Category Archives: Inflammatory Bowel Disease
Diversion colitis
Diversion colitis is an inflammatory condition developing in the remaining colorectal part of the large bowel, when the portion above it is diverted to an opening in the abdominal wall by surgical procedures like ileostomy or colostomy.
Diversion colitis starts within a year of the diversion surgery and results in mucus discharge and bleeding from rectum.
Ileostomy is a surgical procedure in which the last part of the small intestine called ileum is surgically attached to an opening created on the wall of the abdomen for excretion. In colostomy, part of the large intestine is connected to the abdominal opening created. Both theses surgical procedures are usually done as part of the treatment for various diseases affecting the intestines. Inflammatory bowel diseases such as ulcerative colitis, and Crohn’s disease, cancers of the intestines, diverticulitis, intestinal obstructions, ruptures, and perforations, are some of the reasons for the partial or complete removal of intestines. Injuries caused to the intestines also may require surgical diversion. Sometimes, ileostomy or colostomy may be temporary measures for diverting the passage of stool, till the diverted upper portion can be reattached to the remaining colorectal part.
The colorectal part left intact may get inflamed in about one third of cases, resulting in diversion colitis characterized by mucus discharge and bleeding from the rectum, often accompanied by pain. This inflammatory condition usually develops within a year following the diversion procedure. The symptoms are usually mild and may not require treatment. Surgical reattachment of the upper and lower parts of the intestines effectively resolves both the inflammation and the symptoms, in addition to restoring normal bowel movements.
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Collagenous colitis and lymphocytic colitis
Collagenous colitis is a chronic inflammatory disease in which white blood cells of a certain type infiltrate the lining of the large bowel, causing severe inflammation and thickening of the wall, and resulting in watery diarrhea. Lymphocytic colitis is another inflammatory condition similar to collagenous colitis.
The disease is not limited to any specific area of the large intestine and can affect the whole length of it, including the last part called sigmoid colon, as well as the rectum. Often the diseased areas are not continuous, but occur intermittently along the large bowel. A type of WBC called lymphocytes may accumulate in the walls in large numbers. A connective tissue called collagen develops as a thick layer on the lining of the large bowel making it less absorbent of fluids resulting in watery stools.
The exact reason for the development of these diseases is not known. Excessive reaction of the immune system to dietary or environmental triggers is thought to be resulting in the inflammation of the intestinal lining. These diseases are more frequently found in people who use non-steroidal anti-inflammatory drugs regularly, but there is no conclusive proof of the role of NSAIDs in causing them. Neither collagenous colitis nor lymphocytic colitis elevates colon cancer risk, unlike the other chronic inflammatory diseases like ulcerative colitis and Crohn’s disease.
The incidence of collagenous colitis is higher in women, especially among those who are middle aged and older. However, irrespective of age, both men and women are equally prone to developing lymphocytic colitis.
Symptoms and Diagnosis
Thin watery diarrhea is the most common symptom associated with both collagenous colitis as well as lymphocytic colitis. However, the diarrhea is not bloody, unlike other inflammatory diseases of the bowel such as ulcerative colitis and Crohn’s disease. Other symptoms include nausea, distention of abdomen, pain, and abdominal cramps. Loss of appetite and weight loss are also common. A few days of fasting has a beneficial effect of alleviating symptoms. The symptoms appear during flare ups, with periods of remission in between.
Chronic watery diarrhea without bloody stools may alert the doctor to the possibility of these two inflammatory bowel diseases, especially when other causes are not detected. These two inflammatory conditions are together known as microscopic colitis, because a microscopic analysis of a tissue sample of the lining of the large bowel is the diagnostic test for both collagenous colitis as well as lymphocytic colitis. A colonoscopy is conducted to view the interiors of the large intestine and to obtain a tissue sample of the lining.
