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Inflammatory bowel disease (IBD)
is a group of chronic disorders
that cause inflammation or
ulceration in the small and
large intestines. Most often IBD
is classified as ulcerative
colitis or Crohn's disease but
may be referred to as colitis,
enteritis, ileitis, and
proctitis.
Ulcerative colitis causes
ulceration and inflammation of
the inner lining of the colon
and rectum, while Crohn's
disease is an inflammation that
extends into the deeper layers
of the intestinal wall.
Ulcerative colitis and Crohn's
disease cause similar symptoms
that often resemble other
conditions such as irritable
bowel syndrome (spastic
colitis). The correct diagnosis
may take some time.
Crohn's disease usually involves
the small intestine, most often
the lower part (the ileum). In
some cases, both the small and
large intestine (colon or bowel)
are affected. In other cases,
only the colon is involved.
Sometimes, inflammation also may
affect the mouth, esophagus,
stomach, duodenum, appendix, or
anus. Crohn's disease is a
chronic condition and may recur
at various times over a
lifetime. Some people have long
periods of remission, sometimes
for years, when they are free of
symptoms. There is no way to
predict when a remission may
occur or when symptoms will
return.
Upper GI Tract
1) What Are the Symptoms?
The most common symptoms of
Crohn's disease are abdominal
pain, often in the lower right
area, and diarrhea. There also
may be rectal bleeding, weight
loss, and fever. Bleeding may be
serious and persistent, leading
to anemia (low red blood cell
count). Children may suffer
delayed development and stunted
growth.
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2) What Causes Crohn's
Disease and Who Gets It?
There are many theories about
what causes Crohn's disease, but
none has been proven. One theory
is that some agent, perhaps a
virus or a bacterium, affects
the body's immune system to
trigger an inflammatory reaction
in the intestinal wall. Although
there is a lot of evidence that
patients with this disease have
abnormalities of the immune
system, doctors do not know
whether the immune problems are
a cause or a result of the
disease. Doctors believe,
however, that there is little
proof that Crohn's disease is
caused by emotional distress or
by an unhappy childhood.
Crohn's disease affects males
and females equally and appears
to run in some families. About
20 percent of people with
Crohn's disease have a blood
relative with some form of
inflammatory bowel disease, most
often a brother or sister and
sometimes a parent or child.
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3) How Does Crohn's Disease
Affect Children?
Women with Crohn's disease who
are considering having children
can be comforted to know that
the vast majority of such
pregnancies will result in
normal children. Research has
shown that the course of
pregnancy and delivery is
usually not impaired in women
with Crohn's disease. Even so,
it is a good idea for women with
Crohn's disease to discuss the
matter with their doctors before
pregnancy. Children who do get
the disease are sometimes more
severely affected than adults,
with slowed growth and delayed
sexual development in some
cases.
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4) How Is Crohn's Disease
Diagnosed?
If you have experienced chronic
abdominal pain, diarrhea, fever,
weight loss, and anemia, the
doctor will examine you for
signs of Crohn's disease. The
doctor will take a history and
give you a thorough physical
exam. This exam will 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 an
inflammatory process in your
body. Examination of a stool
sample can tell the doctor if
there is blood loss, or if an
infection by a parasite or
bacteria is causing the
symptoms.
The doctor may look inside your
rectum and colon through a
flexible tube (endoscope) that
is inserted through the anus.
During the exam, the doctor may
take a sample of tissue (biopsy)
from the lining of the colon to
look at under the microscope.
Later, you also may receive
x-ray examinations of the
digestive tract to determine the
nature and extent of disease.
These exams may include an upper
gastrointestinal (GI) series, a
small intestinal study, and a
barium enema intestinal x-ray.
These procedures are done by
putting the barium, a chalky
solution, into the upper or
lower intestines. The barium
shows up white on x-ray film,
revealing inflammation or
ulceration and other
abnormalities in the intestine.
If you have Crohn's disease, you
may need medical care for a long
time. Your doctor also will want
to test you regularly to check
on your condition.
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5) What Is the Treatment?
Several drugs are helpful in
controlling Crohn's disease, but
at this time there is no cure.
The usual goals of therapy are
to correct nutritional
deficiencies; to control
inflammation; and to relieve
abdominal pain, diarrhea, and
rectal bleeding.
Abdominal cramps and diarrhea
may be helped by drugs. The drug
sulfasalazine often lessens the
inflammation, especially in the
colon. This drug can be used for
as long as needed, and it can be
used along with other drugs.
