Skip to main content.

Inflammatory Bowel Disease (IBD)

What is IBD?

Inflammatory bowel disease refers to illnesses in which the bowel (intestine) becomes inflamed, which means it gets swollen and red. Most often, doctors use this name to refer to Crohn disease or ulcerative colitis. These two conditions have some similarities but also some important differences.

Crohn disease

In this condition, all layers of the intestinal wall can get inflamed. Crohn disease can affect any segment of the digestive tract. Usually it affects the far end of the small intestine (also called the ileum) and the large intestine (also called the colon). There may be healthy patches of intestine between inflamed patches. Surgery cannot cure Crohn disease. It’s used to treat complications, such as an abnormal channel (fistula) that forms in the intestine or a blockage (obstruction). The approach in surgery is to repair or remove the affected part of the intestine and to preserve as much of the healthy intestine as possible.

Ulcerative colitis

In this condition, only the lining, or mucosa, of the intestine gets inflamed. Ulcerative colitis usually involves the whole length of the colon. But it may involve only part of the colon. There are no healthy patches between inflamed patches, as may be seen in Crohn disease. Surgery can cure ulcerative colitis. The approach in surgery is to remove all of the colon.

Some of the symptoms, related health problems, and treatments for these diseases are the same, and others are not. Both diseases are chronic, or ongoing.

Who gets IBD?

Most people diagnosed with IBD get it between the ages of 15 and 35, though we see some children with IBD as young as 3 to 4 years old. It tends to run in families. About 20% of people with either Crohn disease or ulcerative colitis have a close relative with some form of IBD.

What are the symptoms?

The most common symptoms of IBD are crampy pain in the belly and ongoing diarrhea. There may be blood in the stool. The person with IBD may lose weight.

The symptoms range from mild to severe. It’s normal for people with IBD to have periods without any symptoms (remission), sometimes for months or years, and then to get symptoms again (recurrence). The periods of remission can make it difficult for doctors to make a diagnosis.

IBD can lead to other health problems, which cause symptoms, too. Read more about the complications of Crohn disease or ulcerative colitis.

How do you diagnose IBD?

The doctor will ask for a detailed history of your child’s illness and will examine your child.

Tests

Several tests can help doctors diagnose this disease.

  • Blood tests to check for anemia, caused by excessive bleeding, and to look for a high level of white blood cells, a sign of inflammation. There are also other blood tests that may help determine if the problem is Crohn disease or ulcerative colitis.
  • Tests on a stool (feces) sample to look for blood or signs of infection.
  • X-rays, including an upper GI (PDF 48KB) (short for gastrointestinal) series with a small bowel follow-through to check the stomach and small intestine.
  • CT scan (short for "computed tomography scan" and sometimes said "cat scan"), which can help diagnose a fistula or pocket of pus (abscess).

Looking inside

One of the best ways to tell what’s happening in your child’s intestine is for the doctor to look at it. Doctors do this by inserting a thin, flexible, lighted tube (endoscope) through your child’s anus. The tube has a camera that’s connected to a computer and a TV monitor. Using this camera, the doctor can look for inflammation, ulcers and bleeding. They can even take a tiny sample of the intestine for testing (biopsy).

When doctors look at only the lower colon, this procedure is called sigmoidoscopy (pronounced sig-moid-OSS-cope-ee). When they look at the whole colon, it’s called colonoscopy (pronounced coal-un-OSS-cope-ee). Another procedure may need to be done to look at the stomach and the first part of the small intestine. Again, an endoscope is used for this. The endoscope is passed through the mouth and down into the stomach. These procedures are usually done under anesthesia or sedation.

Sometimes the doctor may use another device that is a camera that can be swallowed like a pill. This instrument takes pictures of the intestine. It passes into the colon and into the stool. (It does not need to be retrieved.) The pictures can then be downloaded onto a computer for viewing. This device allows the doctor to see many more parts of the intestine than using the endoscope.

What is your experience with IBD at Children’s?

We have treated many children with IBD at Children’s. Some can control their disease with medicines and careful choices about what they eat and drink.

Some children do need surgery because medicines and diet are not beneficial. Our surgeons are experienced at performing the operations these children need to improve their health and quality of life.

When you come to Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists, social workers and others. We work together to meet all of your child’s health needs and help your family through this experience.

Since 1907, Children’s has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.

How do you treat IBD?

The goals of treatment are to decrease inflammation in your child’s intestine and help it heal, get rid of your child’s symptoms and ensure your child is getting good nutrition. To help achieve these goals, all patients with IBD are seen by our gastrointestinal (GI) doctors. We start by using many types of medicines and nutritional support.

If medicine and other non-surgical therapies are not enough or if your child develops a serious complication of IBD, they may need surgery. Our GI doctors and surgeons work closely together with you to help determine the best plan of care for your child.

The surgery for Crohn disease and the surgery for ulcerative colitis are very different. The type of operation needed will depend on the diagnosis. The surgery for Crohn disease focuses on removing the part of the intestine that is causing the problem but preserving as much intestine as possible. There are multiple techniques that can be used to do this. In general, when the diagnosis is ulcerative colitis, the colon and lining of the rectum need to be removed and the rectum reconstructed in a procedure called an ileoanal pullthrough. Our surgeons have performed well over 100 of these operations.

Our surgeons are experienced in doing the operations for Crohn disease and ulcerative colitis both laparoscopically and in the more traditional open methods. Your surgeon will help you decide which technique is best for your child.

Read details about using medicine, nutrition and surgery to treat Crohn disease or ulcerative colitis.

Resources

Read more about what to expect when your child visits a clinic at Children's, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child's care team. You can also take a virtual tour of our surgery rooms and other parts of the hospital.

To learn more about this condition, you may want to visit our resource list.