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INFLAMMATORY BOWEL DISEASE

WHAT IS IT?
Inflammatory bowel disease, or IBD, is a general term for chronic diseases that cause the intestines to become inflamed. Crohn’s disease and ulcerative colitis are the most common forms of IBD. Both can cause swollen, inflamed intestines, pain, diarrhea, and other symptoms.Crohn’s disease usually extends deep into the tissues. It can attack any part of the digestive tract but often begins in the lower section of the small intestine, called the ileum. Crohn’s disease may also cause joint pain and eye problems. With ulcerative colitis, large raw, inflamed areas develop in the lining of the large intestine. These sores may start in the rectum-the end of the digestive tract-and spread to other areas. Unlike Crohn’s disease, ulcerative colitis affects only the outer lining of the intestine. Between 10 and 20 percent of those with IBD have neither Crohn’s disease nor ulcerative colitis.

IBD is a chronic condition. That means it can last a lifetime. The symptoms, though, may come and go. There is no known cure for Crohn’s disease, although many people with the problem suffer only one or two attacks, then have no symptoms for the rest of their lives. Most people with ulcerative colitis have only mild symptoms. It can be cured with surgery, but doctors operate only in the worst cases and as a last resort.

IBD can be very serious. But with lifestyle changes and medications, you can prevent flare-ups or ease symptoms when they occur.
WHAT IS HAPPENING?
When you eat, food gets mixed with acids and enzymes in your stomach. These acids and enzymes break the food down into smaller and smaller pieces, which move from your stomach into your small intestine. Nutrients in your food are broken down in the small intestine and are absorbed by your bloodstream. What’s left-undigested food and old cells that have been shed by the intestinal lining-travels into your large intestine, the colon, where water, salts, and more nutrients are absorbed. The waste that’s left passes into the rectum and out of your body.

Lots of things, such as stress, an infection, or certain foods, can upset this process, causing bouts of diarrhea, cramps, and other symptoms. Most of the time, these bouts last for only a day or two, and then things return to normal.

But if you have IBD, symptoms can last far longer. When they do, the continuing diarrhea, day after day, is hard on the cells lining the colon. Ulcers can form as a result. And when the digestive tract becomes inflamed, it can become more difficult for your body to digest food, so you may not be able to get enough of the vitamins, minerals, and other nutrients you need.

In the worst cases of IBD, the intestines may not be able to heal themselves between flare-ups. Left untreated, an ulcer may eat through the intestinal wall to create a fistula-a hole. This can cause lots of problems, including infection.
WHAT CAUSES IT?
No one knows what causes IBD, but some things can raise your risk. Many others, such as eating certain foods or stress, can trigger flare-ups or make symptoms worse.

THINGS YOU CAN’T CHANGE

Age
IBD most often begins in people between ages 15 and 25 or between ages 55 and 80. No one is sure why.

Family history
IBD appears to run in families. If a parent, sibling, or child has it, your risk may be 25 percent higher than that of someone without a family history of the disease.

Race
IBD is most common among whites. Still higher rates are seen in American Jews of European descent. Experts don’t know why.

Immune system
Some experts think IBD may be caused by problems with a person’s immune system-the body’s built-in defense against germs and diseases. One theory holds that IBD sometimes gets its start when bacteria in the intestines set off an over-aggressive attack from the immune system. As cells release chemicals to destroy the germs, the intestines may become damaged.

THINGS YOU CAN CHANGE

Stress
Being tense or upset may trigger flare-ups of IBD or make symptoms worse. This doesn’t mean IBD is “all in your head”-it may mean your intestines are highly sensitive to stress.

Diet
Some people with IBD get symptoms after they eat or drink certain foods. Common culprits include eggs, wheat, high-fiber or spicy foods, and the lactose (a type of sugar) in milk and other dairy products.

Pain relievers
Some drugs can make IBD worse, above all painkillers such as aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs can trigger flare-ups, increase bleeding, and even cause ulcers or make them worse.

Smoking
Smoking seems to raise the risk of Crohn’s disease, but not the risk of ulcerative colitis. Patients who have an operation for Crohn’s disease should avoid cigarettes at all costs. A smoking habit increases the chances that the problem will come back.
WHAT YOU CAN DO FOR YOURSELF
There’s a lot you can do to prevent IBD flare-ups and to ease the symptoms when they occur.

During an attack
Put a hot water bottle or heating pad on your abdomen to ease cramps.
Get plenty of rest during severe attacks.
Drink plenty of fluids. Diarrhea can rob your body of much-needed water. Watch for signs of dehydration.
Stay away from anything you know makes your symptoms worse, such as high-fiber foods, spicy foods, or dairy products.
If you have diarrhea, give your intestines a rest by staying away from solid food for a while. Sip clear, warm liquids such as decaffeinated tea, broth, flat soda, or a sports drink. When you’re feeling better, you can add bland, solid food to your diet, including bananas, toast, or white rice.
Many over-the-counter drugs can help relieve diarrhea. If you think you might want to try one, wait a few hours after eating to let your intestines empty. Don’t use these products for longer than two days without asking your doctor. Side effects include constipation, dizziness, fatigue, a dry mouth, and nausea. Also, check with your doctor before taking these drugs if you’re also taking antibiotics, or if you’re pregnant or nursing a baby.
On an ongoing basis
Keep a food diary
If you’re not sure which foods cause your symptoms or make them worse, keep a food diary for a week or two.

List all the things you eat and when you eat them.
Note any symptoms you have, what time they come on, and how strong they are.
Note whether certain symptoms always occur after you’ve eaten certain foods.
If you suspect a certain food or drink is causing problems, avoid it for at least ten days. Then try adding it back to your diet slowly. If you have a flare-up, you’ll know the suspected food or drink is probably to blame.