Side effects such as nausea,
vomiting, weight loss,
heartburn, diarrhea, and
headache occur in a small
percentage of cases. Patients
who do not do well on
sulfasalazine often do very well
on related drugs known as
mesalamine or 5-ASA agents. More
serious cases may require
steroid drugs, antibiotics, or
drugs that affect the body's
immune system such as
azathioprine or 6-mercaptopurine
(6-MP).
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6) Can Diet Control Crohn's
Disease?
No special diet has been proven
effective for preventing or
treating this 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 your symptoms
worse. Large doses of vitamins
are useless and may even cause
harmful side effects.
Your doctor may recommend
nutritional supplements,
especially for children with
growth retardation. Special
high-calorie liquid formulas are
sometimes used for this purpose.
A small number of patients may
need periods of feeding by vein.
This can help patients who
temporarily need extra
nutrition, those whose bowels
need to rest, or those whose
bowels cannot absorb enough
nourishment from food taken by
mouth.
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7) What Are the Complications
of Crohn's Disease?
The most common complication is
blockage (obstruction) of the
intestine. Blockage occurs
because the disease tends to
thicken the bowel wall with
swelling and fibrous scar
tissue, narrowing the passage.
Crohn's disease also may cause
deep ulcer tracts that burrow
all the way through the bowel
wall into surrounding tissues,
into adjacent segments of
intestine, into other nearby
organs such as the urinary
bladder or vagina, or into the
skin. These tunnels are called
fistulas. They are a common
complication and often are
associated with pockets of
infection or abcesses (infected
areas of pus). The areas around
the anus and rectum often are
involved. Sometimes fistulas can
be treated with medicine, but in
many cases they must be treated
surgically.
Crohn's disease also can lead to
complications that affect other
parts of the body. These
systemic complications include
various forms of arthritis, skin
problems, inflammation in the
eyes or mouth, kidney stones,
gallstones, or other diseases of
the liver and biliary system.
Some of these problems respond
to the same treatment as the
bowel symptoms, but others must
be treated separately.
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8) Is Surgery Often
Necessary?
Crohn's disease can be helped by
surgery, but it cannot be cured
by surgery. The inflammation
tends to return in areas of the
intestine next to the area that
has been removed. Many Crohn's
disease patients require
surgery, either to relieve
chronic symptoms of active
disease that does not respond to
medical therapy or to correct
complications such as intestinal
blockage, perforation, abscess,
or bleeding. Drainage of
abscesses or resection (removal
of a section of bowel) due to
blockage are common surgical
procedures.
Sometimes the diseased section
of bowel is removed. In this
operation, the bowel is cut
above and below the diseased
area and reconnected.
Infrequently some people must
have their colons removed
(colectomy) and an ileostomy
created.
In an ileostomy, a small opening
is made in the 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 about the size of a
quarter or a 50-cent piece. It
usually is located in the right
lower corner of the abdomen in
the area of the beltline. A bag
is worn over the opening to
collect waste, and the patient
empties the bag periodically.
The majority of patients go on
to live normal, active lives
with an ostomy.
The fact that Crohn's disease
often recurs after surgery makes
it very important for the
patient and doctor to consider
carefully the benefits and risks
of surgery compared with other
treatments. Remember, most
people with this disease
continue to lead useful and
productive lives. Between
periods of disease activity,
patients may feel quite well and
be free of symptoms. Even though
there may be long-term needs for
medicine and even periods of
hospitalization, most patients
are able to hold productive
jobs, marry, raise families, and
function successfully at home
and in society.
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The Crohn's and Colitis
Foundation of America
www.ccfa.org
Additional Readings
Bleeding in the Digestive Tract
and Ulcerative Colitis. National
Digestive Diseases Information
Clearinghouse, 2 Information
Way, Bethesda, MD 20892-3570;
(301) 654-3810. General patient
information fact sheets.
Brandt, LJ, Steiner-Grossman, P,
eds. Treating IBD: A Patient's
Guide to the Medical and
Surgical Management of
Inflammatory Bowel Disease. New
York: Raven Press, 1989. General
guide for patients with sections
on treatment and descriptions
and drawings of surgical
procedures. Available from the
Crohn's & Colitis Foundation of
America.
Hanauer, SB, Peppercorn, MD,
Present, DH. Current concepts,
new therapies in IBD. Patient
Care, 1992; 26(13): 79-102.
General review article for
health care professionals.
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. 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 Resources
Crohn'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
NIH Publication No. 95-3410
October 1992 |
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