|
Contact Us Search Make an Appointment Request |
 |
 Inflammatory Bowel Disease
What is Inflammatory Bowel Disease? Inflammatory bowel disease is a term that encompasses several disorders of the digestive tract — most commonly ulcerative colitis and Crohn's disease — that have similar characteristics and symptoms. Both cause inflammation and ulceration (with the primary symptoms of abdominal pain, bloody diarrhea or perhaps constipation) but they differ in the extent of the digestive system affected and the way that each affects it. Ulcerative colitis generally occurs only in the colon and rectum. It usually affects only the innermost lining of the intestinal wall, and it extends along it continuously without any intervals of normal tissue. Although Crohn's disease most often occurs in the small intestine, it can cause ulcers in any part of the gastrointestinal tract, from the mouth to the anus. It generally affects the full thickness of the intestinal wall and tends to occur in sections with intervals of normal intestine in between. Other forms of inflammatory bowel disease are sometimes diagnosed, but they tend to include characteristics of both ulcerative colitis and Crohn's disease, with similar symptoms. It should be emphasized that, as dire as the consequences of ulcerative colitis and Crohn's disease may sound, they are treatable (if not curable), and many people with them lead long, active and fulfilling lives. (return to top) What are the Anatomical Parts of the Gastrointestinal Tract? The gastrointestinal tract begins with the mouth and esophagus, which leads to the stomach. After food begins to travel through your intestinal tract, it is progressively broken down in the stomach, the small intestine (a 22-foot-long, one-to-two-inch-wide muscular tube where most of the food's nutrients are absorbed) and the large intestine. This is a much-broader, four-to-six-foot-long muscular tube that continues to absorb water and nutrients and that passes along waste to the rectum and anus for elimination from the body. Your colon is divided into four parts — progressively, the ascending colon, the transverse colon, the descending colon and the sigmoid colon. The rectum is the final six to eight inches of the large intestine, connecting the sigmoid colon to the anus, through which waste is excreted. (return to top) How Common is Inflammatory Bowel Disease? It's estimated that ulcerative colitis and Crohn's disease afflict as many as half-a-million Americans each year, occurring pretty much equally among men and women. Either disease can occur at any age, but both are most commonly found in young adults. In most victims, it's diagnosed before the age of 30. Both diseases can be found in every racial or ethnic group, but are more common in individuals of European and Jewish ancestry. Studies have indicated that you are at increased risk for developing it if you have a close relative who has had an inflammatory bowel disease, although it remains unclear that IBD is inherited. (return to top) What Are the Symptoms of Inflammatory Bowel Disease? The most obvious symptoms of inflammatory bowel disease are abdominal cramping (especially after eating), diarrhea and blood in the stool. Bloody stools are common with ulcerative colitis and may or may not be present with Crohn's disease. Other symptoms can include fever, anemia and the fatigue that results from it, poor appetite, unexpected weight loss, and, sometimes, constipation. Each case is individual. Symptoms can develop gradually or they can come on suddenly. They can be mild or severe, occasional or chronic. Some experts believe that the first attack is the worst and that subsequent experiences will be less severe. In some cases, follow-up episodes are rare. (return to top) What Causes Inflammatory Bowel Disease? The causes of inflammatory bowel disease and Crohn's disease are unknown. A leading theory is that inflammation begins with an allergic reaction to a virus or bacterium that, in people with a genetic predisposition, causes the body's immune system to create antibodies that attack the intestinal lining. It is known that many sufferers of Crohn's disease have problems with their immune systems, but it's not clear if that is a cause or an effect of the disease. Although once considered a possible cause, emotional stress may precipitate symptoms or make them worse but there is no evidence that stress itself causes the existence of the disorder. Medicines, hormonal changes and infections may cause an attack. In Crohn's patients, smoking seems to enhance the likelihood of an attack, but for ulcerative colitis patients it actually seems to calm symptoms down — temporarily. A nicotine patch is sometimes prescribed for this reason, but the protective effect eventually wears off. Since as many as 20 percent of inflammatory bowel disease patients have a close relative with the disease, a genetic factor is considered possible but not proven. Similarly, since IBD is more prevalent among people living in industrialized nations, environmental factors such as high-fat diets are considered potential factors. (return to top) What are the Tests for Inflammatory Bowel Disease? The first line of diagnosis is your doctor's performing a physical examination, including taking a medical history. He or she may order a blood test to check for anemia and a stool analysis to check for blood or other factors in the stool. You are also likely to have any of several endoscopic procedures ordered to allow visual examination of your gastrointestinal tract. Endoscopes are flexible fiberoptic instruments that enable doctors to directly view internal tissue, photograph it and even take tissue samples with tiny forceps for analysis. These procedures are performed under mild sedation. Sigmoidoscopy is the endoscopic examination of the first several feet of your rectum and colon, and