Treatment
Drug therapy includes treating the diarrhea with diphenoxylate and loperamide which are antidiarrheal drugs having anticholinergic effect. Mesalamine and sulfasalazine are immonomodulating drugs used for their anti-inflammatory effect. Bismuth subsalicylate is another useful drug to relieve inflammation. Antibiotics, and another drug called cholestyramine which can bind to bile salts, are also used for the treatment.
Prednisone is a corticosteroid which is very effective in the treatment of inflammatory bowel diseases, but it is used only when other drug therapies are not effective because of the potential ill effects of long-term corticosteroid use. Another corticosteroid called Budesonide which has lesser side effects may be tried.
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What Is Ulcerative Colitis
Ulcerative colitis is an inflammatory bowel syndrome affecting the large intestine, characterized by ulcers or sores which develop on the wall of the large bowel, resulting in recurrent bloody diarrhea accompanied by fever, and abdominal pain and cramping.
- Intermittent bouts of diarrhea, with stools mixed with blood, abdominal pain and cramps, and fever, are the usual symptoms
- The reason for the development of ulcerative colitis is unknown.
- Colonoscopy to examine the interiors of the colon, and sigmoidoscopy to detect abnormalities in the sigmoid colon, which is the last part of the large intestine, are the usual tests for diagnosing this condition.
- Ulcerative colitis for prolonged periods may lead to the development of colon cancer.
- The treatment focuses on reducing the inflammation and alleviating the symptoms.
Ulcerative colitis usually start developing in people in the age group 15-30 years, but sometimes it appears as late as when a person is over 50 years also.
Ulcerative colitis is often restricted to the large intestine; the inflammation usually starting in the rectum and then spreading upward into the sigmoid colon, which is the last portion of the large intestine. The disease may gradually spread further, to cover the whole length of the large intestine. However, it rarely affects the small intestine. Ulcerative colitis is limited to the inner wall of the bowel too, usually not affecting the entire thickness.
When the inflammation is restricted to the rectum, it is termed as ulcerative proctitis, which is the more common and less troublesome form of ulcerative colitis. But in several cases, within a short period, the inflammation affects the colon too.
The exact reason for the development of ulcerative colitis is still unknown but is thought to be resulting from the over reaction of the immune system. Hereditary factor also is suspected, as most people suffering from this condition usually have a close relative with the same disease. Smoking is found to trigger flare ups of Crohn’s disease but contrary to expectation, it is found to reduce the risk of developing colitis. However, smoking, as a way to prevent ulcerative colitis, is not recommended at all, as the ill effects of smoking far outweighs the benefits.
Symptoms
Ulcerative colitis has active and passive phases which occur intermittently. The typical symptoms appear during the flare ups. During a severe flare up which may occur suddenly, it causes severe bloody diarrhea accompanied by pain in the abdomen and high fever. The peritoneal lining of the abdomen also may become inflamed leading to a condition called peritonitis. Flare ups may start any time, and each episode may last from several days to many weeks. People become severely ill during this time. Usually, the flare ups may be milder, and develop gradually, beginning with an urgency to defecate. It may be accompanied by milder abdominal cramps and blood stained stools.
When ulcerative colitis is restricted to the last portion of the colon and the rectum only, diarrhea may not be present. The stool may be well-formed and dry, but it may contain large amounts of blood stained mucus produced by the rectum. Other symptoms such as fever may be completely absent or may be present in a milder form.
When ulcerative colitis has spread to most parts of the large bowel, it results in frequent bowel movements, sometimes as frequent as ten to twenty times a day. The watery stools usually contain blood, mucus and pus. Often, the stool may be just pus and blood. The frequent urge to have a bowel movement is usually accompanied by painful abdominal spasms and cramping, even during the night. Fever may be present and loss of appetite may lead to weight loss.
Complications: Bleeding from the rectum is one of the complications which results in anemia. In one tenth of people with this condition, the initial attack is extremely severe, accompanied by fever as well as bleeding, and may result in spread of infections and perforations of the intestine.
