All the content of the library is provided from Mayo Clinic in English.
As a member of the Mayo Clinic Care Network, RSPP has special access to Mayo Clinic knowledge and resources.
Inflammatory bowel disease, also called IBD, is an umbrella term for a group of conditions that cause swelling and inflammation of the tissues in the digestive tract.
The most common types of IBD include:
Symptoms of both ulcerative colitis and Crohn's disease usually include belly pain, diarrhea, rectal bleeding, extreme tiredness and weight loss.
For some people, IBD is only a mild illness. But for others, it's a condition that causes disability and can lead to life-threatening complications.
Inflammatory bowel disease symptoms vary depending on how bad the inflammation is and where it occurs. Symptoms may range from mild to severe. A person with IBD is likely to have periods of active illness followed by periods of remission.
Symptoms that are common to both Crohn's disease and ulcerative colitis include:
See a healthcare professional if you experience a lasting change in your bowel habits or if you have any of the symptoms of inflammatory bowel disease. Although inflammatory bowel disease usually isn't fatal, it's a serious disease that, in some people, may cause life-threatening complications.
The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now, healthcare professionals know that these factors may aggravate IBD but aren't the cause of it. Several factors likely play a role in its development.
Risk factors for inflammatory bowel disease include:
Cigarette smoking. Cigarette smoking is the most important controllable risk factor for getting Crohn's disease.
Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract as well as provide many other health benefits.
Ulcerative colitis and Crohn's disease have some complications in common and others that are specific to each condition. Complications found in both conditions may include:
Complications of Crohn's disease may include:
Complications of ulcerative colitis may include:
To help confirm a diagnosis of IBD, a healthcare professional generally recommends a combination of tests and procedures:
Blood tests. Blood tests can check for signs of infection or anemia — a condition in which there aren't enough red blood cells to carry oxygen to the tissues.
These tests also may be used to check for levels of inflammation, liver function or the presence of infections that aren't active, such as tuberculosis. Blood also may be screened for the presence of immunity against infections.
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risk of complications. IBD treatment usually involves either medicines or surgery.
Anti-inflammatory medicines are often the first step in the treatment of ulcerative colitis, typically for mild to moderate disease. Anti-inflammatories include aminosalicylates, such as mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum).
Time-limited courses of corticosteroids also are used to induce remission. In addition to being anti-inflammatory, steroids are immunosuppressing. The type of medicine recommended depends on the area of the colon that's affected.
These drugs work in a variety of ways to suppress the immune response that releases inflammation-inducing chemicals into the body. When released, these chemicals can damage the lining of the digestive tract.
Some examples of immunosuppressant drugs include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).
More recently, medicines given by mouth that are known as small molecules have become available for IBD treatment. Janus kinase inhibitors, also called JAK inhibitors, are a type of small molecule medicine that helps reduce inflammation by targeting parts of the immune system that cause inflammation in the intestines. Some JAK inhibitors for IBD include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).
Ozanimod (Zeposia) is another type of small molecule medicine available for IBD. Ozanimod is a medicine known as a sphingosine-1-phosphate receptor modulator, also called an S1P receptor modulator.
The U.S. Food and Drug Administration, also called the FDA, recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related conditions and cancer from taking this medicine. If you're taking tofacitinib for ulcerative colitis, don't stop taking the medicine without first talking with a healthcare professional.
Biologics are a newer category of therapy in which treatment is directed toward neutralizing proteins in the body that are causing inflammation. Some of these medicines are administered via intravenous, also called IV, infusions and others are injections you give yourself. Examples include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio), ustekinumab (Stelara) and risankizumab (Skyrizi).
Antibiotics may be used with other medications or when infection is a concern — if there is perianal Crohn's disease, for example. Often-prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
In addition to managing inflammation, some medicines may help relieve symptoms. But always talk to a healthcare professional before taking any nonprescription medicines. Depending on how bad your IBD is, one or more of the following may be recommended:
Antidiarrheals. A fiber supplement — such as psyllium (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to the stool. For more-severe diarrhea, loperamide (Imodium A-D) may be effective.
These medicines and supplements could be harmful or not effective in some people with strictures or certain infections. Consult your healthcare team before starting these treatments.
If weight loss is significant, a healthcare professional may recommend a special diet given via a feeding tube, called enteral nutrition, or nutrients injected into a vein, called parenteral nutrition. Nutritional support can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.
If you have stenosis or stricture in the bowel, your care team may recommend a low-residue diet. This diet can help minimize the chance that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage.
If diet and lifestyle changes, drug therapy, or other treatments don't relieve your IBD symptoms, surgery may be recommended.
Surgery for ulcerative colitis. Surgery involves removal of the entire colon and rectum. An internal pouch is then made and attached to the anus. This allows the passing of stool without having a bag for stool on the outside of the body.
In some people, creating an internal pouch is not possible. Instead, surgeons create a permanent opening in the abdomen, called an ileal stoma, through which stool passes for collection in an attached bag.
Surgery for Crohn's disease. Up to two-thirds of people with Crohn's disease require at least one surgery in their lifetimes. However, surgery does not cure Crohn's disease.
During surgery, the surgeon removes a damaged part of the digestive tract and then reconnects the healthy sections. Surgery also may be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn's disease are usually temporary. The disease recurs in many people, often near the reconnected tissue. The best approach is to follow surgery with medicine to lessen the risk of recurrence.
Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help manage your symptoms and lengthen the time between flare-ups.
There's no firm evidence that what you eat causes inflammatory bowel disease. But some foods and beverages can make symptoms worse, especially during a flare-up.
You might find it helpful to keep a food diary to track what you're eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating those foods.
Here are some general dietary suggestions that may help you manage your condition:
Smoking increases your risk of having Crohn's disease, and once you have it, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medicines and repeat surgeries.
Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits.
The association of stress with Crohn's disease is controversial, but many people who have the disease report symptom flares during high-stress periods. If you have trouble managing stress, try one of these strategies:
Many people with digestive disorders have used some form of complementary and alternative medicine. However, there are few well-designed studies of the safety and effectiveness of these treatments.
Researchers suspect that adding more of the beneficial bacteria that are typically found in the digestive tract might help combat IBD. These bacteria are called probiotics. Although research is limited, there is some evidence that adding probiotics along with taking medicines may be helpful.
IBD doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, you may find it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:
Although you may feel discouraged about living with IBD, research is ongoing, and the outlook is improving.
Symptoms of inflammatory bowel disease may first prompt a visit to your main healthcare team. However, you may then be referred to a professional who specializes in treating digestive disorders, called a gastroenterologist.
Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect at your visit.
Preparing a list of questions beforehand may help you make the most of your visit. List your questions from most important to least important in case time runs out. For inflammatory bowel disease, some basic questions to ask include:
Your healthcare team is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. You may be asked: