• Colorectal (Large Intestinal)
  Polyps & Cancer
• Anorectal Disorders
• Inflammatory Bowel Disease (IBD)
• Irritable Bowel Syndrome (IBS)

Inflammatory bowel diseases include a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Typically, people are first diagnosed with IBD in their late teens to early twenties, but may develop the condition at any age.

Most often, IBD is classified as:

• Ulcerative colitis: an inflammation of the innermost lining of the large intestine (colon or bowel) and/or rectum.
• Crohn's Disease: an inflammation that usually involves the lining and walls of the small intestine, most often the lower part called the ileum. It may also affect the large intestine and other parts of the digestive system and can spread deep into the tissue.

Early Detection & Screening

The Center provides early detection and screening for long-term complications of IBD, including colorectal cancer and osteoporosis; and we work closely with celiac disease investigators exploring the overlap between Crohn's disease and celiac disease.

Diagnosis

Initial Tests

Your physician will ask you to describe your symptoms, when they began and what makes them better or worse. You will receive a physical exam to look for any outward signs of IBD, such as pain when your doctor presses on areas of your abdomen, mouth sores, rashes and abdominal masses. You may also get a blood test, as well as have a sample of your stool examined.

X-Rays

In order to see what is happening in your gastrointestinal (GI) tract, your doctor may use a series of x-rays called a GI series. To view the stomach and upper part of the small intestine (upper GI series), your doctor will ask you to drink a liquid containing barium that coats your GI tract, allowing it to be seen on an x-ray. To view the rectum, large intestine and lower small intestine, you may receive a barium enema, called a Lower GI series, given through your rectum.

Upper Endoscopy (EGD)

Your physician may use a procedure that allows the physician to examine the inside of the esophagus, stomach or duodendum.

Sigmoidoscopy or Colonoscopy

These procedures allow the doctor to view either the lower part of your large intestine, or your entire large intestine to look for inflammation or bleeding. Both procedures use a thin flexible tube inserted into your rectum with a camera at the end. If necessary, the doctor may take a small tissue sample (biopsy) from the lining of the intestine to look at later under a microscope.

Treatment

While there is no cure for inflammatory bowel disease (IBD), lifestyle changes, medications and surgery may help reduce the signs and symptoms of IBD and help bring about remission (a period of time when symptoms fade).

Diet and Lifestyle Changes

Diet: What you eat cannot cause IBD, but certain foods may worsen your symptoms. Our nutrition team, working in close collaboration with your gastroenterologists, can help you modify your diet to reduce symptoms of IBD and also make sure that you are eating and absorbing enough food to meet your nutritional needs.

Smoking cessation: Smoking may be a cause of IBD and may also worsen symptoms. Talk to your doctor about the various options available to help you stop smoking.

Stress relief: While stress is not a known cause of IBD, it can worsen the symptoms or bring about a relapse, as with many chronic diseases. It may be helpful for people with IBD to use positive ways to reduce stress, such as exercise, yoga, meditation, massage, breathing exercises, biofeedback, therapy, and support groups.

Drug Therapy

Drugs to treat IBD are designed to decrease the inflammation in the mucosal lining of the colon. The risks and benefits to patients are always carefully reviewed before therapy begins. We focus on limiting prolonged, less effective treatments that do not favorably alter the course of the disease.

A variety of medications are available to manage the symptoms of IBD and help keep the disease in remission. It is important to work with your doctor to determine what medication is right for you.

• Anti-inflammatory agents -- Aminosalicylates like 5-ASA -- are aspirin-like anti-inflammatory agents often used as first line treatment in early disease.
• Steroids such as prednisone typically are used to treat moderate to severe disease and reduce symptoms that have been unresponsive to other treatments. However, because steroids do not maintain remission and have side effects, we discuss strategies with patients to limit or avoid their use.
• Antibiotics and probiotics used to treat Crohn's disease may also have a role in effectively treating some forms of colitis.
• Immunosuppresants target the immune system response, helping to reduce inflammation and maintain remission.
• Biologic therapies have proven to be effective treatments and include: Remicade, Humira, and Cimzia, as well as newer biologic agents like Tysabri.
• Promising new medications and therapies are always being investigated by our active research group.