Another complication of ulcerative colitis is the development of toxic colitis, a condition in which the disease damages the whole thickness of bowel wall. It may lead to ileus or the temporary halting of the normal peristaltic movements of the intestine. This causes the contents of the bowel to stagnate, resulting in the distention of the abdomen. Eventually, the muscle tone of the large intestine is lost, and the paralyzed parts start to enlarge, filling up with gas.
Toxic megacolon is a dangerous complication which develops when the large bowel becomes greatly distended. Abdominal pain and high fever are usually present, and the WBC count is elevated. There is a high risk of the intestine rupturing and leading to a potentially fatal situation. Toxic megacolon is a medical emergency, and with immediate treatment, the rupture of the intestine and the fatal outcome may be prevented.
Colon cancer is another potentially fatal complication developing in about 1% of those who have long-standing ulcerative colitis. The risk of developing colon cancer depends on the duration and extent of the disease; the risk being highest when the whole of the large intestine is involved, and the when the disease has been present for more than eight years. That is the reason why people suffering from ulcerative colitis should undergo a viewing test called colonoscopy every year or at least once in two years, especially after about eight years from the onset of the disease. In addition to viewing the interiors of the colon and the rectum for abnormalities, a tissue sample for biopsy is also collected using the colonoscope. The biopsy can detect precancerous conditions like dysplasia. Appropriate treatment initiated on the detection of dysplasia, or even in the initial stages of cancer, can be lifesaving. Surgical removal of colon effectively cures the cancer at this stage.
Several other complications of ulcerative colitis include inflammatory conditions in other parts of the body which develop during the flare-ups. Episcleritis, which is the inflammation of the sclera or the white part of the eye ball, arthritis characterized by painful inflammation and stiffness of the joints, or inflamed nodules developing on the hands and legs called erythema nodosum, and pyoderma gangrenosum, in which pus-filled, blue-red sores break out on the skin, are some of the complications.
In people with ulcerative colitis, even during the remission period, inflammatory conditions such as pyoderma gangrenosum, uveitis or eye inflammation, sacroiliitis or inflammation in the pelvic joint and ankylosing spondylitis or the inflammation occurring in the spine, are usually found. Blood clot formation in the veins is a rare but dangerous complication which may occur in people with ulcerative colitis.
Liver dysfunction is common in those who have ulcerative colitis, but it is usually a minor dysfunction. However, up to three cases out of every hundred may develop mild or severe forms of liver disease. When the liver disease is severe, wide ranging inflammations may occur, such as active hepatitis caused by liver inflammation and primary sclerosing cholangitis, which is bile duct inflammation. Chronic inflammation of the liver may cause the normal liver tissue to be replaced by scar tissue, resulting in cirrhosis. Inflamed bile ducts may become narrowed and get completely closed. Inflamed bile ducts have a higher risk of developing into cholangiocarcinoma or bile duct cancer. The risk of developing colon cancer is usually found to have a direct link to the incidence of cholangiocarcinoma.
Diagnosis
The typical symptoms of the ulcerative colitis, and a stool test, help the doctor to diagnose this disease. There are no specific blood tests to detect this condition. Low hemoglobin count, higher than normal WBC count, high ESR rate, and low blood levels of albumin, may be indicative of anemia and inflammation. When the sigmoid part of the colon is examined with a viewing tube called sigmoidoscope, the abnormalities and signs of inflammation observed, help confirm the disease. A biopsy is also done, and the detailed examination of the tissue sample may reveal inflammation, which is taken as a conclusive evidence of the disease.
An x-ray can show the location and spread of the inflammation, but barium enema x-ray is not done when the disease is in the active phase. Colonoscopy is also avoided during this time, but it is conducted later to examine the whole of the large intestine and determine the severity and spread of ulcerative colitis.
Prognosis and Treatment
This chronic inflammatory bowel syndrome is characterized by active and passive phases, which appear intermittently throughout a person’s life. The initial attack of ulcerative colitis, which is usually severe, results in the quick spread of the inflammation and the development of complications associated with it. In around ten cases out of a hundred, people recover completely after the first attack. However, there is a possibility that the typical symptoms of ulcerative colitis displayed during the attack may have been the result of some other severe infection. A biopsy of a tissue sample from the colon may help in proper diagnosis.
