Inflammatory bowel disease (IBD) is a group of chronic disorders thatcause inflammation or ulceration in the small and large intestines. Most oftenIBD is classified as ulcerative colitis or Crohn’s disease but may be referredto as colitis, enteritis, ileitis, and proctitis. Ulcerative colitis causesulceration and inflammation of the inner lining of a couple of really bad places,while Crohn’s disease is an inflammation that extends into the deeper layers ofthe intestinal wall. Ulcerative colitis and Crohn’s disease cause similarsymptoms that often resemble other conditions such as irritable bowel syndrome(spastic colitis). The correct diagnosis may take some time. Crohn’s diseaseusually involves the small intestine, most often the lower part (the ileum). Insome cases, both the small and large intestine (those really bad places again)are affected. In other cases, only the SUPER really bad place is involved.
Sometimes, inflammation also may affect the mouth, esophagus, stomach, duodenum,appendix, or some nasty sounding word. Crohn’s disease is a chronic conditionand may recur at various times over a lifetime. Some people have long periodsof remission, sometimes for years, when they are free of symptoms. There is noway to predict when a remission may occur or when symptoms will return.
The most common symptoms of Crohn’s disease are abdominal pain, often inthe lower right area, and diarrhea. There also may be rectal bleeding, weightloss, and fever. Bleeding may be serious and persistent, leading to anemia (lowred blood cell count). Children may suffer delayed development and stuntedgrowth.
What Causes Crohn’s Disease and Who Gets It?There are many theories about what causes Crohn’s disease, but none hasbeen proven. One theory is that some agent, perhaps a virus, affects the body’simmune system to trigger an inflammatory reaction in the intestinal wall.
Although there is a lot of evidence that patients with this disease haveabnormalities of the immune system, doctors do not know whether the immuneproblems are a cause or a result of the disease. Doctors believe, however, thatthere is little proof that Crohn’s disease is caused by emotional distress or byan unhappy childhood. Crohn’s disease affects males and females equally andappears to run in some families. About 20 percent of people with Crohn’sdisease have a blood relative with some form of inflammatory bowel disease, mostoften a brother or sister and sometimes a parent or child.
How Does Crohn’s Disease Affect Children?Women with Crohn’s disease who are considering having children can becomforted to know that the vast majority of such pregnancies will result innormal children. Research has shown that the course of pregnancy and deliveryis usually not impaired in women with Crohn’s disease. Even so, it is a goodidea for women with Crohn’s disease to discuss the matter with their doctorsbefore pregnancy. Children who do get the disease are sometimes more severelyaffected than adults, with slowed growth and delayed sexual development in somecases.
How Is Crohn’s Disease Diagnosed?If you have experienced chronic abdominal pain, diarrhea, fever, weightloss, and anemia, the doctor will examine you for signs of Crohn’s disease. Thedoctor will take a history and give you a thorough physical exam. This examwill include blood tests to find out if you are anemic as a result of blood loss,or if there is an increased number of white blood cells, suggesting aninflammatory process in your body.The doctor may look inside your body through aflexible tube, called an endoscope, that is inserted somewhere really bad!During the exam, the doctor may take a sample of tissue from the lining of thereally bad place to look at it under the microscope. Later, you also mayreceive x-ray examinations of the digestive tract to determine the nature andextent of disease. These exams may include an upper gastrointestinal (GI)series, a small intestinal study, and a barium enema intestinal x-ray. Theseprocedures are done by putting the barium, a chalky solution, into the upper orlower intestines. The barium shows up white on x-ray film, revealinginflammation or ulceration and other abnormalities in the intestine. If you haveCrohn’s disease, you may need medical care for a long time. Your doctor alsowill want to test you regularly to check on your condition.
What Is the Treatment?Several drugs are helpful in controlling Crohn’s disease, but at thistime there is no cure. The usual goals of therapy are to correct nutritionaldeficiencies; to control inflammation; and to relieve abdominal pain, diarrhea,and bleeding in a really bad place. Abdominal cramps and diarrhea may behelped by drugs. The drug sulfasalazine often lessens the inflammation,especially in the colon. This drug can be used for as long as needed, and itcan be used along with other drugs. Side effects such as nausea, vomiting,weight loss, heartburn, diarrhea, and headache occur in a small percentage ofcases. Patients who do not do well on sulfasalazine often do very well onrelated drugs known as mesalamine or 5-ASA agents. More serious cases mayrequire steroid drugs, antibiotics, or drugs that affect the body’s immunesystem such as azathioprine or 6-mercaptopurine.
Can Diet Control Crohn’s Disease?No special diet has been proven effective for preventing or treatingthis disease. Some people find their symptoms are made worse by milk, alcohol,hot spices, or fiber. But there are no hard and fast rules for most people.
Follow a good nutritious diet and try to avoid any foods that seem to make yoursymptoms worse. Large doses of vitamins are useless and may even cause harmfulside effects. Your doctor may recommend nutritional supplements, especially forchildren with growth retardation. Special high-calorie liquid formulas aresometimes used for this purpose. A small number of patients may need periods offeeding by vein. This can help patients who temporarily need extra nutrition,those whose bowels need to rest, or those whose bowels cannot absorb enoughnourishment from food taken by mouth.
