Posts Tagged ‘Jejunum’

Crohns Disease in Children

10.31.09

In the last quarter century, it has become clear that Crohns disease and ulcerative colitis affect large numbers of children and young teens. Nutritional deficiency is a major issue in treatment of children with Crohns disease. Children are growing machines.

Inflammatory bowel disease may not cause great weight loss for youngsters at first, so failure to grow normally or backsliding on height and weight charts should be taken as signs that something is wrong and worth investigating. Children facing Crohns disease also have significant self-image issues to deal with.

The disease changes their routines, and its effects may separate them from the normal activities of childhood and adolescence. Therefore, these youngsters need sensitive support from family, friends, and physicians to help them maintain their social, as well as their physical, growth. Crohns disease is a serious, chronic disease affecting the digestive system. Chronic means that the disease is long-term and persistent, usually lifelong. Crohns disease causes inflammation, most often in the small intestine (which has three parts: duodenum, jejunum, and ileum).

The walls and lining of the affected areas become red and inflamed, leading to ulcers and bleeding. Crohns disease sometimes is named by referring to inflammation in the part of the intestine affected, such as jejunoileitis, ileitis, ileocolitis, or colitis (when it involves the large intestine, also called the colon).

Crohns disease can appear at any age, but it is most often diagnosed in adults in their 20s and 30s. However, approximately 30% of people with Crohns disease develop symptoms before 20 years of age. In the United States, about 100,000 teens and preteens have Crohns disease.Along with ulcerative colitis, a similar illness, Crohns disease is also called inflammatory bowel disease, or IBD.

Ulcerative colitis attacks only the large intestine in a continuous manner and does not affect the entire thickness of the bowel wall. Crohns disease, on the other hand, can occur anywhere in the digestive tract, from mouth to the anus, attacks different sites in the intestine with areas of normal intestine in between (“skip lesions”), and affects the full thickness of the intestinal wall.

Both conditions wax and wane: there are times when symptoms reappear or get worse (exacerbations or “flares”) and other periods when symptoms get better or go away altogether (“remission”).While Crohns disease causes many problems for people of all ages, it can present special challenges for children and teens. In addition to bothersome and often painful symptoms, the disease can stunt growth, delay puberty, and weaken the bones. Crohns disease symptoms may sometimes prevent a child from participating in enjoyable activities.

The emotional and psychological issues of living with chronic disease can be especially difficult for young people. As many as 70% of children with the disease have inflammation of the lower part of the ileum. More than half of these children also have inflammation in variable segments of the colon.

•    About 10%-20% of children have inflammation in the colon only.
•    Another 10%-15% have inflammation scattered around the small bowel, mainly in the middle section (jejunum and upper ileum).
•    A very small number have inflammation only in the stomach and the uppermost section of the small intestine where the stomach empties into the bowel (duodenum).

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Crohns Disease and Post Surgical Blockage

08.31.09

An intestinal obstruction is a partial or complete blockage of the small or large intestine. Surgery is sometimes necessary to relieve the obstruction. The small intestine is composed of three major sections: the duodenum just below the stomach; the jejunum, or middle portion; and the ileum, which empties into the large intestine.

The large intestine is composed of the colon, where stool is formed; and the rectum, which empties to the outside of the body through the anal canal. A blockage that occurs in the small intestine is called a small bowel obstruction, and one that occurs in the colon is a colonic obstruction.There are numerous conditions that may lead to an intestinal obstruction. The three most common causes of small bowel obstruction are adhesions, which are bands of scar tissue that form in the abdomen following injury or surgery; hernias, which develop when a portion of the intestine protrudes through a weak spot in the abdominal wall; and cancerous tumors.

Adhesions account for approximately 50% of all small bowel obstructions, hernias for 15%, and tumors for 15%. Other causes include volvulus, or formation of kinks or knots in the bowel; the presence of foreign bodies in the digestive tract; intussusception, which occurs when a portion of the intestine telescopes or pulls over another portion; infection; and congenital defects.