The prognosis of people with ulcerative proctitis is very good as they usually have no major complications. But in 10% to 30% of cases, the inflammation may progress into ulcerative colitis affecting the large bowel.
The treatment of ulcerative colitis is focused on bringing the inflammation under control and alleviating symptoms and ensuring quality of life. There is no permanent cure for this disease except the complete removal of the rectum as well as the large intestine.
Dietary Restrictions: People with ulcerative colitis are usually advised to avoid raw vegetables and fresh fruits, as they may worsen the inflammation of the intestinal lining. A dairy-free diet is found to be effective in reducing symptoms in some people. It can be tried, and if found to be beneficial, can be continued for better management of the disease. Supplemental iron should be taken to prevent anemia due to frequent bleeding from the rectum.
Antidiarrheal Drugs: Anticholinergic drugs, including antihistamines and certain antidepressants, are effective in controlling diarrhea. Depending on the severity of the diarrhea, the drug loperamide or another drug diphenoxylate may be taken in small or high doses. Codeine and deodorized tincture of opium are also used to control severe diarrhea. Antidiarrheal medication in high doses should be used under medical supervision to prevent the potentially fatal condition called toxic megacolon from developing.
Anti-Inflammatory Drugs: Sulfasalazine, and related drugs mesalamine, olsalazine as well as balsalazide may help in treating ulcerative colitis, as they can bring down inflammation and the severity of symptoms. They are most effective in treating mild to moderate forms of the disease; and they help prevent frequent flare ups and maintain remission for longer periods. The risk of developing cancers of the colon or the rectum may be decreased by the use of these drugs.
The use of corticosteroids like prednisone has an immediate beneficial effect on patients with severe or moderately severe form of ulcerative colitis. Prednisone can be taken orally, but high doses may be needed initially, to bring the disease under control. After some amount of control is achieved, the drug sulfasalazine or other related drugs such as mesalamine or olsalazine are used for the maintenance of the remission. To reduce the side effects of long-term corticosteroid usage, predinisone is gradually weaned off. When the disease is mild and is restricted to the rectum and to the descending colon on the left side of the body, corticosteroids as well as mesalamine may be administered as suppositories or enemas.
Hospitalization of the patient may be necessary in severe cases of ulcerative colitis. All medications, nutritional support and rehydration therapy are administered intravenously till the condition improves. If blood loss has been heavy, blood transfusion may be given.
Immunomodulating Drugs: Mercaptopurine and azathioprine are immunomodulators used to treat ulcerative colitis. They reduce the immune response of the body by inhibiting the normal actions of T cells, and help avoid the log-term use of corticosteroids. The drawback is that their action is slow and it may take one to four months before any tangible benefits are felt. Their potential side effects are also a cause of concern, and the patients taking these medications have to be closely monitored during the therapy for adverse reactions.
The drug cyclosporine is found to be effective in some cases which show poor response to corticosteroids. But the beneficial effect is often temporary, and in some cases, surgery may have to be done eventually.
The comparatively new drug Infliximab, synthesized from monoclonal antibodies, is found to be effective in the treatment of ulcerative colitis in some people, whose response to immunomodulating drugs as well as corticosteroid therapy is not adequate.
Surgery: Around 30% of the ulcerative colitis cases may require surgical intervention at some time or the other. The surgery can be an emergency procedure or a pre-planned event. Perforations of the intestine, heavy bleeding, formation of blood clots, and toxic megacolon, are some of the potentially dangerous situations which necessitate emergency surgical intervention. Biopsy showing dysplasia, and colon cancer detected in the early stages, and narrowing of the large bowel, are the usual reasons for planned surgeries. When the symptoms of ulcerative colitis remain severe despite possible drug therapies, surgery is an option. Sometimes surgery is performed to avoid constant heavy use of corticosteroids, and to prevent growth retardation due to frequent flare ups, and malabsorption, in children.
