Inflammatory Bowel Disease: Intestinal Problems (cont.)
Leslie J. Schoenfield, MD, PhD
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
In this Article
- What is inflammatory bowel disease?
- What are the intestinal complications of IBD?
- Are the intestinal complications of ulcerative colitis and Crohn's disease different?
- Do intestinal ulcers occur in IBD?
- Does gastrointestinal bleeding occur in IBD?
- How do intestinal strictures form in IBD?
- What are the symptoms of intestinal strictures, and how are they diagnosed and treated?
- What are intestinal fistulas?
- What symptoms do fistulas cause and how are they diagnosed and treated?
- What are fissures and how are they treated?
- What is small intestinal bacterial overgrowth (SIBO)?
- Does colon cancer occur in IBD?
- What should be done about polyps in IBD?
- What is toxic megacolon and what are its causes?
- What kind of malabsorption occurs in IBD?
- Intestinal Problems in IBD At A Glance
- Find a local Gastroenterologist in your town
Intestinal Problems in IBD At A Glance
- The inflammatory bowel diseases (IBD) are Crohn's
disease (CD) and ulcerative colitis (UC). The intestinal complications of
Crohn's disease and ulcerative colitis differ because of the
characteristically dissimilar behaviors of the intestinal inflammation in
these two diseases.
- The intestinal complications of IBD are caused by
intestinal inflammation that is severe, widespread, chronic, and/or extends
beyond the inner lining (mucosa) of the intestines.
- While ulcerative colitis involves only the large
intestine (colon), Crohn's disease occurs throughout the gastrointestinal
tract, although most commonly in the lower part of the small bowel (ileum).
- Intestinal ulceration and bleeding are complications
of severe mucosal inflammation in both ulcerative colitis and Crohn's disease.
- Intestinal inflammation in Crohn's disease involves
the entire thickness of the bowel wall, whereas the inflammation in ulcerative
colitis is confined to the inner lining. Accordingly, complications such as
intestinal strictures, fistulas, and fissures are far more common in Crohn's
disease than in ulcerative colitis.
- Intestinal strictures and fistulas do not always
cause symptoms. Strictures, therefore, may not require treatment unless they
cause significant intestinal blockage. Likewise, fistulas may not require
treatment unless they cause significant abdominal pain, infection, external
drainage, or bypass of intestinal segments.
- Small intestinal bacterial overgrowth (SIBO) in
Crohn's disease can result from an intestinal stricture, is diagnosed by a
hydrogen breath test, and is treated with antibiotics.
- Because of an increased risk of colon cancer in
ulcerative colitis, yearly monitoring with colonoscopies and biopsies of the
colon for premalignant cells (dysplasia) and cancer is recommended for
patients after 8 to10 years of chronic inflammation of the colon (colitis).
- Narcotics, codeine, and anti-diarrheal medications
such as Lomotil and Imodium should be avoided during severe episodes of
colitis because they might induce a toxic megacolon.
- In Crohn's disease of the duodenum
and jejunum, malabsorption of nutrients can cause malnutrition, weight loss, and
diarrhea, whereas in Crohn's disease of the ileum, malabsorption of bile salts can cause
diarrhea and malabsorption of vitamin B12 can lead to anemia.
Last Editorial Review: 9/18/2005
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