Archive for the ‘Uncategorized’ Category

What is Colitis

06.13.10

Colitis is a general term for a large number of causes that result in inflammation in the lining of the bowel. Common symptoms associated with colitis are abdominal cramping, frequent loose stools or persistent diarrhea, loss of control of bowel function, fever, sleepiness, and weight loss.

Depending on the cause, colitis may be treated in several ways.One of the first steps in diagnosing colitis is identifying the cause. Some forms of colitis may be caused by infection through bacteria, certain viruses, and some parasites.

For example, exposure to the salmonella bacteria or any other bacteria needs to be treated with antibiotics to resolve the condition. Parasitic or amoebic infection usually warrants a course of either antibiotics or anti-parasitic medication. Viral colitis can be more difficult to treat.

Viruses like Rotavirus or Norovirus can result in dehydration, particularly in the very young or very old. Rest and increased fluid intake are often prescribed. However, if a person becomes severely dehydrated, he or she may need care in a hospital to receive intravenous fluids.

Certain diseases can predispose one to attacks of colitis. The most frequent cause of colitis in those with intestinal diseases is Crohn’s disease, which is a degenerative intestinal disorder. People with Crohn’s are more prone to colitis and to other serious conditions like perforated bowel.

Those with Crohn’s need to take seriously the symptoms listed above and see a doctor immediately. Any of these symptoms can necessitate medical treatment.Irritable bowel disorder (IB) can also cause bouts of colitis.

Since IB is both difficult to diagnose and to treat, anyone who has had frequent recurrences of the symptoms above is prone to colitis and should contact a doctor if he or she suspects colitis. Especially if bacteria or parasites causes the colitis, this can only worsen IB and needs immediate treatment.

While antibiotics are used to treat bacterial colitis, they can also be indicated as a cause of colitis in some cases. Additional causes of colitis may include taking birth control medication, having autoimmune disorders, or smoking.

If diarrhea and fever persist for more than two days, and you don’t have a disease that would necessitate earlier treatment, you should see a doctor quickly. If you have severe stomach pain with fever, you should not wait to see a physician during office hours but proceed to the emergency room, as this may indicate appendicitis or bowel injury.

If you suspect food poisoning, it is better to go the emergency room, since some bacteria can be very harmful.You can reduce your risk of colitis by using sanitary cooking and eating practices, avoiding caffeinated beverages, and not taking medications like ibuprofen if you have irritable bowel or inflammatory bowel conditions.

Treatment for those with frequent bouts of colitis will focus on trying to reduce symptoms such as diarrhea and stomach cramping. Sometimes these treatments of symptoms are the only way to address colitis.

Yet even with treatment, those with Crohn’s and other autoimmune or known stomach disorders should be vigilant if they suspect colitis, since other more serious conditions may also have the same symptoms as colitis.

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Ulcerated Colitis

06.05.10

Ulcerative colitis is a chronic disease in which the large intestine becomes inflamed and ulcerated (pitted or eroded), leading to flare-ups (bouts or attacks) of bloody diarrhea, abdominal cramps, and fever. The long-term risk of colon cancer is increased. Ulcerative colitis may start at any age but usually begins between the ages of 15 and 30.

A small group of people have their first attack between the ages of 50 and 70.Ulcerative colitis usually does not affect the full thickness of the wall of the large intestine and hardly ever affects the small intestine. The disease usually begins in the rectum or the rectum and the sigmoid colon (the lower end of the large intestine) but may eventually spread along part or all of the large intestine.

Ulcerative proctitis, which is confined to the rectum, is a very common and relatively benign form of ulcerative colitis. In some people, most of the large intestine is affected early on.

The cause of ulcerative colitis is not known for certain, but heredity and an overactive immune response in the intestine seem to be contributing factors. Cigarette smoking, which is detrimental in Crohns disease, seems to decrease the risk of ulcerative colitis.

However, smoking in order to reduce the risk of ulcerative colitis is ill-advised in light of the many health problems that smoking can cause. Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD).

Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine.

Because of the name, IBD is often confused with irritable bowel syndrome (“IBS”), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohns disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.

Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America. The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility.

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Pathophysiology of Crohns Disease

05.28.10

Crohns disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Transmural spread of inflammation leads to lymphedema and thickening of the bowel wall and mesentery. Mesenteric fat typically extends onto the serosal surface of the bowel. Mesenteric lymph nodes often enlarge.