Since ulcerative colitis is normally restricted to the large bowel and the rectum, surgical removal of these parts of the digestive tract effectively cures the disease. Earlier, this surgery used to be followed by an ileostomy, by which an outlet for excretion is created in the abdominal wall, to which the ileum or the last portion of the small intestine is attached. Patients had to carry a removable plastic bag to collect stool which is attached to the opening by a plastic tube. Now there are better options available, such as ileo-anal anastomosis in which normal defecation is made possible. After the removal of the large bowel and the major portion of the rectum, the cut end of small intestine is enlarged to form a reservoir for stool, which is then attached to the remaining portion of the rectum. Since the anal sphincter is left intact, it ensures fecal continence and the patient is able to lead a normal life. However, the reservoir may get inflamed, resulting in a condition called pouchitis.
Surgery is not necessary to treat ulcerative proctitis. But some cases may not be responsive to treatment and the symptoms may not subside easily. But it does not in any way affect the life span of a person.
When a potentially fatal complication called toxic megacolon is detected, it is treated as a medical emergency. The patient is put on fast and antidiarrheal medications are stopped. A suction tube is inserted into the small intestine via the nose, to remove the contents and secretions of the stomach and the intestine from time to time. All the necessary drugs and nutritional feeding are administered intravenously. The patient is kept under observation to detect perforation of the intestine and the development of peritonitis. Infliximab or cyclosporine may be given, depending on the patient’s condition. The large intestine is either partially, or totally, removed in an emergency operation, if the other measures do not improve the condition.
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What Is Crohn’s Disease
Crohn’s disease is an intestinal inflammation affecting the wall of the intestines and other parts of the gastrointestinal tract. It is also called regional enteritis, ileocloitis or granulomatus ileitis.
- Chronic or recurring diarrhea accompanied by abdominal cramps and pain are the usual symptoms. Fever, bloody stools and significant weight loss due to loss of appetite and malabsorption are also common.
- The reason for developing Crohn’s disease is not known but abnormalities of the immune system and a genetic predisposition are thought to be responsible for this condition.
- Barium x-rays and a viewing test called colonoscopy help diagnose the condition.
- The treatment focuses on controlling intestinal inflammation and reducing symptoms as Crohn’s disease cannot be cured.
- In some cases, surgical intervention may be necessary.
The exact reason for Crohn’s disease is still not clear though it is believed to be caused by the overreaction of the immune system to various stimuli such as infections, food and environmental factors. A genetic factor also is involved. Smoking is found to be an environmental factor which increases the risk of developing Crohn’s disease as well as worsening it.
Crohn’s disease is becoming increasingly common all over the world but it is more prevalent in the developed countries situated in the northern part of the world. Both men and women are equally affected, and a strong family history is often encountered. People of Jewish descent, especially having Ashkenazim origin are predisposed to Crohn’s disease, the majority of them developing it by the time they are 35 years old. Some may develop it much earlier, at 15 to 25 years of age.
Crohn’s disease usually develops in the large intestine and the latter part of the small intestine called ileum. But its occurrence is not limited to the intestines; it can affect any location along the digestive tract, including the mouth and the anus. The perianal skin also can be affected. The disease affects different people in different ways. In 35% of those affected, the disease is restricted to the small intestine, while 20% have it in the large intestine only. In 45% of those with this condition may have it in both the intestines. Along the length of the affected areas there may be healthy portions called skip areas. But during an active flare up, the entire length and thickness of the intestines may be affected.