colonoscopy is the visual examination of your entire colon. Endoscopic examination of your upper gastrointestinal tract may be ordered to visually examine your esophagus and stomach for signs of inflammation. During an endoscopic examination, a sample of tissue from your intestine is likely to be taken to confirm that you have an inflammatory bowel disease, and identify which type. A barium enema may also be ordered. This is a diagnostic radiology procedure in which barium is used as a contrast agent to obtain an image of the entire lower intestine. The barium coats the lining of the intestine to create a silhouette that can be captured on an x-ray. It should be noted that these procedures are important in ruling out other problems that can cause similar symptoms, such as colorectal cancer, as well as to test for inflammatory bowel disease. (return to top) What Complications are Possible from Inflammatory Bowel Disease? There are a number of serious complications that can result from ulcerative colitis and Crohn's disease, some potentially requiring surgery to resolve. With ulcerative colitis, the most obvious problems arising from it are diarrhea, chronic bleeding and anemia, but the disease can lead to a rare but potentially dangerous condition called toxic megacolon. In this situation, the muscle wall of your colon becomes paralyzed. Unable to perform a bowel movement, your colon begins to swell and you will likely experience abdominal pain, fever and extreme fatigue. If not treated, your colon could burst, causing the infection of the abdominal cavity called peritonitis. Crohn's disease is a more complicated disease to deal with than ulcerative colitis, with more potential complications. These include:
Patients with Crohn's disease may be subject to problems with malnutrition, and more vulnerable to other conditions, such as joint pain or arthritis. This may be a consequence of the same immune system abnormality that causes the inflammatory bowel disease rather than a consequence of it. If you've had either ulcerative colitis or Crohn's disease for at least eight to10 years, your risk of colon cancer is higher. The longer you've had it and the more your colon is affected, the greater your risk. For this reason, your doctor is likely to order periodic colonoscopies — probably every two years or so — to screen for this possibility. (return to top) What Dietary Considerations Should I Be Aware of with Regard to Inflammatory Bowel Disease? Medical management of nutritional issues is essential for patients with inflammatory bowel diseases because the problems with malabsorption and diarrhea that characterize them can result in deficiencies of nutrients, vitamins and minerals, and fluids. While foods don't cause inflammatory bowel disease, they can make your symptoms worse. You may find it best to concentrate on bland foods and avoid foods that cause problems. While you will have to go on your own experience, these are likely to include spicy foods, citrus juices, many raw fruits and vegetables, foods that cause gas (such as beans and broccoli), alcohol and caffeinated beverages. High-fiber foods can be a problem for inflammatory bowel disease patients. Since you may have trouble digesting fat, you may want to avoid fatty foods such as red meat, butter, peanut butter and chocolate. (return to top) What Medications are Used to Treat Inflammatory Bowel Disease? Ulcerative colitis and Crohn's disease cannot be cured, but there are a number of medications that can be used to relieve symptoms, encourage healing of diseased tissue and suppress the inflammation process and effectively place the diseases in remission. To reduce inflammation, doctors often begin with a group of medications called aminosalicylates, aspirin-like drugs that include sulfasalazine (brand name: Azulfadine), mesalamine (Asacol and Rowasa) and balsalazide (Colazal). These can be taken orally or as suppositories or enemas, and have varied levels of side effects that can range from nausea to headache and abdominal pain. If these drugs prove insufficient, your doctor may add corticosteroids such as prednisone. To block the immune system reaction that is believed to cause inflammation, your doctor may prescribe immunosuppressants such as azathioprine (Imuran) and 6-mercaptopurine (6-MP). Inflixmab (Remicade) is a drug used for Crohn's patients who's disease has not responded to corticosteroid treatment. It's also used to treat fistulas. It neutralizes a protein called tumor necrosis factor, removing it from your bloodstream before it can cause inflammation. While antibiotics don't actually affect inflammatory bowel disease itself, they may be used to address the bacterial overgrowth involved in fistulas and abscesses. Antidiarrheal drugs may be used to deal with that problem. All of these drugs have varying levels of side effects, from nausea with Azulfadine to a risk of infection with Remicade. You should talk with your physician about all the benefits and side effects of any medication you are taking or contemplating taking. (return to top) What is the Role of Laparoscopic Surgery in Inflammatory Bowel Disease? As many as 40 percent of ulcerative colitis patients and 75 percent of Crohn's disease patients will need surgery at some point in their lives, either because of complications that require surgical correction or because of the severity of their symptoms and the ineffectiveness of medical treatment. Advances in surgical technique in recent years have made it possible to perform many colorectal operations as laparoscopic procedures, using flexible fiber-optic instruments to operate on internal organs through several tiny incisions rather than a large open incision. The result is reduced pain, shorter hospitalization and faster recovery with outcomes equivalent to traditional surgical techniques. Hartford Specialists is experienced