CONDITIONS

Inflammatory Bowel Disease (IBD)

The term inflammatory bowel disease (IBD) describes a group of disorders that cause chronic inflammation in part or all of the digestive tract. The most common types of inflammatory bowel diseases are Ulcerative Colitis and Crohn's Disease.

Ulcerative colitis causes chronic inflammation and ulcers in the internal lining of the large intestine and rectum while Crohn's Disease causes inflammation in the lining of the entire digestive tract from the oesophagus to the rectum, spreading deep into the tissues of the intestines. It is unknown what causes these diseases, but a combination of hereditary, genetic, and/or environmental factors are believed to trigger them. IBD may also be an autoimmune condition.

Those with inflammatory bowel diseases often go through stages of flares-ups in which the symptoms become worse, and remission where inflammation dies down. Both of these conditions can be debilitating and lead to serious complications.

1Symptoms
IBD is a chronic, intermittent disease. Symptoms range from mild to severe during relapses and may disappear or decrease during remissions. In general, symptoms depend on the segment of the intestinal tract involved.

Symptoms related to inflammatory damage in the digestive tract:
  • Diarrhoea
  • Stool may contain mucus or blood
  • Nocturnal diarrhoea
  • Constipation
    • Constipation can be primary symptom in Ulcerative Colitis limited to the rectum (proctitis) to the point of obstipation and with no passage of flatus seen in cases of bowel obstruction
  • Pain or rectal bleeding with bowel movement
  • Severe bowel movement urgency
  • Tenesmus
  • Abdominal cramps and pain
    • Pain in the right lower quadrant of the abdomen common in Crohn's Disease, or around the umbilicus, in the lower left quadrant in moderate to severe nausea and vomiting may occur, but more so in Crohn's disease than Ulcerative Colitis.
  • In some cases Ulcerative Colitis and Crohn's Disease may cause the following general symptoms:

  • Fever
  • Loss of appetite
  • Weight loss
  • Fatigue
  • Night sweats
  • Growth retardation
  • Absence of menstruation
2Intestinal complications
  • Hemorrhage: profuse bleeding from ulcers in Ulcerative Colitis. Bleeding less common in Crohn's Disease.
  • Massive bleeding in Crohn's Disease is more often seen from ileal ulceration than colitis.
    • 5–10% of persons with Crohn's Disease show ulceration in the stomach or duodenum.
    • Proximal small-bowel involvement occurs more often in children.
    • Bowel perforation.
    • Intra-abdominal abscesses in Crohn's Disease.
    • Strictures and obstruction (narrowing of the bowel may be from acute inflammation and edema, or from chronic fibrosis):
    • Strictures in Crohn's Disease are often inflammatory
    • Inflammatory strictures can resolve with medical treatment.
    • Scarring (fixed or fibrotic) strictures may require endoscopic or surgical intervention to relieve the obstruction.
    • Colonic strictures in Ulcerative Colitis are presumed to be malignant until proven otherwise.
    • Fistulas and perianal disease: Hallmark of Crohn's Disease.
    • Surgical intervention is required in cases not responding to vigorous medical treatment, or when abscesses have developed.
    • High risk of recurrence.
    • Some simple fistulas can be treated surgically if medical therapy is not available. Fistulas to the urinary tract or vagina are not uncommon and can lead to pneumaturia or fecaluria or passage of air from the vagina. This may result in urinary tract infection or gynecological inflammation.
    • Toxic megacolon – while relatively rare, life-threatening colitis complication (characterized by dilation of the colon diagnosed on plain abdominal radiography) requiring aggressive medical therapy and urgent surgical intervention if there is no response within 24 h (more common in UC than CD).
    • Malignancy: Significantly increased risk of colon cancer in UC after 8 years of diagnosis; there is a similar risk in Crohn's Disease if a substantial area of colon is involved. The risk increases relative to disease duration, early age of disease onset, and if there is a family history of sporadic colorectal cancer.
    • Primary sclerosing cholangitis (PSC) in Ulcerative Colitis is also associated with an increased risk of cholangiocarcinoma and colorectal cancer. PSC is also increased in Crohn’s, although it is more common in Ulcerative Colitis. There is an increased risk of small-bowel adenocarcinoma in small bowel Crohn's Disease, but it is rare.
3Extraintestinal complications
Affect up to 25% of those with IBD, although 15–20% have arthralgias, while the remainder have frank inflammatory disease in other organ systems. Some complications may antedate the diagnosis of IBD, and some may run an independent course from the IBD (even colectomy in Ulcerative Colitis does not affect the course of ankylosing spondylitis or primary sclerosing cholangitis, although for many, arthralgia activity parallels the activity of the bowel disease).

May include:
  • Arthritis, the most common complication.
  • Other extraintestinal complications include ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, iritis, uveitis, episcleritis, and primary sclerosing cholangitis.
  • Patients may have multiple extra intestinal complications.
  • Osteoporosis, venous thromboembolism, avascular necrosis, and ischemic arterial events are all more frequent in IBD than in the general population.
  • Mood disorders such as anxiety and depression are increased in IBD.
  • The most common liver disorder is probably nonalcoholic fatty liver disease (NAFLD).
    • Nephrolithiasis and gallstones in Crohn's Disease

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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