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Inflammatory bowel disease (IBD)

Ulcerative colitis and Crohn's disease are two types of Inflammatory Bowel Disease (IBD). In ulcerative colitis, the inflammation involves the inner lining of the large intestine, colon. In Crohn’s disease, the inflammation extends deeper into the intestinal wall and can involve any part of the digestive tract.

IBD can result in chronic diarrhea, abdominal pain, bleeding, fever, weight loss, malnutrition, fistulae, etc. It can also have extra-intestinal manifestations where the skeletal system, skin or eyes may be involved.

There is no single explanation for the development of IBD. A process, possibly viral, bacterial, or allergic, initially inflames the digestive system and, depending on a genetic predisposition, results in the development of antibodies which chronically attack the digestive system leading to inflammation.

Colonoscopy, cross-sectional imaging studies of the GI tract, along with newer tests that detect markers that are commonly associated with IBD, along with a patient's history and physical exam, can all be useful in establishing a diagnosis of IBD.

There are many treatments available for IBD:

Various formulations of 5-ASA, anti-inflammatories that work directly on the bowel lining to reduce inflammation, are available as oral preparations, suppositories and enemas.

Corticosteroid therapies, such as prednisone or hydrocortisone, are given when the 5-ASA products are insufficient to control inflammation.

Drugs which suppress the body's immune response in IBD (known as immunomodulators) are used. Azathioprine and 6-mercaptopurine (6-MP) are the two most commonly used immunomodulators.

Another class of medications called biologics is used for patients with moderate to severe disease. Biologics include medications like infliximab (Remicade®), adalimumab (Humira®), certolizumab pegol (Cimzia®). Newer medications include vedolizumab (Entyvio®), ustekinumab (Stelara®), tofacitinib (Xeljanz®).

With early and proper treatment the majority of patients with IBD lead healthy and productive lives. Some patients may require surgery for treatment of complications of IBD such as an abscess, bowel obstruction or inadequate response to treatment.