Extensive inflammation may result in hypertrophy of the muscularis mucosae, fibrosis, and stricture formation, which can lead to bowel obstruction. Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle.

Fistulas may even extend to the skin of the anterior abdomen or flanks. Independently of intra-abdominal disease activity, perianal fistulas and abscesses occur in 25 to 33% of cases; these complications are frequently the most troublesome aspects of Crohns disease.

Noncaseating granulomas can occur in lymph nodes, peritoneum, the liver, and all layers of the bowel wall. Although pathognomonic when present, granulomas are not detected in about half of patients with Crohns disease.

The presence of granulomas does not seem to be related to the clinical course.Segments of diseased bowel are sharply demarcated from adjacent normal bowel (“skip areas”); hence, the name regional enteritis. About 35% of Crohns disease cases involve the ileum alone (ileitis); about 45% involve the ileum and colon (ileocolitis), with a predilection for the right side of the colon; and about 20% involve the colon alone (granulomatous colitis), most of which, unlike ulcerative colitis (UC), spare the rectum.

Occasionally, the entire small bowel is involved (jejunoileitis). The stomach, duodenum, or esophagus is clinically involved only rarely, although microscopic evidence of disease is often detectable in the gastric antrum, especially in younger patients. In the absence of surgical intervention, the disease almost never extends into areas of small bowel that are not involved at first diagnosis.

There is an increased risk of cancer in affected small-bowel segments. Patients with colonic involvement have a long-term risk of colorectal cancer equal to that of UC, given the same extent and duration of disease.

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Mucous Colitis

05.21.10

A common gastrointestinal disorder involving an abnormal condition of gut contractions (motility) characterized by abdominal pain, bloating, mucous in stools, and irregular bowel habits with alternating diarrhea and constipation, symptoms that tend to be chronic and to wax and wane over the years.

Although the disorder can cause chronic recurrent discomfort, it does not lead to any serious organ problems. Making the diagnosis usually involves excluding other illnesses. Treatment is directed toward relief of symptoms and includes changes in diet (eating high fiber and avoiding caffeine, milk products and sweeteners), exercise, relaxation techniques, and medications.

A disease of the mucous membrane of the colon, characterized by colicky pain, constipation or diarrhea, and the passage of mucous or slimy pseudomembranous shreds and patches. Also called myxomembranous colitis. Mucous Colitis or Spastic Colon is a condition of abnormally increased spontaneous movement (motility) of the small and large intestine, generally exacerbated by emotional stress.

An eroded sore in the inner lining of digestive track Syndrome is characterized by a combination of abdominal Discomfort and altered bowel function. The cause is a disturbance in the muscle movement (motility) in the large intestine; however, there is no abnormality in intestinal structure. The condition occurs more frequently in women and usually begins in those between 20 and 30 years old. Predisposing factors may be a low residue diet, emotional stress, bowel consciousness, and use of laxatives.

The incidence is 5 out of 1000 people. The objective of Favorable Effects is to relieve symptoms. Changes in diet may Enhance alleviate symptoms in some patients. No diet is applicable to all patients. Increasing dietary fiber and eliminating gastrointestinal stimulants such as caffeine containing beverages may be beneficial. Other possible Favorable Effects may include:

1.Uneasyness reducing measures, such as regular exercise
2.Anticholinergic medications before meals
3.Counseling in cases of severe Uneasyness or Despair

Expectations (prognosis): An eroded sore in the inner lining of digestive track syndrome may be a life-long chronic condition, but symptoms can often be improved or relieved through Favorable Effects.

Complications:
1. Discomfort
2. Dehydration
3. Malnutrition
4. Despair Calling your healthcare provider: Call your health care provider if there is a change in bowel habits that persists more than 10 days.

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Microscopic Colitis

05.14.10

Microscopic colitis refers to inflammation of the colon that is only visible when the colon’s lining is examined under a microscope. The appearance of the inner colon lining in microscopic colitis is normal by visual inspection during colonoscopy or flexible sigmoidoscopy.

The diagnosis of microscopic colitis is made when a doctor, while performing colonoscopy or flexible sigmoidoscopy, takes biopsies (small samples of tissue) of the normal-appearing lining, and then examines the biopsies under a microscope. There are two types of microscopic colitis; lymphocytic colitis and collagenous colitis. In lymphocytic colitis, there is an accumulation of lymphocytes (a type of white blood cell) within the lining of the colon.