and adept at techniques of laparoscopic surgery. Surgery can't cure inflammatory bowel disease in the usual sense of the word. Some surgical procedures are designed to remove a damaged portion of intestine and rejoin healthy sections to continue functioning. In some cases — usually with ulcerative colitis but sometimes with Crohn's — it may be necessary to remove the entire colon and rectum and create a stoma — an opening in the abdomen for collection of body wastes in an external bag. Surgery for complications may mean a procedure to remove (or sometimes widen) an obstruction in which the walls of the intestine have thickened (or scar tissue has built up) to block the channel. If a fistula or abscess has formed and is causing infection in the abdominal cavity, surgery may be required to drain the abscess and cleanse the cavity. (return to top) What are the Surgical Options for Ulcerative Colitis? For patients with ulcerative colitis, diseased sections of the colon and rectum can be removed (a procedure called resection) and healthy sections rejoined (anastomosis) for continued bowel function. This can provide remission of the disease but the unfortunate reality is that eventually the disease is likely to redevelop in the healthy tissue, often near the location of the anastomosis. Surgery can usually "cure" ulcerative colitis by removing the entire colon and rectum — a procedure known as proctocolectomy. For many years, the result of this surgery was an ileostomy — diversion of the small intestine directly to an opening in the skin through which waste was collected in a small bag worn about the abdomen. While this sounds drastic, multitudes of patients who have undergone it have led active, productive and fulfilling lives. Since 1980, a procedure that allows the patient to maintain relatively normal bowel function even with the colon and rectum removed has been used successfully in thousands of cases. In this procedure, called ileoanal pouch anastomosis, the surgeon uses tissue from the end of the small intestine (the ileum) to fashion a pouch to collect waste and connects it directly to the anus. The result is somewhat normal bowel control, albeit often with half-a-dozen bowel movements of much-less-solid stools each day. This procedure is usually performed in two stages, the first involving a temporary ileostomy in the abdomen while the pouch heals. This stoma is closed after six-to-eight weeks and normal bowel activity is resumed. For some patients, ileoanal pouch anastomosis may not be possible and an ileostomy will be a necessity. A possible alternative to wearing an external collection bag may be a continent ileostomy, in which a pouch is fashioned from the small intestine and joined to a stoma in the abdomen. With this arrangement, the patient does not need to wear a bag full time but instead can empty the internal pouch into a collection bag when it is convenient. It should be noted that as many as a third of patients who undergo pouch surgery afterwards experience some degree of diarrhea, abdominal pain and other mild to serious problems, such as fever and joint pain. This usually can be managed with medications, but about eight percent of pouches eventually need to be removed, leading to a permanent ileostomy. (return to top) What are the Surgical Options for Crohn's disease? Crohn's disease is more difficult to deal with surgically than ulcerative colitis because of its characteristic of developing in intervals of diseased and healthy sections of intestine. For some patients, diseased segments of an intestine can be removed (a procedure called resection) and healthy sections rejoined (anastomosis) for continued bowel function. This can provide remission of the disease but the unfortunate reality is that eventually the disease is likely to redevelop in the healthy tissue, often near the location of the anastomosis. Since the small intestine (the most common site for Crohn's disease) is the part of the gastrointestinal tract in which most nutrients are absorbed from food, it is not desirable to remove long segments of that organ. In cases in which diseased segments have become narrowed and form strictures that block the movement of intestinal contents, a procedure called strictureplasty may be used to widen the narrowed area rather than simply remove it. When it is necessary to remove the entire length of the colon and rectum (the procedure known as proctocolectomy) the result will be some form of ileostomy — diversion of the small intestine directly to an opening in the skin through which waste was collected in a small bag worn about the abdomen. Since 1980, a procedure that allows the patient to maintain relatively normal bowel function even with the colon and rectum removed has been used successfully in thousands of cases. In this procedure, called ileoanal pouch anastomosis, the surgeon uses tissue from the end of the small intestine (the ileum) to fashion a pouch to collect waste and connects it directly to the anus. The result is somewhat normal bowel control, albeit often with half-a-dozen bowel movements of much less solid stools each day. This procedure is usually performed in two stages, the first involving a temporary ileostomy in the abdomen while the pouch heals. This stoma is closed after six-to-eight weeks and normal bowel activity is resumed. For some patients, ileoanal pouch anastomosis may not be possible and an ileostomy will be a necessity. A possible alternative to wearing an external collection bag may be a continent ileostomy, in which a pouch is fashioned from the small intestine and joined to a stoma in the abdomen. With this arrangement, the patient does not need to wear a bag full time but instead can empty the internal pouch into a collection bag when it is convenient. It should be noted that as many as a third of patients who undergo pouch surgery afterwards