While most small bowel blockages can be treated with the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube, surgical intervention is necessary in approximately 25% of patients with a partial obstruction, and 50%–65% of patients with a complete obstruction.An obstruction of the large intestine is less common than blockages of the small intestine.

Blockages of the large bowel are usually caused by colon cancer; volvulus; diverticulitis (inflammation of sac-like structures called diverticula that form in the intestines); ischemic colitis (inflammation of the colon resulting from insufficient blood flow); Crohns disease (a disease that causes chronic inflammation of the intestines); inflammation due to radiation therapy; and the presence of foreign bodies. As in the case of small bowel obstruction, most patients with a blockage of the large intestine can be treated with IV fluids and bowel decompression. To cut is not to cure. Every clinician involved in caring for patients with Crohns disease is facing this dilemma.

Although resection of stenotic or perforated intestinal segments is often unavoidable, surgical remission is only temporary in patients with Crohns disease. More than 70% of patients will have new lesions detected by endoscopy within a year, and 40% will be symptomatic within 4 years.1 Repeated bowel resections can result in short-bowel syndrome, and the quest for bowel-conserving strategies has introduced both endoscopic and surgical strictureplasty to clinical practice over the last 25 years.

Material and methods : We prospectively evaluated 128 patients with Crohns disease at the moment of diagnosis. We predicted the evolution of their disease using the mathematical model Z = -9.49 + 2.2643 (AD) – 0.0066 (DD) + 2.5282 (AM) + 1.3433 (OS). The cut-off value (reveiver operating characteristics curve) obtained in the training set of patients was P = 0.45. A value higher than this cut off discriminated patients who developed a stricturing pattern. The actual behaviour of the patients’ Crohns disease was observed after a median of 19 months from diagnosis. Of the 128 patients, 80 were classified into one of the two known patterns. Thirty-nine patients (48.8%) developed a stricturing pattern while 41 (51.2%) had a penetrating form of Crohns disease. Results : The sensitivity of the model for predicting a stricturing type was 100% and the specificity was 31.7%. A P value of < 0.45 proved to be highly reliable in predicting the evolution to a penetrating pattern (positive predictive value was 100% and negative predictive value was 58%). No statistical differences were found between stricturing-type or penetrating-type groups in terms of anal disease, abdominal mass, duration of disease or onset of symptoms.

Compared to patients with the penetrating form, initial ileal location was significantly more frequent than colonic location in patients with the stricturing type of Crohns disease.Conclusions : We have validated a simple mathematical model that is able to predict the behaviour of Crohns disease in patients based on clinical variables collected at their initial evaluation.

This model can be considered a useful tool for patient management. The anatomical location of the disease is related to the evolutive pattern.

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Colitis and Crohns

06.07.09

Inflammatory bowel disease, or IBD, describes two similar yet distinct conditions called Crohns disease and ulcerative colitis. These diseases affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily. Symptoms include abdominal pain, cramping, fatigue and diarrhea.Crohns disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Patches of inflammation occur, with healthy tissue between the diseased areas.

The inflammation can extend through every layer of affected bowel tissue. Crohns disease can not be cured by drugs or surgery, although either or both can help relieve symptoms.Ulcerative colitis affects only the inner layer of the colon, or large bowel. It always starts in the rectum and may extend as a continuous inflammation from there into the rest of the colon. Usually ulcerative colitis can be controlled with medication. The disease can be completely eliminated by surgically removing the colon, but afterward, waste material may have to be stored and expelled through an external appliance.

While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohns disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.The patterns of inflammation in Crohns disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform. (All of the lining in the affected segment of the intestine is inflamed.) Unlike ulcerative colitis, the inflammation of Crohns disease is concentrated in some areas more than others and involves layers of the bowel that are deeper than the superficial inner layers. Therefore, the affected segment(s) of bowel in Crohns disease often is studded with deeper ulcers with normal lining between these ulcers.

The most common disease that mimics the symptoms of Crohns disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.

Currently there is no cure for Crohns disease and remission may not be possible or prolonged if achieved; in cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes and in some cases, surgery. Adequately controlled, Crohns disease may not significantly restrict daily living. Treatment for Crohns disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.

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