Inflammatory Bowel Disorders (Crohn's Disease; Ulcerative Colitis)
The term inflammatory bowel disease describes a chronic condition of intestinal inflammation and ulceration that has no identifiable cause. The two most common examples are Crohn's disease and ulcerative colitis.
Crohn's disease, also called ileitis or regional enteritis, can affect any part of the gastrointestinal system, from the mouth to the anus, but most often attacks the lowermost portion of the small intestine, or ileum, and the colon. The disease usually appears early in life, commonly between the ages of 14 and 24. Men and women are equally affected and, for unknown reasons, there has been a worldwide increase in the disease since it was first described by Dr. Burrill B. Crohn, a New York gastroentcrologist, in the 1930s.
Ulcerative colitis also causes inflammation and often severe ulcerations as well, but it is confined mostly to the lining of the colon and rectum. More than 2 million Americans suffer from one of these disorders. The main symptoms of both conditions are persistent diarrhea, rectal bleeding, fever, abdominal cramps, and weight loss. A number of non-intestinal symptoms are also associated with inflammatory bowel disorders, including eye inflammation, arthritis, skin and mouth ulcers, and liver disease.
Although no cause for inflammatory bowel diseases has been identified, certain predisposing factors are known. For instance, researchers believe that susceptibility is inherited, because there is a tendency for the disorders to run in families, with people of Jewish descent the most vulnerable. They also suspect that the disorders might be triggered by an infectious organism or immune system reaction, but this theory remains unproven. Psychological factors also may play a role, as the conditions often develop during periods of high stress and emotional turmoil. But exactly how stress triggers the inflammatory response is unknown.
Diagnostic Studies and Procedures
The characteristic symptoms will prompt a doctor to suspect inflammatory bowel disease, but the diagnostic process requires a thorough physical examination and tests to rule out other intestinal problems. Blood tests are conducted to look for signs of infection as well as anemia, a common consequence of intestinal bleeding. X-rays of the colon will also be ordered.
An examination of the colon using a colonoscope, a viewing instrument with special lights and magnifying devices, is the next diagnostic step. During this procedure, tissue samples are removed for biopsy studies.
In ulcerative colitis, the mucous membrane lining the entire colon will be seen as uniformly inflamed and ulcerated. A portion of the small intestine that joins the colon may also be inflamed, but this is not a major characteristic. In addition, the lining might show evidence of dysplasia, precancerous changes that eventually develop into invasive colon cancer.
In its early stages, Crohn's disease can be difficult to differentiate from ulcerative colitis, but the colonoscopy and biopsies usually reveal some significant differences. In Crohn's disease, the inflammation involves all layers of the intestine, not just the lining, but is often confined to specific areas interspersed between normal sections.
Laparoscopy, in which a viewing device is inserted into the abdominal cavity through a small incision, may show that the tissue surrounding the intestines, the mesentery, as well as nearby lymph nodes, are also swollen and inflamed As the disease progresses, the intestine becomes thickened and leathery, and the channel through which food and waste must flow becomes progressively narrowed and stiff. Extensive ulcerations often lead to the formation of fissures, or tears, and fistulas, abnormal channels between segments of the intestine.
Medical Treatments
Inflammatory bowel disorders cannot be cured by medications, although in some cases, they will disappear for long periods or even for life. The goal of treatment is to alleviate symptoms and, if possible, achieve a remission. Mild cases can be treated on an outpatient basis, but severe flare-ups require hospitalization for intravenous fluids, drugs, and in cases where there is significant bleeding, blood transfusions.
Sulfasalazine (Azulfidine), a combination of a sulfa drug and a compound similar to aspirin, and corticosteroids are the principal drugs used to control inflammatory bowel diseases. Steroids may be given by mouth or by injection during a flare-up and then tapered off slowly. They also may be administered as an infusion into the lower colon and rectum. This enema form has fewer side effects than systemic steroids.
In some cases, medications that suppress the immune system may be prescribed. Broad-spectrum antibiotics may also be administered, especially in severe cases in which perforation of the intestine is a possibility.
Surgery is often required to treat severe Crohn's disease, especially if there is an intestinal obstruction or other complication. Usually, the operation involves removing the diseased section of intestine and joining together the two healthy ends, a procedure called resection and anastomosis. This often improves the patient's condition dramatically, with the symptoms disappearing for many years. It is not a cure, however, as the disease frequently recurs at or near the site where the two healthy sections were joined.
In cases of ulcerative colitis, surgery to remove the entire colon and rectum affords a permanent cure. However, the treatment is one of last resort because it usually means that the patient must eliminate solid wastes through a stoma, an artificial opening in the abdominal wall. To avoid this, a new procedure called ileoanal anastomosis is used. It involves retaining the rectum but stripping off its innermost layer and inserting, just above the anus, a pouch made from the ileum portion of the small intestine. Because the rectal muscles are preserved, the patient can have normal bowel movements.
Alternative Treatments
Inflammatory bowel diseases require expert medical care. In general, any alternative therapies should be directed to reducing stress or devising a diet that minimizes symptoms.
Aromatherapy. Massages or relaxing baths incorporating basil, bergamot, and jasmine oils are recommended by aromatherapists to reduce stress.
Nutrition Therapy. Proper nutrition is probably the single most important non medical treatment for inflammatory bowel disease. Patients should consult a clinical dietitian trained in their management. Although foods play no role in causing these disorders, the typical symptoms of reduced appetite, poor absorption of nutrients, and diarrhea rob the body of essential fluids, nutrients, vitamins, and minerals.
Nutrition therapy is aimed at restoring a proper nutritional balance and, in severe cases, resting the bowel to give it a chance to heal. Thus, bland, low-fiber foods are recommended during a flare-up. Foods that are difficult to digest, such as raw vegetables, raw or dried fruits, nuts and seeds, bran, and whole grains should also be avoided.
Patients with Crohn's disease are often put on a high-protein diet, and many require nutritional supplements and concentrated liquid feedings, or an elemental diet, which does not produce any solid wastes. Intravenous feedings may be necessary, especially for children who cannot otherwise eat enough for proper growth and development.
Psychotherapy. Inflammatory bowel diseases are not psychosomatic, but emotional problems are a precipitating factor in both their instigation and flare-ups. Also, coping with a serious chronic illness is stressful in itself. Some form of counseling or therapy is often helpful, particularly if the therapist has a special interest in dealing with patients who have these disorders.
Yoga and Meditation. The breathing, meditation, and gentle exercises of yoga are helpful in controlling stress and perhaps preventing recurrences.
Self-Treatment
Most people with these diseases can lead productive lives, even though symptoms may flare up periodically and possibly require hospitalization. Doctors stress that patients should continue with school, work, and other activities as much as possible, but in moderation, to minimize undue stress and to conserve weight and strength.
During a flare-up, self-care can reduce complications. To combat dehydration, a potentially serious side effect of diarrhea, increase your fluid intake. Drink water, clear broth, or a rehydration fluid such as Gatorade, which also helps replace the electrolytes that are lost during bouts of diarrhea. Try the BRAT diet—bananas, rice, applesauce, and toast to reduce diarrhea. Also keep a list of foods that seem to be associated with worsening the symptoms, and avoid them.
Other Causes of the Symptoms of Intestinal Inflammation
Diarrhea and cramping can be due to irritable bowel syndrome, a viral or bacterial infection, intestinal parasites, lactose intolerance, and malabsorption syndromes. Blood in the stool may be caused by hemorrhoids, colon polyps, or intestinal cancer.