...

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