Watch what you eat and drink
Pay close attention to your diet to help reduce symptoms.

Eat several small meals a day instead of three large ones.
Stay away from any foods you know cause problems.
Stay away from alcohol; it can irritate the stomach.
Choose pain medications carefully
Some people with Crohn’s disease have joint pain. Over-the-counter painkillers can help, but some types may do more harm than good.

Try acetaminophen (Tylenol) instead of aspirin, ibuprofen, and other NSAIDs, which can all be hard on the stomach.
Don’t stress out
Too much stress, on the job or at home, can harm your health. Your natural response to any problem or high-pressure situation causes changes in your body: Your blood pressure goes up, your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy.

Brief bouts of stress aren’t harmful, but a lot of stress day after day can take a toll. Built-up stress raises your risk of a number of health problems, including IBD.

Here are some tips for staying on an even keel, even in these stressful times:

Exercise. People who exercise regularly tend to feel less anxious and more relaxed.
Laugh more. Use humor to ease tense moments. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and ask yourself whether everything you do really has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is “no,” take a few deep breaths and tell yourself to calm down. If any answer is “yes,” don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. Aim for at least 20 minutes a couple of times a day.
Keep a pet. Animals may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, stretching exercises, or meditation.
WHAT YOUR DOCTOR CAN DO FOR YOU
IBD can be treated in many ways. Your doctor may prescribe drugs to control swelling, reduce pain, and fight infection. If your immune system seems to be causing problems, your doctor may also prescribe drugs to help control it.

During very bad flare-ups, you may need to be treated in the hospital to bring your attack quickly under control. You’ll likely get large doses of drugs by enema and will also be fed through a tube in one of your veins. These treatments give your digestive system a much-needed rest while keeping your body well nourished. After you leave the hospital, you may need to take medication for a while to keep symptoms at bay and allow your intestines to heal.

Prescription anti-inflammatories
These drugs, which include sulfasalazine, olsalazine, and mesalamine, are often the first line of defense against IBD. They all work to control inflammation.

Pro
Work well to reduce symptoms.
Con
May cause headaches, abdominal pain, nausea, skin rash, dizziness, and decreased fertility.
Corticosteroids
These drugs are very strong anti-inflammatories and are most often used when other drugs fail. They are given orally or by enema.

Pro
Effective for treating severe symptoms.
Con
May cause increased appetite, fluid retention, facial hair growth, easy bruising, acne, and high blood pressure. If they’re used long-term (12 months or more), your body’s natural hormone levels can be altered.
You can’t quit steroids all at once: instead, you must taper off. Some people even have steroid withdrawal. Withdrawal symptoms mimic those of IBD, including dizziness, fever, abdominal pain, headaches, and rapid weight loss.
Infliximab
The first medicine ever approved by the FDA specifically for Crohn’s disease, infliximab contains a genetically-engineered protein that blocks inflammation. The drug is approved only for patients who don’t get better with other treatments.

Pro
In a clinical trial, it was shown that a single dose of infliximab eased diarrhea and stomach cramps for two to four weeks, and some patients enjoyed relief for several months.
Infliximab can close abnormal holes in the intestinal wall (fistulas) caused by IBD.
Con
Side effects include chills, fever, hives, headache, wheezing, and shortness of breath.
Immunomodulators
If your IBD seems to be linked to problems with your immune system, your doctor may prescribe drugs that control symptoms by either boosting or suppressing your body’s natural defenses. These drugs, which include azathioprine and mercaptopurine, are called immunomodulators.

Pro
Can work when other drugs fail.
Con
Can cause severe side effects, including fatigue, liver damage, and yellow skin and eyes.
Because these drugs weaken the immune system, they can make a person prone to infections.
Long-term use may raise the risk for some cancers such as leukemia.
Antibiotics
These drugs kill bacteria, germs that seem to play a major role in IBD.

Pro
Help reduce symptoms, especially for Crohn’s disease.
Con
Side effects may include nausea, vomiting, abdominal pain, loss of appetite, and rashes.
Surgery
An estimated 70 percent of those with Crohn’s disease choose surgery to remove a section of inflamed colon. Between 25 and 40 percent of people with ulcerative colitis choose to have their colon removed. Normally, surgery is used only when all other treatments fail.

The most common procedures for IBD include a colectomy, which is removal of either all or some of the colon, or a proctocolectomy, removal of the colon and rectum.

When the colon, rectum, or both are removed, the surgeon must create another way for waste to leave the body. In such cases, the surgeon performs a procedure called an ostomy. In an ostomy, the end of the remaining intestine is sewn into a hole made in the abdomen-called a stoma-leading to the outside of the body close to the waistline. Ostomy patients wear a special pouch outside the body to collect waste; they have to empty the pouch by hand several times a day. With practice, cleaning the bag takes no longer than a normal bowel movement.

An ostomy isn’t always needed, thanks to a newer technique called ileoanal anastomosis. The damaged colon and rectum are removed, but the sphincter muscles that were around the rectum are left in place. The remaining part of the colon is sewn to the anus. Passage of waste is nearly normal.

Pro
For ulcerative colitis, surgery offers more hope when drugs fail.
Removing the colon cures ulcerative colitis and can also remove the risk of colon cancer.
In many cases, the operation can now be performed through a small hole in the abdomen with a device called a laparoscope. This type of operation causes little pain, patients recover quickly, and there’s little chance of infections or other complications.
Con
Surgery is not a cure for Crohn’s disease. In fact, the surgery must sometimes be repeated as the disease continues.

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November 2013
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