experience some degree of diarrhea, abdominal pain and other mild to serious problems, such as fever and joint pain. This usually can be managed with medications, but about eight percent of pouches eventually need to be removed, leading to a permanent ileostomy. (return to top) What is the Process in Creating and Caring for a Stoma? A stoma is an opening in the abdominal wall for the collection of body waste in an external bag, performed when the intestine cannot be connected to the anus for normal bowel function. The procedure is called a colostomy when the colon is the intestinal area directed to the stoma, and an ileostomy when the small intestine, or ileum, is channeled to it. A stoma is also often referred to by the term "ostomy." Even when bowel function is being preserved by the creation of an ileal pouch for anastomosis to the anus, a temporary stoma may be established while the pouch heals over a six-to-eight-week period. Following your surgery, after several days of receiving nutrients intravenously, you will start on a special diet and begin using the bag. You will be helped in learning to use the bag by ostomy nurses, staff trained in stoma care. Many stoma patients achieve a relatively normal routine, some needing to empty the bag as little as once a day. It cannot be emphasized enough that although a colostomy or ileostomy may represent a major change in your personal life, thousands of patients with stomas have gone on to lead normal, active, productive and fulfilling lives. (return to top) What do I Need to Know to Make Informed Decisions about my Treatment? Hopefully, this article has given you important information about the basics of inflammatory bowel disease that will help you in discussing your case with your doctor. There are links to other sources of information on the last page of this document. The most important thing to know about inflammatory bowel disease is that a great multitude of patients with these disorders lead active, productive and fulfilling lives. You should also realize that while there is no cure for inflammatory bowel disease at present, there are a wide range of treatments to counter the symptoms, reduce inflammation and hopefully place the disease in remission for extended periods. And you should understand that dietary, medical and surgical approaches are not endpoints but parts of a process of managing your disease. (return to top) Questions & Answers If I have surgery for my inflammatory bowel disease, what is the likelihood of my needing more surgery later? As noted, neither ulcerative colitis or Crohn's disease can currently be cured. Surgical treatment is intended to remove diseased tissue and thus eliminate inflammation and reduce symptoms, but (with the exception of total removal of the colon and rectum for ulcerative colitis) it is not unusual for either disease to redevelop in healthy tissue. According to the Crohn's and Colitis Foundation of America, 40 to 50 percent of Crohn's patients with recurrent symptoms will need a second surgical procedure at some point, and 10 to 30 percent will require a third. How does inflammatory bowel disease affect my desire to become pregnant and bear children? The symptoms of inflammatory bowel disease may seem to become more severe during the early months of pregnancy, but they can safely be handled with medications. There is no reason not to expect to bear healthy babies because of inflammatory bowel disease. How is irritable bowel syndrome related to inflammatory bowel disease? Irritable bowel syndrome shares a number of symptoms with inflammatory bowel disease, including abdominal pain, diarrhea and constipation. But it is an entirely separate disease and has no connection with IBD. It is a functional bowel disorder as opposed to an inflammatory disease. What is the role of stress in inflammatory bowel disease? Although once considered a possible cause of inflammatory bowel disease, emotional stress may precipitate symptoms or make them worse but there is no evidence that it itself causes the existence of the disorder. Stress has physiological effects on the body — for example, it causes your stomach to secrete more acid — but stress control techniques such as meditation, yoga and regular exercise may be helpful in reducing them. I've read that there is now a procedure for intestinal transplants. Is this a possibility for me? Intestinal transplants, involving small intestines acquired from cadavers, is an operation for people whose own small intestine has experienced so much disease (whether IBD or cancer, among others) or such a degree of resectioning that their body has no way of absorbing nutrients. It is a complicated procedure and would essentially be a last resort. What kind of research is being done about inflammatory bowel disease? There is considerable research and development going on in the area of improving medications for treatment of inflammatory bowel disease, including studies on anti-tumor necrosis factor, a substance that might negate a protein believed to cause inflammation. Research to find the genes that may be responsible for ulcerative colitis and Crohn's disease would aim to eliminate the diseases by fixing those genes. Why is Crohn's disease called by that name? An American physician, Burrill Bernard Crohn, M.D., was one of the first doctors to describe it in an article published in 1932. (return to top) For Additional Information You can find additional information about inflammatory bowel disease at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations. Likely sources include: The National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov) The Crohn's and Colitis Foundation of America, Inc. (www.ccfa.org) American College of Gastroenterology (www.acg.gi.org) The United Ostomy Association (www.uoa.org) The Mayo Clinic (www.mayoclinic.org) WebMD (www.webmd.com) |
|
|
|
