Inflammatory bowel disease treatment
Crohn’s disease, ulcerative colitis and IBD complications
Crohn’s disease and ulcerative colitis are often difficult to manage. and are best treated by gastroenterologists who specialize in these inflammatory bowel diseases. Crohn’s disease can be treated but not cured, while ulcerative colitis can be “cured” by surgically removing the colon when medical treatments have failed. Duke's team of inflammatory bowel disease specialists help you manage your IBD when your disease is not active and help you get your disease back into remission if you experience a relapse.
Seek care from an IBD specialist
Gastroenterologists who specialize in care for people with IBD can work with you to control your disease and its symptoms. We help restore your quality of life and watch for possible complications related to the disease as well as its treatment.
Duke gastroenterologists have extensive expertise with IBD.
- As a regional referral center, we are well known for our expertise in diagnosing and treating IBD and its complications. Doctors across the region refer their patients to us because of our experience treating people whose IBD ranges from mild to complex. If you are referred to us, we will partner with your current doctors to ensure you receive the best possible care. We also welcome people who are new to the Triangle and want to establish care with an experienced IBD provider.
- Whether you are newly diagnosed with Crohn’s or ulcerative colitis, or have been diagnosed and are seeking another opinion about your treatment, our IBD providers are ready to see you. We work with men and women whose IBD history is complex, with those who have other medical problems that make treatment options challenging, and with those who are not responding to conventional treatments. We often see adults who have developed a complication related to their disease or its treatment and require more comprehensive care.
- In addition to seeing people before they need surgery, we help people after surgery. Some people with Crohn’s have had surgery to remove a piece of intestine or close a fistula. We also help people with ulcerative colitis who have undergone surgery to “cure” the disease by removing their colon. Some people need help managing “pouchitis,” an inflammation of the ileal pouch, that may occur after removing the colon.
The benefits of a team approach for IBD treatment
One of the most important aspects of IBD management is having a team of experts at your fingertips. Your IBD team may include doctors from many specialties. We meet regularly to review complex cases and work together to make treatment recommendations. At Duke, the IBD team includes:
- Our team includes adult and pediatric gastroenterologists who specialize in caring for people with IBD. Our expertise allows us to word toward understanding the cause of your symptoms and identify the best approach to treating your disease.
- Duke colorectal surgeons complete advanced training and have years of experience performing surgery on the small and large intestine (the colon). We are skilled in minimally invasive, laparoscopic techniques, as well as robotic technology. Our surgeons are experts in performing the surgery to “cure” ulcerative colitis by removing the colon and rectum and creating an ileal pouch-anal anastomosis (“pouch”).
- Our gastrointestinal-specific radiologists focus solely on abdominal imaging, including CT scans and MR enterography, a special type of magnetic resonance imaging (MRI) used to evaluate the small intestine. Cutting-edge diagnostic radiology and imaging equipment helps us accurately diagnose and manage inflammatory bowel disease and its related complications.
- Your IBD team works closely with highly specialized pathologists who examine samples of tissue taken during an endoscopic procedure (biopsy) under a powerful microscope to help your doctors know what is going on at a microscopic level. That can help your IBD team make the diagnosis of IBD, determine how active the disease is, look for complications such as infections in the tissue or even precancerous or cancerous changes.
- Because IBD can cause other health problems as well as symptoms in areas outside the gastrointestinal tract, your team may include specialists in skin and wound care, joint diseases, eye diseases, or bone diseases as needed.
Choose Duke for your IBD care
- Our specialists have access to advanced techniques to guide endoscopes deeply into the small intestine beyond the reach of standard procedures such as colonoscopy and upper endoscopy. We also use pill cameras to view areas of the gastrointestinal tract that cannot be reached with scopes, or dye sprays to help identify abnormal or precancerous areas in the lining of the colon. These techniques help us detect abnormalities including bleeding, ulceration, inflammation, scarring and other problems that could alter the treatment and management of your disease.
- Biologics are the newest class of medication developed to target and stop inflammation in the body. intravenous medications that stop inflammation in the body, and may be used to start remission in people with moderate to severe Crohn’s disease or ulcerative colitis. Biologics are powerful medications that help control inflammation in the body. They not for everyone. If you are a candidate, biologics may be used to get your disease into remission and to keep it inactive. Our IBD team is equipped to provide the close supervision these medications provide, or to assist your local doctor in the process.
- We offer a comfortable setting for tests and consultation. Our IBD specialists see people in Durham and Raleigh, and our infusion centers, located at Duke and at Brier Creek provide convenient options for the administration of intravenous medicine. The Duke specialty infusion center offers Saturday morning infusions.
- A separate team of pediatric gastroenterologists provides long-term care for children with inflammatory bowel disease. Our goal is to also provide a seamless transition of care as children mature from adolescence to adulthood.
- You may be eligible to participate in studies of new therapies that are not available elsewhere. Some of our patients help further our knowledge and understanding of IBD by letting us collect a sample of blood or tissue, or by joining a clinical trial.
INFLAMMATORY BOWEL DISEASE
Depending on your needs, your medical treatment may range from antibiotics and steroids to immune suppressing agents, biologics and other cutting-edge therapies.
Surgical removal of the colon or the colon and rectum may be necessary to treat ulcerative colitis. It may be recommended when medical therapy is no longer effective, if you are experiencing significant bleeding or when you face a risk of cancer. When the entire colon is removed, an opening, called a stoma, may be created in the abdominal wall, and an external pouch is attached, which must be worn at all times.
For patients with Crohn’s disease, surgery is not considered curative, but it may be necessary when complications such as strictures (narrowed areas of the small or large intestine that can occur as a result of the inflammatory process) develop and cause intermittent blockages. The blockages can cause debilitating symptoms, and surgery to remove the narrowed segment and reconnect the intestine can help restore the quality of life for Crohn’s patients with this complication.
A section of small intestine is sewn to form a small pouch that is attached to the rectum on the inside of the body. This enables people to have bowel movements by sitting on the commode rather than having to wear an ostomy bag to collect waste outside the body.
INFLAMMATORY BOWEL DISEASE
Gastrointestinal endoscopy advances
In addition to commonly performed procedures such as colonoscopy and upper endoscopy, our gastroenterologists are experts in advanced endoscopic procedures. These procedures are not widely available, yet ensure you receive an accurate diagnosis, and are the first step to determining the most effective treatment plan.
May distinguish Crohn’s disease from ulcerative colitis. An ultrasound attached to an endoscope obtains deep images and may be used to identify connections between the intestines and skin or other organs, called fistulas, in the rectal area.
A blue spray dye is used during colonoscopy to highlight abnormal areas of the colon. It can detect an abnormal development of cells called dysplasia -- an early sign of colorectal cancer -- in patients with ulcerative colitis or Crohn’s disease involving the colon.
Obtains pictures of the entire small bowel. After swallowing, a capsule camera about the size of a large vitamin tablet travels through the small intestine and transmits photos to a recorder worn on a belt around the waist.
An inflating and deflating balloon identifies abnormalities as it helps move the endoscope deeply into the small intestine.