Inflammatory Bowel Disease: Diagnosis and Treatment

Diagnosis

• History and physical examination are the first steps and may reveal risk factors.
  
• Blood tests may help establish the diagnosis and are also routinely used to identify anemia and nutritional deficiencies.
  
• In some cases, stool cultures may be used to identify bacterial infections that can trigger the disease.
  
• Abdominal X–ray and CT scan can aid in diagnosis, rule out other diseases, and evaluate for complications, including bowel obstruction and abscess.
  
• Colonoscopy with biopsy is usually recommended to diagnose and observe the extent of disease, and rule out other diseases that may appear similar to IBD, such as cancer and hemorrhoids. However, colonoscopy should be avoided in patients with severe disease because it increases the risk of colon perforation.

Treatment

• Treatment involves medications in mild to moderate cases, or surgery in severe and recurrent cases.
• Common medications include sulfasalazine, corticosteroids (e.g., prednisone), azathioprine, and cyclosporine. In addition, antibiotics (e.g., ciprofloxacin, metronidazole, and ampicillin) are often used when infection is a concern.
  
  Additional medications are used for symptomatic relief, including antidiarrheals (e.g., loperamide), iron supplements, and vitamin B₁₂ supplements.
• Surgery to address complications of the disease, such as abscess formation, or to remove all or part of the colon may be necessary for severe disease. However, it usually will not cure the disease.
• Lifestyle factors may affect the disease. Limited evidence indicates that stress reduction reduces symptoms in patients with Crohn’s disease, and results in less pain and decreased need for anti–inflammatory medication in patients with ulcerative colitis. However, additional clinical trials are necessary to learn more about the psychological aspects.