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Inflammatory Bowel Disease

Intro

Questions to Ask the Doctor

If you have the above symptoms, a visit to your doctor is warranted. Although those symptoms can suggest that you may have inflammatory bowel disease, tests must first be performed to see if you do have IBD. The above symptoms are seen in several other disorders as well, and so the above symptoms alone do not necessarily mean that you have IBD. Irritable bowel syndrome (IBS) is a different disorder that may have symptoms similar to those of IBD.

Self-Care at Home

It is important to eat a healthy diet. Depending on your symptoms, your health care provider may ask you to decrease the amount of fiber or dairy products in your diet.

Diet has little or no influence on the inflammatory activity in ulcerative colitis. However, diet may influence symptoms. For this reason, people with inflammatory bowel disease often are placed on a variety of diet interventions, especially low-residue diets. Evidence does not support a low-residue diet as beneficial in treating the inflammation of ulcerative colitis, though it might decrease the frequency of bowel movements.

Unlike ulcerative colitis, diet can influence inflammatory activity in Crohn disease. Nothing by mouth (NPO status) can hasten reduction of inflammation, as might the use of a liquid diet or a predigested formula. When you become extremely upset, your symptoms may get worse. Therefore, it is important that you learn to manage the stress  in your life.

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Follow-up

Persons with inflammatory bowel disease are prone to the development of malignancy (cancer). In Crohn disease, there is a higher rate of small intestinal malignancy. Persons with involvement of the whole colon, particularly ulcerative colitis, are at a higher risk of developing colonic malignancy after 8-10 years of the onset of the disease. For cancer prevention, surveillance colonoscopy every 1-2 years after 8 years of disease is recommended.

Use of corticosteroids may lead to debilitating illness, particularly after long-term use. You should consider trying more aggressive therapies rather than remaining on corticosteroids because of the potential for side effects with these drugs.

If you are taking steroids, you should undergo a yearly ophthalmologic examination because of the risk of development of cataract.

Persons with IBD have a reduction in bone density, either from decreased calcium absorption (because of the underlying disease process) or because of corticosteroid use. Crippling osteoporosis can be a very serious complication. If you have significantly low bone density, you will be administered bisphosphonates and calcium supplements.

Prevention

No known dietary or lifestyle change prevents the development of inflammatory bowel disease.

Dietary manipulation may help symptoms in persons with ulcerative colitis, and it actually may help reduce inflammation in Crohn disease. However, there is no evidence that consuming or avoiding any particular food item causes or avoids flare-ups of IBD.

Smoking cessation is the only lifestyle change that may benefit persons with Crohn disease. Smoking has been linked to increases in the number and severity of flare-ups of Crohn disease. Smoking cessation occasionally is sufficient to make a person with refractory (not responding to treatment) Crohn disease go into remission.

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Outlook

The typical course of the inflammatory bowel diseases (for the vast majority of persons) includes periods of remission interspersed with occasional flare-ups.

  • Ulcerative colitis
    • A person with ulcerative colitis has a 50% probability of having another flare-up during the next 2 years. However, a very broad range of experiences exists; some persons may only have 1 flare-up over 25 years (as many as 10%); others may have almost constant flare-ups (much less common).
    • Persons with ulcerative colitis limited to the rectum and sigmoid at the time of diagnosis have a greater than 50% chance of progressing to more extensive disease and a 12% rate of colectomy over 25 years.
    • More than 70% of persons presenting with proctitis (inflammation of the rectum) alone continue to have disease limited to the rectum over 20 years. Most who develop more extensive disease do so within 5 years of diagnosis.
    • Among persons with ulcerative colitis involving the entire colon, 60% eventually require colectomy, whereas very few persons with proctitis do.
    • Most of the surgical intervention is required in the first year of disease; the annual colectomy rate after the first year is 1% for all persons with ulcerative colitis. Surgical resection for persons with ulcerative colitis is considered curative for the disease.
  • Crohn disease
    • The course of Crohn disease is much more variable than that of ulcerative colitis. The clinical activity of Crohn disease is independent of the anatomic location and extent of the disease.
    • A person in remission has a 42% likelihood of being free of relapse for 2 years and only a 12% likelihood of being free of relapse for 10 years.
    • Over a 4-year period, approximately 25% of persons remain in remission, 25% have frequent flare-ups, and 50% have a course that fluctuates between periods of flare-ups and remissions.
    • Surgery for Crohn disease generally is performed for the complications (stricture, stenosis, obstruction, fistula, bleeding) rather than for the inflammatory disease itself.
    • After operation, there is a high frequency of recurrence of Crohn disease, generally in a pattern mimicking the original disease pattern, often on one or both sides of the surgical anastomosis.
    • Approximately 33% of persons with Crohn disease who require surgery, require surgery again within 5 years, and 66% require surgery again within 15 years.
    • Endoscopic evidence for recurrent inflammation is present in 93% of persons 1 year after surgery for Crohn disease.
    • Surgery is an important treatment option for Crohn disease, but you should be aware that it is not curative and that disease recurrence after surgery is the rule.

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