My Doctor Online The Permanente Medical Group

Symptoms

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The symptoms of inflammatory bowel disease may include:

• Abdominal pain
• Frequent diarrhea that may contain blood or mucus
• Fever
• Chills
• Weight loss
• Fatigue

These symptoms can either be mild or severe, and they may vary over time from person to person.

Diagnosis

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When you come in for an appointment, we will start with a discussion of your medical history. Then we will do a physical exam before performing medical tests, as appropriate. Several medical tests (such as a colonoscopy, biopsy, or stool test) are used to diagnose inflammatory bowel disease and help rule out other gastrointestinal conditions (such as irritable bowel syndrome) with similar symptoms.

Sometimes it can be difficult to distinguish between the two main types of inflammatory bowel disease: ulcerative colitis or Crohn's disease. Therefore, we may request additional tests to help confirm a diagnosis.

Causes and Risk Factors

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Causes

We do not know the exact cause of inflammatory bowel disease. Research suggests that IBD may be related to an abnormal response by your immune system to normal intestinal bacteria.

Risk factors

Certain people are at greater risk of developing IBD than others. Risk factors can either be genetic or the result of lifestyle factors.

One of the biggest risk factors for IBD is genetics. A person who has a family history of either ulcerative colitis or Crohn's disease is more likely to get either disease. This is especially true if an immediate family member (parent, brother, or sister) has either disease. We also know that both diseases can exist in the same family. In addition, certain ethnic groups, such as people of Ashkenazi Jewish ancestry, are at higher risk.

Lifestyle-related risk factors for IBD include:

• Tobacco use. People who use tobacco are more likely to develop Crohn's disease than those who don't. Smoking can decrease the effectiveness of treatment and worsen IBD symptoms. If you smoke and are ready to quit, we can help.
• Certain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief have been linked to flare-ups. Instead, we recommend taking acetaminophen (Tylenol).
• Nutrition. A diet high in sugar is a risk factor for Crohn's disease. We can help you learn to eat a more nutritious, healthy diet to help control IBD.

Treatments

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Unfortunately, there is no cure for inflammatory bowel disease. The good news is that treatment methods are effective at reducing the pain and discomfort associated with the disease. Most people learn how to manage their symptoms and lead active, healthy lives.

Your treatment will depend on your symptoms and how severe they are. Depending on your symptoms, we will work together to choose one or more of the following treatment options:

• Home treatment
• Medications
• Complementary and alternative medicine (CAM) 
• Surgery

We might need to try more than one combination of treatments to ease your symptoms. Long-term treatment may be necessary to help manage symptoms.

Home Treatment

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Home treatment for inflammatory bowel disease depends on the severity of your symptoms.

We do not recommend the use of nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen to treat inflammatory bowel disease. Research has linked these pain relievers with IBD flare-ups.

If you are experiencing mild symptoms, we may recommend one or several of the following:

• Antidiarrheal medicines. Over-the-counter medicines and prescription medicines may help with diarrhea. We can discuss which of these medicines is best suited to help address your symptoms.
• Topical medicines (suppository, enema, or foam). These may help with rectal problems. We can discuss which of these medicines is best suited to help address your symptoms.
• Changes to your diet. Avoid certain foods (milk, alcohol, spicy foods, or high-fiber foods) that seem to trigger your symptoms. Eat a balanced diet with plenty of fruits, vegetables, and whole grains.

If you are experiencing severe symptoms, we may recommend:

• Supplemental nutrition (high-calorie liquid formulas). This rare treatment is sometimes recommended for children with slowed growth or for adults with Crohn's disease in large areas of the small intestine.

Prescription Medications

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Several different types of anti-inflammatory medicines are used to help control or prevent inflammation in the intestines. The prescription medications can also help:

• Relieve your symptoms
• Promote healing of damaged tissues
• Keep the disease from flaring up again
• Postpone or prevent the need for surgery

Complementary and Alternative Medicines (CAM)

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Because there is no cure for IBD, many people consider complementary or alternative medicines to help ease symptoms. While not all of these therapies have been proven equally effective for IBD, many improve your overall well-being.

