Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease Care at UVM Health

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is an autoimmune disorder. It occurs when the immune system attacks the gastrointestinal (GI) tract. The resulting inflammation damages the GI tract and causes abdominal pain, diarrhea and other symptoms. IBD is a lifelong disease that can affect your ability to participate in daily activities.

At University of Vermont Health, we provide advanced IBD care in a compassionate and supportive environment. We help you manage inflammation and painful symptoms to improve your quality of life.

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Why Choose UVM Health?

As a leading gastroenterology program in the region, we offer:

Multidisciplinary teams: Our gastroenterologists work alongside skilled surgeons, pathologists, pharmacists and nutritionists. They also partner with other specialists across our health system, including rheumatologists and dermatologists, for a comprehensive, seamless approach to care.
Expert diagnosis: IBD can be challenging to diagnose because it causes symptoms similar to other gastrointestinal conditions. Our gastroenterologists and pathologists have extensive experience diagnosing IBD. They meet regularly to review test results to ensure you receive an accurate diagnosis.
Leading-edge treatments: IBD treatment often includes a range of options, including medications that can reduce your need for surgery. We work with you to find treatments suited to your medical needs and lifestyle, including clinical trials when appropriate.
Convenience: Our network of providers gives you access to IBD care in clinic locations throughout the region. Whenever possible, we schedule multiple appointments on the same day and offer digital health visits to bring care to you.

Types of IBD

IBD includes two similar but separate diseases that cause inflammation of the GI tract.

Crohn's disease: Can affect any part of your GI tract. Symptoms vary depending on where it occurs, but typically include abdominal pain, bloating, diarrhea and weight loss. The inflammation can extend through the layers of the GI tract walls and cause inflamed pockets (abscesses) or holes (fistulas).
Ulcerative colitis: Affects your large intestine (colon) and rectum. The main symptoms are bloody diarrhea, abdominal pain, fatigue and weight loss. In ulcerative colitis, inflammation is limited to the inner layers of the walls of the GI tract.

IBD can also affect other tissues and organs outside your digestive tract, including your skin, eyes and joints. Our gastroenterologists work with specialists across UVM Health to coordinate your care.

Health care providers are not sure what causes the autoimmune response in IBD. It is likely a combination of:

Environment: Foreign invaders, such as viruses or bacteria, may trigger your immune system to attack your GI tract.
Genetics: You are at higher risk of IBD if you have a family history of the disease.

Wellness & Prevention

Evidence shows that proactive health care focused on preventing illness leads to better outcomes. We're here to help you live a healthier, happier life. We offer wellness and prevention services to empower you to take control of your health.

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Diagnosing IBD

Your provider will discuss your symptoms, ask for your medical history and perform a physical exam. Physicians often diagnose IBD by ruling out other possible conditions. Your provider may order tests for this purpose, including:

Blood tests: Look for anemia and markers of inflammation in your blood
Imaging tests: Identify areas of inflammation using CT or MRI scans
Stool tests: Check for blood, inflammation or an infection in your GI tract

The gold standard for diagnosis is a biopsy.

In a biopsy, your provider uses an endoscope (a thin, lighted tube with a camera at the end) to look at the inside of your GI tract. They pass small instruments through the endoscope to take samples of abnormal tissue, which are then sent to a laboratory for analysis by a pathologist. Endoscopic procedures for diagnosing IBD include:

Colonoscopy of your rectum, large intestine and part of your small intestine
Upper GI endoscopy of your esophagus, stomach and small intestine

IBD Treatment

IBD often comes and goes, alternating between periods of low disease activity and more severe symptoms (flares). Medication therapy can reduce flares and help you achieve remission (a period when symptoms disappear). If medications are not effective or the damage to your GI tract is severe, your provider may recommend surgery.

Our providers get to know your needs and preferences to ensure you receive the care that’s right for you. They develop a personalized treatment plan that may include:

Lifestyle Changes

Quitting smoking is the only lifestyle-related strategy recommended to help manage Crohn’s disease. Other changes, such as eating certain foods or getting enough sleep may improve symptoms, but do not reduce inflammation.

Medications

Your provider may recommend one medication or a combination of different drugs. The main drug classes are:

Aminosalicylates: Reduce inflammation in the lining of your intestine
Antibiotics: Treat infections that occur as a complication of IBD or other treatment
Biologics: Interfere with specific immune system pathways
Corticosteroids: Reduce overall immune system function. We typically use corticosteroids only to control disease flares, since long-term use can cause organ damage.
Immunomodulators: Change how your immune system functions

IBD mediations come in different forms, including:

Pills you take by mouth
Injections you or a caregiver administer at home
Intravenous (IV) infusions you receive at a UVM Health clinic
Suppositories you insert into your rectum
Liquid enemas you instill in your colon

Our GI pharmacist provides education about your medications and potential side effects. They can also teach you or a caregiver how to inject medications.

IBD medications are an active area of research. At UVM Health, you’ll find the latest medications, dosages and drug combinations. We also offer clinical trials of new therapies under development. Participation in a clinical trial is voluntary and can give you access to new care methods years before they are widely available.

Surgery

If surgery is your best treatment option, our gastroenterologists work closely with UVM Health colorectal surgeons to co-manage your care. This partnership allows for close coordination before, during and after surgery.

For Crohn’s disease, your surgeon may remove the affected section of intestine or repair a fistula or abscess. Surgery for ulcerative colitis typically involves removing your entire colon (colectomy) or colon and rectum (proctocolectomy). A proctocolectomy requires another procedure to allow you to pass waste, such as:

Ileoanal anastomosis: Procedure is done to construct an internal pouch that allows you to pass stool through your anus. We offer ileoanal anastomosis whenever possible.
Ostomy: Procedure creates an opening in your abdomen for waste to exit. Your care team will help you learn how to live with an ostomy.

After surgery, you will continue to take medications to control disease progression.

Nutrition Services

IBD can affect your ability to absorb nutrients and cause weight loss. If your provider is concerned about your nutritional status, our GI nutritionist can work with you to recommend foods and supplements to keep you healthy.

Cancer Surveillance

Crohn’s disease and ulcerative colitis can increase your risk of colorectal cancer. Experts recommend colorectal cancer screening every one to three years, starting eight to 10 years after IBD symptoms begin.

Pregnancy Planning

IBD often affects young people in their reproductive years. If you are planning on becoming pregnant, we can help you have a safe pregnancy. Our gastroenterologists work closely with UVM Health maternal-fetal medicine providers to help you plan pregnancy and manage your care during pregnancy and childbirth.