Symptoms
The earliest symptoms of this condition are usually chronic diarrhea and fever accompanied by abdominal cramping and pain. Loss of appetite is another symptom. Significant weight loss also may develop. Once the symptoms appear, they usually continue for several days and even weeks, and then subside without any specific treatment. But the recovery is temporary and the disease generally continues throughout life with intermittent active and passive phases. The flare ups may be severe or mild; it may last for a short period or may be prolonged. During severe episodes, pain may be intense and loss of blood and fluids through diarrhea may make a person severely dehydrated and weak. The flare ups usually occur in the same area but may spread to the areas nearby, especially when the affected portion is surgically removed. The reason for the unpredictable and irregular flare ups as well as the severity of the episodes is unknown, making the management of the disease difficult.
When Crohn’s disease develops in children, the usual symptoms are not similar to those of the adult onset of the disease. Fever and inflammation of the joints are the first symptoms in children. Slower rate of growth and fatigue due to anemia are common while typical symptoms like diarrhea and abdominal cramps may be completely absent.
Complications: Obstruction of the intestines, caused by the scar tissue which may have formed there due to this disease, is a major complication of Crohn’s disease. Ulcers may grow deep into the wall of the intestines forming abscesses filled with pus. Abnormal channels called fistulas may develop between the intestines and surrounding organs such as the urinary bladder. Sometimes fistulas from the large intestine grow towards the surface of the skin and develop openings around the anus, leaking fecal matter. Fistulas may originate from the small intestine also, but large perforations are uncommon.
Bleeding from the rectum is a common occurrence when Crohn’s disease affects the large intestine. Prolonged intestinal inflammation due to Crohn’s disease increases the risk of developing colon cancer. One third of people who have Crohn’s disease of the large intestine usually develop disorders such as fissures and fistulas in the anus or in the surrounding area. Other complications due to this condition include infections of the urinary tract and malabsorption syndromes. People with this condition have a higher risk of developing gallstones and kidney stones, as well as a condition called amyloidosis, characterized by the deposits of an abnormal substance called amyloid protein in various organs of the body.
During flare ups of Crohn’s disease, apart from the symptoms related to the digestive system, various other abnormal conditions also appear, such as:
- aphthous stomatitis or painful sores in the mouth,
- arthritis, characterized by inflammation, pain, and stiffness of the joints,
- erythema nodosum or inflamed nodules developing on the hands and legs,
- episcleritis, which is the inflammation of the sclera or the white part of the eye ball, and,
- pyoderma gangrenosum, in which pus-filled, blue-red sores develop on the skin.
Certain other inflammatory conditions are usually present in people who have Crohn’s disease even when it is in remission. Some of them are; uveitis, or eye inflammation, sacroiliitis, or pelvic joint inflammation, sclerosing cholangitis, which is an inflammation affecting the bile ducts, and ankylosing spondylitis, or the inflammation occurring in the spine.
Diagnosis
Crohn’s disease is suspected when a person has several episodes of diarrhea accompanied by abdominal cramps and pain. The medical history of the patient also helps in diagnosis, as a person with this condition usually has disorders associated with the anus such as fistulas and anal fissures. If there are family members diagnosed with Crohn’s disease, there is a high probability as well. Inflammation of eyes, joints and skin are other symptoms which indicate this disease. During physical examination, a lump may be detected on the right side of the lower abdomen.
There are no specific lab tests to detect Crohn’s disease, but abnormal conditions such as high white blood cell count, anemia, and lower blood levels of albumin, when detected in a blood test, may be indicative of this condition. C-reactive protein level in the blood may be high too, which is a sign of intestinal inflammation.
The large intestine is examined through a flexible viewing tube called colonoscope and a tissue sample is collected for detailed examination under the microscope. Colonoscopic examination may not detect Crohn’s disease in the small intestine. Since the most probable location of Crohn’s disease affecting the small intestine is its last portion, which is nearest to the large intestine, the colonoscope is further extended to view the small intestine too. Barium swallow x-ray is usually done to detect Crohn’s disease in the small intestine. Barium enema followed by an x-ray can often detect Crohn’s disease in the large intestine too.
