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Inflammatory Bowel Disease

Digestion of food begins in the mouth and moves through the esophagus, stomach, and the small and large intestine. In the mouth, stomach, and the small intestine, food is mixed with digestive juices. The digestive juices break the food down into smaller chemical pieces or nutrients. These nutrients move along the small intestine, which is made up of three parts: the duodenum, jejunum, and ileum. The nutrients are absorbed into the bloodstream through the small intestine and carried to all parts of the body. Nutrients are needed for the body to grow and remain healthy.

The water and solid waste that remain after the nutrients are absorbed move into the large intestine. Most of the remaining water is absorbed into the bloodstream from the colon. The solid waste is passed out of the body as a bowel movement (BM) through the anus.

Inflammatory Bowel Disease (IBD) is a term that refers to both ulcerative colitis and Crohns disease. Ulcerative colitis causes inflammation of the lining of the large intestine. Crohns disease causes inflammation of the lining and wall of the large and/or small intestine. When inflamed, the lining of the intestinal wall is red and swollen, becomes ulcerated, and bleeds.

What Causes IBD?

The cause(s) of IBD are not known, but there are several theories. One theory is based on genetics indicating that IBD does run in families. About 15 percent to 30 percent of patients with IBD have a relative with the disease. There is research going on to find out if a specific gene or a group of genes makes a person more susceptible to getting the disease.

Many changes in the bodys immune system (bodys natural defense system against disease) have been discovered in patients with IBD. What is still unknown is what causes those changes to happen. There is a large amount of research being done in this area.

There is little evidence that stress causes IBD. As with other illnesses, stress may aggravate symptoms and require a treatment program.

IBD occurs most frequently in people in their late teens and twenties. There have been cases in children as young as two years old and in older adults in their seventies and eighties. Men and women have an equal chance of getting the disease.

Ulcerative Colitis

Most often ulcerative colitis occurs in young people 15 to 40 years of age. Ulcerative colitis occurs only in the inner lining of the colon (large intestine) or rectum. When it is located only in the rectum, it is called proctitis. Inflammation of the rectum and colon keeps water from being absorbed into the bloodstream and results in diarrhea.

Symptoms of Ulcerative Colitis

The most common symptoms of ulcerative colitis are diarrhea, abdominal cramps, and rectal bleeding. Some people may be very tired and have weight loss, loss of appetite, abdominal pain, and loss of body fluids and nutrients. Bleeding may be serious, leading to anemia (low red blood cell count). Joint pain, redness and swelling of the eyes, and liver problems can also occur. No one knows for sure why problems outside the colon are linked with colitis. These problems may improve when the colitis is managed.

Ulcerative colitis is an illness that has periods of remission (time when you feel well) and relapse (time when you feel ill). Half of the people who have ulcerative colitis have only mild symptoms. Others have frequent fever, bloody diarrhea, nausea, and severe abdominal cramps.

Some people with severe symptoms of ulcerative colitis must go to the hospital to correct malnutrition and stop diarrhea and loss of blood. In the hospital, a patient may need a treatment program including a special diet and feeding through a vein. Sometimes surgery is needed.

How Do I Know if I Have Ulcerative Colitis?

To find out if you have ulcerative colitis, your doctor must take your medical history and perform a physical examination. The exam may include blood tests and samples of a bowel movement. Other tests include:

Flexible Sigmoidoscopy or Colonoscopy - A small flexible tube inserted by your doctor into the anus. The flexible tube is slowly passed into the lower third of the colon in flexible sigmoidoscopy and through the entire colon in a colonoscopy, allowing your doctor to see the lining of the colon. If necessary, the doctor can take a tissue sample called a biopsy to make a diagnosis of your condition.

Barium Enema---This is an X-ray of the colon. A white substance called barium is put into the colon by an enema. This test may allow your doctor to see areas of the colon that are abnormal.

Does Ulcerative Colitis Increase the Risk of Colon Cancer?

Risk of colon cancer is higher in ulcerative colitis patients with involvement of the entire colon and in patients who have had the diagnosis for eight to ten years. Patients with a diagnosis of left-sided ulcerative colitis for 15-20 years also fall into a higher risk group for developing cancer. Individuals in these groups should consult their doctor and plan for periodic colonoscopy with biopsy.

Crohns Disease

Crohns is a chronic disease that has periods of remission (time when person feels well) and relapse (when a person feels ill).

Crohns disease is an inflammation and ulceration process that occurs in the deep layers of the intestinal wall. The most common areas affected are the lower part of the small intestine, called the ileum, and the first part of the colon. This type of Crohns disease is called ileocolitis.

Crohns disease can infrequently affect any part of the upper gastrointestinal tract. Aphthous ulcers, which are similar to cold sores, are common. Ulcers can also occur in the esophagus, stomach, and upper small intestine (duodenum). It is difficult to tell these ulcers from peptic ulcers except by biopsy exam.