What Are the Complications of Crohn’s Disease?The most common complication is the closing of the intestine. Blockageoccurs because the disease tends to thicken the bowel wall with swelling scartissue, narrowing the passage. Crohn’s disease also may cause deep ulcer tractsthat burrow all the way through the bowel wall into surrounding tissues, intoadjacent segments of intestine, into other nearby organs such as the urinarybladder or into the skin. These tunnels are called fistulas. They are a commoncomplication and often are associated with pockets of infection or abcesses orinfected areas of pus. The areas around the really bad part and another reallybad part having to do with the southern part of the body often are involved.
Sometimes fistulas can be treated with medicine, but in many cases they must betreated surgically. Crohn’s disease also can lead to complications that affectother parts of the body. These systemic complications include various forms ofarthritis, skin problems, inflammation in the eyes or mouth, kidney stones,gallstones, or other diseases of the liver and biliary system. Some of theseproblems respond to the same treatment as the bowel symptoms, but others must betreated separately.
Is Surgery Often Necessary?Crohn’s disease can be helped by surgery, but it cannot be cured bysurgery. The inflammation tends to return in areas of the intestine next to thearea that has been removed. Many Crohn’s disease patients require surgery,either to relieve chronic symptoms of active disease that does not respond tomedical therapy or to correct complications such as intestinal blockage,perforation, abscess, or bleeding. Drainage of abscesses or removal of a sectionof bowel due to blockage are common surgical procedures. Sometimes the diseasedsection of bowel is removed. In this operation, the bowel is cut above andbelow the diseased area and reconnected. Infrequently some people must havetheir really bad places removed. In an ileostomy, a small opening is made inthe front of the abdominal wall, and the tip of the lower small intestine(ileum) is brought to the skin’s surface. This opening, called a stoma, is aboutthe size of a quarter or a 50-cent piece. It usually is located in the rightlower corner of the abdomen in the area of the beltline. A bag is worn over theopening to collect waste, and the patient empties the bag periodically. Themajority of patients go on to live normal, active lives with an ostomy. Thefact that Crohn’s disease often recurs after surgery makes it very important forthe patient and doctor to consider carefully the benefits and risks of surgerycompared with other treatments. Remember, most people with this diseasecontinue to lead useful and productive lives. Between periods of diseaseactivity, patients may feel quite well and be free of symptoms. Even thoughthere may be long-term needs for medicine and even periods of hospitalization,most patients are able to hold productive jobs, marry, raise families, andfunction successfully at home and in society.
Works Cited.. and a couple other suggested readings.
Bleeding in the Digestive Tract and Ulcerative Colitis.
National Digestive Diseases Information Clearinghouse, 2 Information Way,Bethesda, MD 20892-3570. General patient information fact sheets.
Brandt, LJ, Steiner-Grossman, P, eds. Treating IBD: A Patient’s Guide to theMedical and Surgical Management of Inflammatory Bowel Disease. New York:Raven Press, 1989. General guide for patients with sections on treatment anddescriptions and drawings of surgical procedures. Available from theCrohn’s ; Colitis Foundation of America.
Hanauer, SB, Peppercorn, MD, Present, DH. Current concepts, new therapies inIBD. Patient Care, 1992; 26(13): 79-102. General review article for healthcare professionals.
Steiner-Grossman, P, Banks PA, Present, DH, eds. The New People Not Patients: ASource Book for Living with IBD. Dubuque, Iowa: Kendall/Hunt PublishingCompany, 1992.Book for patients with sections on diagnostic tests,medications, nutrition, coping with employment and health insurance problems,and IBD in children and teenagers, older adults, and during pregnancy.
Available from the Crohn’s ; Colitis Foundation of America.
Additional ResourcesCrohn’s ; Colitis Foundation of America, Inc., 386 Park Avenue South, 17th Floor,New York, NY 10016-8804; (800) 932-2423 or (212) 685-3440.
Pediatric Crohn’s ; Colitis Association, Inc., P.O. Box 188, Newton, MA 02168;(617) 244-6678.
Reach Out for Youth with Ileitis and Colitis, Inc., 15 Chemung Place, Jericho,NY 11753; (516) 822-8010.
United Ostomy Association, 36 Executive Park, Suite 120, Irvine, CA 92714;(800) 826-0826 or (714) 660-8624.
National Digestive Diseases Information Clearinghouse 2 INFORMATION WAY BETHESDA,MD 20892-3570″The National Digestive Diseases Information Clearinghouse (NDDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases, part ofthe National Institutes of Health, under the U.S. Public Health Service. Theclearinghouse, authorized by Congress in 1980, provides information aboutdigestive diseases to people with digestive diseases and their families, healthcare professionals, and the public. The NDDIC answers inquiries; develops,reviews, and distributes publications; and works closely with professional andpatient organizations and government agencies to coordinate resources aboutdigestive diseases. “Category: Science