IBD

Inflammatory bowel disease is a group of chronic diseases affecting predominately the bowel, but also other organs of the body.

Inflammatory Bowel Disease

IBD or Inflammatory bowel disease, encompasses two very different medical conditions; Crohn’s Disease and Ulcerative Colitis.

Both of these conditions share signs, symptoms and to an extent, treatment. A third clinical entity known as indeterminate colitis shares features of both Crohn’s disease and Ulcerative Colitis, and may develop into one of these two conditions over time.

IBD may present in a variety of manifestations, but commonly includes

  • Abdominal pain
  • Weight loss
  • Bleeding per rectum
  • Diarrhoea
  • Extra-intestinal features (affecting skin, eyes or joints)

Crohn’s Disease

Crohn’s disease is an inflammatory process that is transmural – meaning it involves the full thickness of the bowel. Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus. The most common sites affected by Crohn’s disease are the anus, terminal ileum (final part of small bowel) and the large bowel.

As Crohn’s disease can affect the entire gastrointestinal tract, it is not possible to cure Crohn’s disease with surgery. Surgery has a role in dealing with the emergency complications of Crohn’s disease (perforation, bleeding, acute colitis) as well as the chronic problems of the disease (strictures, fistulae, peri-anal abscesses and fistula in ano).

The other important roles for surgery in Crohn’s disease is

  • Removing localised disease that is failing to respond appropriately to medical therapy
  • Removing localised disease to prevent the side effects of escalating medical management

There is a difficult balance in the management of Crohn’s disease between trying to preserve as much healthy bowel as possible, and operating to achieve temporary cure for this chronic disease.

The majority of both small bowel and large bowel operations can be done via laparoscopy (key-hole surgery) which reduces post-operative pain, reduces adhesions (scar tissue), reduces blood loss and results in earlier discharge from hospital.

Ulcerative Colitis

Ulcerative colitis differs from Crohn’s disease in that it can be cured by surgery. It affects only the large bowel in most people. In a minority of people with Ulcerative Colitis (around 15%), the last part of the small bowel can also be involved, and is called ‘backwash ileitis’.

Removal of the colon and rectum cures patients from Ulcerative colitis. This does not necessarily mean you will have a permanent stoma.

A surgical procedure can be done to remove all of the colon and rectum, and reconstruct a ‘new’ rectum using the small bowel; a total proctocolectomy and ileal pouch anal anastamosis (IPAA). This is a complicated and long procedure, but for the majority of people, it means a life free from ongoing medication and without a stoma

Indeterminate Colitis

This term was coined to describe colitis that does not have diagnostic criteria sufficient to categorise it into either Crohn’s disease or Ulcerative Colitis. ┬áSome specialists believe that Indeterminate colitis may be a clinical entity in its own right.

Up to a quarter of patients undergoing surgery for IBD may have the diagnosis of indeterminate colitis. Although it is not an absolute contraindication for IPAA, the decision to embark on this type of surgery, in the presence of Indeterminate Colitis, requires careful consideration of the risks and benefits.

IPAA formation in the presence of Crohn’s disease has a much higher failure rate (around 45%) but this may be an acceptable risk to you.