Infusion Therapy

Outpatient therapeutic intravenous procedures are administered at the Jill Roberts Outpatient Infusion Center in a comfortable and private in-office setting staffed by an expert clinical team with special training in infusion therapy. In-office infusion allows for close observation and communication between patient and staff.

The Center provides the latest intravenous therapies, including:

• Biologic therapies such as Remicade
• Ion infusions for IBD-associated anemias
• Stem cell infusion therapy
• Medications for controlling chronic pain
• Intravenous hydration therapy
• Nutrition therapy

Surgery

While surgery is not the first approach physicians use to treat Crohn's disease or ulcerative colitis, often surgery can greatly restore quality of life in people who are struggling to get well despite medical treatment. Some surgeries control symptoms, while others are more curative.

The majority of elective colon and rectal surgeries are performed laparoscopically. Laparoscopic surgery is performed through a small incision rather than larger incisions made in traditional open surgery, significantly reducing healing time, pain, scarring and hospital stay.

Surgery to treat Crohn's disease

Resection

Surgery for Crohn's disease is offered when medications are no longer effective or may even be harmful. When surgery is needed, our surgeons aim to preserve as much of the bowel as possible. Typically, for isolated disease that affects only a small area of the intestine, the initial operation used is called a resection.

Strictureplasty

Short areas of disease and narrowing caused by scar tissue are often treated with a bowel sparing procedure called strictureplasty. A strictureplasty does not remove the diseased segment of the bowel, but opens the narrowing in a way that restores flow of intestinal contents and allows nutrients to be absorbed. Sometimes, it is necessary to undergo multiple strictureplasties in a single operation if several areas of the small intestine are diseased.

Post-operative Therapies

More than half of people who are diagnosed with Crohn's disease will eventually need an operation during their lifetime. After an initial resection, many patients require additional surgery for inflammation in new areas of the bowel. Our gastroenterologists use early intervention, including postoperative therapies to prevent recurrence.

Surgery to treat ulcerative colitis

Proctocolectomy

A proctocolectomy - removal of the entire colon and rectum - is the most common surgery for ulcerative colitis. Since ulcerative colitis involves only the large bowel, this operation is considered curative.

Ileostomy

The end of the small intestine is surgically disconnected from the large intestine and then used to create an opening, or stoma, on the surface of the abdomen, through which waste is emptied. The patient wears an external bag over the opening.

Ileoanal Pouch Procedure (Ileoanal Anastomosis)

Often referred to as a J-Pouch, this procedure creates an internal pouch from part of the small intestine. This pouch provides a storage place for stool in the absence of the large intestine, allowing the patient to pass waste through the anus in a normal manner.

Some studies suggest that fertility may be decreased after an ileoanal pouch procedure, possibly as a result of internal scarring. However, women of child-bearing age have spontaneously conceived and given birth successfully after this procedure. Laparoscopic techniques used at NewYork-Presbyterian Hospital are attractive in that they reduce the amount of internal scarring.

Maintaining Your Health

Follow-up

We emphasize the importance of IBD annual checkups and frequent visits to maintain control of inflammation that causes symptoms. In addition,

• We use biomarkers to assess the optimal healing and maintenance of remission.
• Endoscopy, imaging and diagnostic testing evaluate disease progression.

Wellness programs

Patient support groups, guest speakers, and seminars that help patients cope with the day-to-day challenges of living with IBD are available through The Jill Roberts Center for Inflammatory Bowel Disease. Support groups address practical and emotional issues such as body image, family issues, how to talk to your doctor and employment problems. Guest speaker topics have included breathing, meditation, complementary medicine and pain management.

Nutrition therapy

Because IBD abdominal pain and inflammation can affect your appetite and ability to digest and absorb food, nutritional health is often compromised. Regular follow-up visits allow for close observation and communication about nutritional needs.