CT scan is the ideal test for inflammatory bowel diseases as it can help differentiate between ulcerative colitis and Crohn’s disease. It can also detect abnormalities such as fistulas and abscesses on the outer wall of the intestine which may be causing the inflammation. Capsule endoscopy, in which a capsule fitted with a tiny camera is swallowed, may help get a clear view of the entire length of the intestinal tract.
Prognosis and Treatment
Crohn’s disease has no direct bearing on the life span of those having this condition. But since people who have Crohn’s disease for prolonged periods have a higher risk of developing intestinal cancers, it may indirectly affect longevity.
There are no treatments to cure Crohn’s disease; hence the focus of the treatment is on managing the disease by reducing the inflammation and alleviating the symptoms. Various drug therapies and surgery are the options available for treating this disease.
Antidiarrheal Drugs: They help in reducing diarrhea and abdominal cramps. They include anticholinergic drugs which block neurotransmitters, such as loperamide and diphenoxylate as well as codeine and deodorized tincture of opium. These drugs are to be taken orally before taking meals. Soluble dietary fibers such as Psyllium husk and methylcellulose help in adding bulk and firmness to stools, thereby reducing irritation to the anus.
Anti-Inflammatory Drugs: Drug sulfasalazine, and other drugs like balsalazide, olsalazine, and mesalamine, related to it, help in reducing the inflammation of the digestive tract, especially when the disease is mild and is mainly affecting the large intestine. Recurrence of the disease has been found to be lowered with the use of mesalamine. However, when the flare ups are severe, these drugs are not very effective.
In spite of the side effects of corticosteroids, especially with their long term use, they are widely and effectively used in the management of Crohn’s disease. The corticosteroid predinisone may be taken orally to reduce symptoms such as diarrhea, fever and abdominal cramping and pain. It may even increase the appetite and help in weight gain. To avoid long term use, the drug is given in high doses at the start of the therapy and then, as the symptoms of intestinal inflammation decrease, the dosage is also reduced, and then gradually tapered off. Side effects are much less with another corticosteroid drug budesonide, but it is not as effective as prednisone and relapses may occur within the next 6 to 9 months.
During very severe flare ups, patients may have to be admitted in the hospital for intravenous corticosteroid therapy, as well as for rehydration and nutritional support given intravenously. Oral feeding is stopped initially till the inflammation is under control. If blood loss through bleeding from the rectum is high, blood transfusion may be given. Anemia is treated by giving iron and folic acid supplements.
Immunomodulating Drugs: Certain drugs like mercaptopurine and azathioprine, which reduce the immune response of the body, are found to be effective in treating Crohn’s disease. They prolong the remission period, and help relieve the symptoms of people who have not benefitted from other drug therapies. Though they can heal fistulas and also help in reducing corticosteroid use, it may take one to three months to derive tangible benefits from their action. Another concern is their potential for causing side effects of a serious nature, such as lowering of white blood cells and pancreatitis. Patients put on immunomodulating drugs have to be closely monitored for the development of low WBC count, pancreatitis and allergic reactions. Blood tests to detect the levels of the metabolites of mercaptopurine and azathioprine may help in adjusting the dosage suitably. Genetic testing also may be done to assess the suitability and dosage of these drugs in different people as the there may be variations in the enzyme which metabolizes these drugs.
Methotrexate is a drug which is given once every week, orally, or by an injection, to people unable to tolerate both immunomodulating drugs and corticosteroids. High doses of Cyclosporine may heal fistulas but it is not safe for long-term use.
A comparatively new drug called infliximab, obtained from monoclonal antibodies, may be administered intravenously to people with severe or moderate forms of the disease. It is an immune modifier which may help some people who are not responding adequately to other medications. It also helps in treating fistulas and in controlling the severity of the disease. However, its action is short-term, and being a new drug, all of its side effects are still not known. When the immunity is lowered due to the use of this drug, it may result in the worsening of infections already existing in the body, including tuberculosis. The risk of developing certain cancers is also elevated. Reactions to the drug may develop in some people in the form of rashes and fever when the drug is being administered. Another related drug called Adalimumab may help those who are unable to tolerate infliximab or have become resistant to it. This drug is also an immuomodifier.