In collagenous colitis, there is an additional layer of collagen (scar tissue) just below the lining. Some experts believe that lymphocytic colitis and collagenous colitis represent different stages of the same disease. The inflammation and the collagen probably interfere with absorption of water from the colon, and cause the diarrhea. The primary symptom of microscopic colitis is chronic, watery diarrhea. Patients with microscopic colitis can have diarrhea for months or years before the diagnosis is made.

This chronic diarrhea of microscopic colitis is different from the acute diarrhea of infectious colitis, which typically lasts only days to weeks. Some patients with microscopic colitis also may report mild abdominal cramps and pain. Blood in the stool is unusual. The prevalence of microscopic colitis in the U.S. is not clearly known.

It is estimated that 10-20% of patients with chronic diarrhea may have microscopic colitis. It is this author’s experience, that the condition is becoming more common in recent years. It is not clear, however, whether there is an actual increase in the frequency of microscopic colitis or whether doctors are just better at diagnosing it.

Microscopic colitis most commonly occurs in middle aged to elderly patients and is more common among women than men. The cause(s) of microscopic colitis is unknown. Some doctors suspect that microscopic colitis is an autoimmune disorder similar to the autoimmune disorders that cause chronic ulcerative colitis and Crohns disease.

The diagnosis of microscopic colitis is made by performing biopsies from different regions of the colon during colonoscopy or sigmoidoscopy. The abnormalities of the colon’s lining in microscopic colitis occur in a patchy distribution (areas of normal lining may exist adjacent to areas of abnormal lining).

For this reason, multiple biopsies should be taken from several different regions of the colon in order to accurately make a diagnosis. The patchy nature of microscopic colitis also is the reason why flexible sigmoidoscopy often is inadequate in diagnosing the condition because the abnormalities of microscopic colitis may be absent from the sigmoid colon (the colonic segment that is closest to the rectum and is within the reach of a sigmoidoscope) in 30-40% of the patients with microscopic colitis.

Thus, biopsies of other regions of the colon accessible only with colonoscopy may be necessary for diagnosing microscopic colitis.

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Lymphocytic Colitis

05.08.10

Lymphocytic colitis, a subtype of microscopic colitis, is a rare condition characterized by chronic non-bloody watery diarrhea. The colonoscopy is normal but the mucosal biopsy reveals an accumulation of lymphocytes in the colonic epithelium and connective tissue (lamina propria).

No definite etiology has been determined. Some reports have implicated long-term usage of NSAIDs, antidepressants, and other drugs; and overactive immune responses are also suspected. Over-the-counter antidiarrheal drugs are effective for many people with lymphocytic colitis. Anti-inflammatory drugs, such as salicylates may also help.

Corticosteroids or Mesalazines may be prescribed for people who do not respond to other drug treatment. The long-term prognosis for this disease is not clear. Lymphocytic colitis is closely related to collagenous colitis. Both are characterized by a syndrome of watery diarrhea, usually occurring in young to middle aged women. The etiology is unknown but an autoimmune basis has long been suspected.

However, an infectious etiology has not been excluded. In favor of an infectious etiology are cases associated with an outbreak of Brainerd diarrhea aboard a cruise ship. Brainerd diarrhea has been applied to cases of diarrhea of unknown etiology with an acute onset and prolonged duration.

Like collagenous colitis, a chronic watery diarrhea is present, but this lasts longer than 6 months and frequently for many years. Biopsies show similar features to lymphocytic colitis except there may a lesser degree of lymphocytic infiltration. lymphocytic colitis, is considered now an important cause of diarrhea in middle aged and elderly patients.

In this entity, endoscopic and radiological examinations are normal while specific histological findings are seen on colonic biopsy. Once the diagnosis of MC is confirmed, a stepwise approach with medical therapy is suggested. Ruling out other causes of chronic diarrhea should be the initial step. Once the diagnosis of MC is confirmed, a stepwise treatment algorithm is suggested.

In this review, I will introduce the entity of MC and describe the stepwise approach to diagnosis and management by reviewing the available evidence. The literature was reviewed regarding both collagenous colitis and lymphocystic colitits focusing on clinical trails. This was then critically examined and an approach to the diagnosis and management of microscopic colitis was suggested. there is inflammation in the lamina propria of the colonic mucosa, with increased intraepithelial lymphocytes.

