Untitled Essay, Research Paper

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 a couple of really bad

places, 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 (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 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.

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.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,

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.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.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.The doctor may look

inside your body through a flexible 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 the really bad place to look at it 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.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 bleeding in a really bad place. 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.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.What Are the Complications of Crohn’s Disease? The most common complication is the closing of the intestine.

Blockage occurs because the disease tends to thicken the bowel wall with

swelling 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 into the skin. These tunnels are called fistulas.

They are a common complication and often are associated with pockets of infection

or abcesses or infected areas of pus. The areas around the really bad part

and another really bad 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 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.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 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 really bad places removed. 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.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

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 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 service

of the National Institute of Diabetes and Digestive and Kidney Diseases,

part of the National Institutes of Health, under the U.S. Public Health Service.

The clearinghouse, authorized by Congress in 1980, provides information about

digestive diseases to people with digestive diseases and their families,

health care professionals, and the public. The NDDIC answers inquiries; develops,

reviews, and distributes publications; and works closely with professional

and patient organizations and government agencies to coordinate resources

about digestive diseases. “