Symptoms of Crohns Disease

The most common symptoms of Crohns disease are pain in the abdomen, often in the lower right side, diarrhea, and weight loss. There may also be rectal bleeding and fever. Chronic bleeding may lead to a low red blood cell count called anemia. Children who develop Crohns disease may have delayed development and stunted growth.

How Do I Know if I Have Crohns Disease?

To find out if you have Crohns disease, your doctor must take your medical history and do a physical exam. The exam may include blood tests and samples of a bowel movement. Other tests are the same as described in the section on Ulcerative Colitis; a barium enema and a colonoscopy examination. In addition, a small bowel X-ray may be required.

What are the Complications Associated with Crohns Disease?

The most common complication of Crohns disease is blockage of the intestine. Blockage or stricture occurs when the disease thickens the bowel wall with swelling and scar tissue. The intestine passage becomes smaller and smaller, until it is completely closed.

Fistulas are a common complication of this disease. Fistulas occur when ulcers in the intestine break through the intestine wall making tunnels into surrounding tissues of the bladder, vagina, or into the skin. Fistulas occur frequently around the anus and rectum.

These fistulas can become infected and may result in abscess formation. Treatment programs are used to manage infected fistulas, but often surgery is needed.

What is the Treatment for IBD?

Your doctor will discuss with you a treatment plan that may include any of the following:
  • Nutrition
  • Emotional Support
  • Surgery
  • Drug Therapy
There are many different types of treatment plans that your doctor can prescribe to control the symptoms of IBD, and each of these has specific actions and side effects. Be sure to follow all of your doctors directions. Never stop your treatment plan until you have completed it or your doctor instructs you to stop.

Should I Modify or Change My Diet?

What you eat does not cause IBD, but can cause symptoms when the disease is active.

The goal of nutritional management for people with IBD is to modify the diet to decrease gastrointestinal (GI) symptoms while maintaining adequate nutrient intake. Your doctor may do a nutritional assessment to determine if you are taking in enough calories, vitamins, and minerals. When nutritional needs are not being met, your doctor may suggest a liquid supplement.

How Do I Cope with IBD?

Although IBD is a chronic disease that has periods of remission and relapse, most people have a normal life span and a good quality of life.

For those who have chronic and continuing symptoms, the following apply:
  • Know your body and how IBD affects you
  • Learn to care for yourselfhave control over those things you can control
  • Develop a support system that works for you: family, friends, and support groups
  • Be sure to follow instructions from your medical team

When is Surgery Needed?

Most people who have IBD respond to their treatment program, including medications and nutritional planning. Many patients have mild episodes of illness after long periods of feeling well. Your doctor will consider surgery usually when certain conditions are present. Surgery may be needed if there is:
  • A large amount of bleeding
  • Long-lasting and serious illness
  • Ulceration that makes a hole in the intestinal wall
  • Medical treatment plan is not controlling the disease
  • Obstruction

There are several surgical choices. Each has advantages and disadvantages. The surgeon and patient must decide on the best option.

Staying informed is an important aspect of dealing with IBD.

Glossary

Absorption - the process of nutrients passing from the intestine into the blood stream.

Anemia - a condition in which the blood does not have enough red blood cells.

Anus - opening at the end of the rectum that allows solid waste to be eliminated.

Aphthous Ulcers - a sore on the mouth that is associated with Crohns disease.

Chronic Disease - illness that occurs at frequent intervals over a long period of time.

Colon - the large intestine.

Chrohns Disease - an inflammatory and ulcerative process that occurs in the deep layers of the small and sometimes large intestine.

Digestion - the process of breaking down food into its simplest chemical compounds so that it can be absorbed.

Duodenum - the first portion of the small intestine. Connects the stomach to the small intestine.

Fistulas - an abnormal passage leading from the colon to other organs in the lower abdominal cavity.

Ileocolitis - a common form of Crohns disease that affects the lower portion of the small intestine and the first portion of the colon called the ileum.

Ileum - the last portion of the small intestine that connects to the large intestine.

Immune System - the bodys natural defense system that fights against disease.

Inflammation - a response to tissue injury that causes redness, swelling, and pain.

Jejunum - the middle portion of the small intestine.

Large Intestine - also known as the colon. Primary function is to absorb water and get rid of solid waste.

Malnutrition - condition that occurs when the body does not have enough calories, vitamins, and minerals to maintain growth and health.

Proctitis - inflammation of the rectum.

Rectum - lowest portion of the colon.

Small Intestine - Connects to the stomach and large intestine. Absorbs nutrients.

Stricture - closure or obstruction of the intestine.

Additional Reading:
  1. Brandt LJ, Steiner-Grossman P, eds. Treating IBD: A Patients Guide to the Medical and Surgical Management of Inflammatory Bowel Disease. New York: Raven Press, 1989
  2. Steiner-Grossman P, Banks PA, Present DH, eds. The New People Not Patients: A Source Book for Living with IBD. Dubuque, Iowa: Kendall/Hunt Publishing Company, 1992.
Resource:

Crohns and Colitis Foundation of America
(CCFA). 386 Park Ave., South, New York, NY, 10016-8804. (212) 685-3440, or (800) 932-2423.
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