Specifically in CC and not in LC, there is, in addition, marked thickening of the sub-epithelial collagen layer, which is the hallmark of this disease. This disease entity has attracted a lot of attention recently as an important and relatively common cause of chronic diarrhea.

The initial description of MC was first published in 1976 and since that time, it has been increasingly recognized as a relatively common cause of chronic diarrhea.

Treatment for Crohns Disease

04.29.10

Crohns Disease treatment is a life-long commitment, as this chronic condition is marked by flare-ups and remission periods that sufferers will unfortunately be forced to deal. Crohns Disease symptoms, and possibly one or more stays in a hospital.

All of that works together with the general stress of life to affect the course of your disease. When it all combines together — you get fatigue. You feel tired, listless. I know. I’ve been there. Proper Crohns Disease treatment is crucial, and it is important to learn everything you can about this debilitating condition.

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohns disease usually involves drug therapy or, in certain cases, surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease.

They include:
• Sulfasalazine (Azulfidine). Doctors have used this drug for many years to treat Crohns disease. Although it can be effective in reducing symptoms of the disease, it has a number of side effects, including nausea, vomiting, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications.
• Mesalamine (Asacol, Rowasa). This medication tends to have fewer side effects than sulfasalazine has. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected.
• Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity.

More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

Also, these medications don’t work for everyone with Crohns disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments.

A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohns disease that involves the lower small intestine and the first part of the large intestine (ileocolitis).

Corticosteroids aren’t for long-term use. They can be used for short-term symptom improvement for about three to four months. They’re also used in conjunction with other medications as a means to induce remission.

For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

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Teens with Crohns

04.24.10

Welcome! I was first diagnosed with Crohn’s Disease nearly ten years ago and, being a teenager at the time, I found it difficult to talk to others about the disease that did not have it. I created this site as a place to share stories and information – for teens, by teens – with Crohn’s Disease, Colitis, or IBS.

Apparently I’ve made a big impact here. I’m glad to do what I can to make a difference.Any advice you may wish to pass on to others is also welcome. Since most all of us follow special diets, there is a recipe section. I have tried many of the recipes listed here, and several have become my favorites.

Try them and let me know what you think. You might be saying to yourself at this point, “But I’m not a teenager!  What can TWC do for me?”  In the past seven years I’ve received e-mail from Crohn’s patients of all ages who have had plenty of advice to offer and stories to share. 

No matter what your age group, be it preteen, teen, or used-to-be-teen, there is all sorts of useful information here that easily applies to all ages. If you feel good there’s no reason you can’t go out with your friends. You may feel more tired than you did before you were diagnosed with IBD, so you’ll want to be sure you can leave and go home if you need to.

You may not be able to eat the same foods you did before, so plan ahead to make sure that if food is involved, there is something that you can eat available. If you aren’t feeling well but you still don’t want to pass up a big date or party, you’ll have to do a bit more planning.

If you can, try to go out somewhere that you can easily make it to a bathroom. A restaurant, a movie, or at your house or your friends’ house are probably the easiest places.

• Eat something at home before you go so you can avoid eating any of your no-no foods.
• Bring your medication with you in case you need to take it while you’re out.

You shouldn’t feel pressured to eat something that is going to make you sick later. Your friends wouldn’t want you to feel badly. So if you explain to them that a food may make you sick, they will understand, I’m sure. If you’re in a situation where food is being served that you can’t eat, you have a few choices available to you.

1. Call ahead or look online to find out the menu. The restaurant may have their menu online, or they may be able to fax or email it to you. You might be able to find something on the menu that would be OK for you to eat. Even just a little something to order and nibble on so you don’t feel out of place.
2. Eat before you go. Have something to eat that’s OK for you, and you won’t be so hungry at the party or event

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Pseudomembranous Colitis

04.16.10

Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression “C. diff colitis” is used almost interchangeably with the more proper term of pseudomembranous colitis.

The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can besevere,causing toxic megacolon, or even fatal. The use of broad-spectrum antibiotics such as clindamycin and cephalosporins causes the normal bacterial flora of the bowel to be altered. In particular, when the antibiotic kills off other, competing bacteria in the intestine, any bacteria remaining will have less competition for space and nutrients there.

The net effect is to permit much more extensive growth than normal of certain bacteria. Clostridium difficile is one such type of bacterium. In addition to proliferating in the bowel, the C. diff also elaborates a toxin. It is this toxin that is responsible for the diarrhea which characterizes pseudomembranous colitis. n most cases a patient presenting with pseudomembranous colitis has recently been on antibiotics.