Broad-Spectrum Antibiotics: Antibiotic drugs, which work against a wide variety of bacteria which cause infections in the digestive tract, are used in treating Crohn’s disease. The antibiotic drug Metronidazole helps in treating anal abscesses and fistulas. In addition to clearing up infections which may be causing the inflammation, Metronidazole also reduces other symptoms like abdominal pain and diarrhea typical of Crohn’s disease. But long-term use of the drug may result in nerve damage, which may be recognizable by the pins and needles sensation in the hands and legs. This side effect is reversible with the discontinuation of the drug, but the benefits are also lost on stopping the medication. Several other antibiotics such as levofloxacin or ciprofloxacin are often used instead of metronidazole, or along with it. Occasionally, an antibiotic named Rifaximin, which is nonabsorbable, is also used to treat Crohn’s disease.
Dietary Regimens: A liquid diet, consisting of all the nutritional substances in the right proportion according to the requirements of the body, is found to help people with Crohn’s disease when fistulas and obstructions in the intestines are present. When tube feeding of the liquid formula is administered to children at bedtime, it improves their nutritional status, resulting in better growth. These liquid diets may be given besides surgery or to help postpone the surgery. In some cases, when Crohn’s disease has resulted in severe malabsorption and nutritional deficiencies, intravenous administration of nutrient solutions may be necessary.
Surgery: It may become necessary at some stage or other in almost all the people suffering from Crohn’s disease. When the drug therapy to heal the fistulas and abscesses in the gastrointestinal tract does not work, surgery may be the only option. Obstructions in the intestines, caused due to scar tissue formation resulting from Crohn’s disease, often necessitate surgical removal of the affected area. Even though the removal of diseased portions may alleviate symptoms, it is not a permanent cure, as the disease may affect new areas, especially those adjacent to the removed area. Though drugs administered following the surgery may help in reducing recurrence, half of those who have undergone a surgery usually require another one. Due to this reason, surgery is considered as a last resort, when all possible drug therapies prove to be ineffective. However, people who have had surgical removal of the diseased portions of their intestines often experience a dramatic improvement in their condition.
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What Are Inflammatory Bowel Diseases
Inflammatory bowel diseases cause inflammation of the intestines, resulting in frequent episodes of diarrhea accompanied by abdominal pain and cramping.
Crohn’s disease is a common inflammatory bowel disease affecting most parts of the digestive tract. Ulcerative Colitis is another inflammatory bowel disease similar to it, often making it difficult to differentiate between the two. However, ulcerative colitis is restricted to the large intestine. The reasons for inflammatory bowel diseases are not clearly understood but they are generally believed to be resulting from the overreaction of body’s immune system. A genetic factor also is suspected to be at play as many people who have these conditions are found to be having relatives with the same condition. There are a few other inflammatory conditions also, such as diversion colitits, lymphocytic colitis and collagenous colitis.
Inflammatory bowel diseases are diagnosed after extensive investigative tests to rule out other conditions which may result in the inflammation of the intestines such as bacterial infections and parasitic infestations. The tests include microscopic examination of stool to detect the presence of worms or other parasites. If the patient has undergone antibiotic therapy recently, it can result in an infection of the bacteria Closridium difficile which multiply in the intestines when other beneficial bacteria are destroyed by the action of the antibiotics. Gonorrhea and other sexually transmitted diseases such as chlamydial infection and herpes virus infection affecting the rectum are also investigated.
A viewing test called sigmoidoscopy is usually done to examine the colon. Biopsy of a tissue sample is done to detect any other possible causes of inflammation. A condition usually found in people above the age of 50 years called ischemic colitis, resulting from the lack of blood supply to the large intestine, should be ruled out. Doctors also check for other probable conditions such as irritable bowel syndrome, celiac disease, and in women, gynecologic problems, before arriving at a diagnosis of inflammatory bowel disease.