If you are interested in trying complementary and alternative medicines, we strongly recommend that you consult with us first. Certain alternative medicines, vitamins, or nutritional supplements can have side effects or contraindications when taken with prescription and/or over-the-counter medicines.

We can work together to manage your medications and supplements.

Some of the common complementary therapies include:

• Nutritional supplements (probiotics and fish oils)
• Vitamin supplements (vitamins D and B12)

Additionally, massage therapy has been shown to have some therapeutic benefit. We also recommend that complementary and alternative approaches be combined with a healthy diet and regular exercise routine.

Surgery

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Surgery is rarely recommended for ulcerative colitis because medications are effective at managing symptoms. Surgery may be recommended for someone who has severe Crohn's disease.

Why Treatment Is Important

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Long-term consequences of inflammatory bowel disease usually appear later in life. In some cases, IBD can lead to more serious problems such as:

Difficulty absorbing certain nutrients such as calcium and vitamin D. Having an inflamed digestive tract affects the amount of nutrients your body absorbs from the foods you eat. We may recommend that you take calcium and vitamin D supplements to avoid bone loss or deficiency in these nutrients.

Increased risk of colorectal cancer. People who have had ulcerative colitis for 8 to 10 years or more have a higher risk of developing colorectal cancer. We recommend regular colonoscopies with biopsies to closely monitor colon health.

Increased risk of arthritis. This is the most frequent complication. There are two different kinds of arthritis:

• Peripheral arthritis affects many people with ulcerative colitis or Crohn's disease. Symptoms include pain, swelling, and stiffness in one or more arm or leg joints (wrists, knees, and ankles). Treatment is quite effective at reducing symptoms. Peripheral arthritis does not cause permanent damage.
• Spinal arthritis (spondylitis) is rarer but does affect some people. Symptoms include pain and stiffness in the spinal column joints, which tend to be worse in the morning. If left untreated, spinal arthritis can cause bones in the vertebral column to fuse (grow together). Physical activity and physical therapy are effective at reducing symptoms and improving range of motion in the spine.

Increased risk of developing osteoporosis. The long-term use of certain IBD medicines, such as corticosteroids, can interfere with normal bone development and growth. If you take corticosteroids for more than 2 to 3 months, we recommend taking calcium and vitamin D supplements or other medicines to help prevent osteoporosis.

Other complications can include liver disease, kidney stones, gallstones, and mouth ulcers that impair swallowing or eating.

Lifestyle Changes

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Inflammatory bowel disease can last for many years and is, unfortunately, not curable. However, for many people, symptoms get better with lifestyle changes and medications. You can reduce the severity of the disease by being sure that you:

• Take your medicines regularly. This can help reduce sudden attacks (flare-ups) and keep the disease in remission (a period without symptoms). Many of the newer medications are long-term and can minimize or eliminate most IBD symptoms.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief. NSAIDs have been linked to flare-ups. Instead, we recommend taking acetaminophen (Tylenol).
• Do not smoke. Smoking makes Crohn's disease worse and contributes to many other health problems. If you smoke and are ready to quit, we can help.
• Eat a healthy diet. Aim for a balanced diet with plenty of fruits, vegetables, and whole grains.
• Avoid trigger foods. Avoid foods which seem to cause a flare-up of your illness.
• Avoid antibiotics unless they have been prescribed by a doctor. Antibiotics can make symptoms worse and should be used only when necessary.
• Have screening tests for colorectal cancer. Having IBD puts you at a slightly higher risk of developing colorectal cancer. We can discuss screening tests for colorectal cancer which helps us find cancer early, when it is easier to treat.

We can help you develop a strategy to manage your symptoms and live a healthy, active life.

Your Care with Me

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Inflammatory Bowel Disease (IBD) includes Ulcerative Colitis and Chron’s disease. IBD is a chronic long-term condition. Either I, or another gastroenterologist in our department, will manage your ongoing care.  I will work closely with your personal physician, who will continue to oversee your care for non-IBD health issues. 

Mild symptoms of IBD disease can be treated at home.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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