Antibiotics disturb the normal bowel bacterial flora. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition. Even though they are not particularly likely to cause pseudomembranous colitis, due to their very frequent use cephalosporin antibiotics (such as cefazolin and cephalexin) account for a large percentage of cases.

Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors. Other risk factors include increasing age and recent major surgery. There is some evidence that proton pump inhibitors are a risk factor for pseudomembranous colitis, but others question whether this is a false association or statistical artifact (increased PPI use is itself a marker of increased age and co-morbid illness).; indeed, one large case-controlled study showed that PPI’s are not a risk factor.

Recently, evidence has emerged to suggest that the use of ciprofloxacin (in addition to a primary causative antibiotic such as clindamycin) is associated with increased mortality in patients with pseudomembranous colitis.)

As noted above, pseudomembranous colitis is characterized by diarrhea, abdominal pain, and fever. Usually, the diarrhea is non-bloody, although blood may be present if the affected individual is taking blood thinners or has an underlying lower bowel condition such as hemorrhoids. Abdominal pain is almost always present and may be severe.

So-called “peritoneal” signs (e.g. rebound tenderness) may be present. “Constitutional” signs such as fever, fatigue, and loss of appetite are prominent. In fact, one of the main ways of distinguishing pseudomembranous colitis from other antibiotic-associated diarrheal states is that patients with the former are sick.

That is, they are often prostrate, lethargic, and generally look unwell. Their “sick” appearance tends to be paralleled by the results of their blood tests which often show anemia, an elevated white blood cell count, and low serum albumin.

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Pediatric Crohns Disease

04.08.10

Delayed growth is a well-established feature of pediatric Crohns disease. Several factors have been shown to affect growth, including disease location, severity, and treatment. The recently discovered NOD2 gene has been correlated to ileal location of Crohns disease and subsequently could affect growth through the resulting phenotype or as an independent risk factor.

The aim of our study was to determine if growth retardation is affected by genotype independently of disease location or severity. Crohns disease is an inflammatory bowel disease of the gastrointestinal tract.

Approximately 500,000 Americans suffer from Crohn’s, and it is estimated that at least 150,000 of them are children under age 17.  In children, the disease usually presents between 12 and 16 years of age; however, it has been detected in children as young as 7 years old.

Both adult and pediatric Crohn’s patients may experience a number of symptoms, including diarrhea, abdominal cramps and pain, fever, rectal bleeding, loss of appetite, and weight loss. However, each individual may experience symptoms differently. If your child has been diagnosed with pediatric Crohn’s disease, talk to your child’s doctor about treatment with REMICADE.

Individual results may vary. Talk to your child’s doctor to see if REMICADE is right for your child.REMICADE is for children (ages 6-17) with moderate to severe Crohns disease who haven’t responded well to other therapies.

REMICADE has been approved for the treatment of pediatric Crohns disease, based on clinical research. Children with pediatric Crohn’s disease may have to deal with things that other children don’t — painful and sometimes embarrassing physical symptoms, eating and treatment regimens, doctor visits, and even occasional hospital stays.

Pediatric Crohn’s can have an impact of all aspects of a child’s life, including school, relationships with friends and family, and self-esteem. But by learning how to cope with the disease, they can still lead an otherwise happy, productive life. If your child has been diagnosed with pediatric Crohn’s disease, it is only natural to feel overwhelmed and scared.

Since this is a chronic illness (meaning that it doesn’t go away) that can involve painful and sometimes embarrassing symptoms, you may have questions:
• How will pediatric Crohn’s disease affect my child’s health and well-being?  Will it affect me and the rest of my family as well?
• Will this disease change my child’s appearance or interfere with normal growth?
• Will my child have to go on a special diet?
• What treatment is available for pediatric Crohn’s disease?

Crohn’s disease can have physical, social, and emotional effects on a child.  Physical symptoms of pediatric Crohn’s disease include growth problems, frequent diarrhea, abdominal pain, loss of appetite, and weight loss.

Children and teenagers may find it especially hard to deal with a chronic disease like Crohn’s and its symptoms since they are already in the process of both physical and emotional development.
Because of the physical manifestations of pediatric Crohn’s, a child may face challenges both socially and emotionally. Below are some of the social and emotional challenges a child with pediatric Crohn’s may face.

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