Preface
Living with inflammatory bowel disease (IBD) can be a challenge, not only for those of you who have Crohn’s disease or ulcerative colitis, but also for those of you who have a family member or close friend afflicted with one of these disorders. Meeting this challenge requires the help of knowledgeable health-care professionals. Knowing what impact Crohn’s disease and ulcerative colitis may have on your life and what management strategies are available is also very important. A well-informed patient will have the best chance for recovery and remaining healthy.
However, the amount of information you can find when trying to learn about inflammatory bowel disease can be overwhelming. There are so many possible sources of information — doctors, nurses, books, pamphlets, websites, patient associations, Internet chat rooms, friends, and relatives. Often this information is confusing and contradictory. The quality of the information varies greatly from source to source. This information overload can leave you confused and frustrated, thus making it even more difficult to deal with these chronic diseases.
We have written this book in order to provide patients, families, friends, and health-care professionals with a clear, current, and concise account of the possible underlying causes, clinical features, and effective treatments of Crohn’s disease and ulcerative colitis. Rather than simply presenting a list of facts about the disorders, we have given them an applied clinical context based on our years of experience with many hundreds of patients who have been evaluated, followed, and treated at the Mount Sinai Hospital IBD Centre. We have also tried to make this information directly relevant to IBD sufferers and their families by recounting case histories and answering the questions patients frequently ask. We hope to provide another means for dealing with these diseases, which we are only now really beginning to understand.
CHAPTER 1
What Is This Disease?
CASE STUDY Kelly
Kelly, a 22-year-old university student, developed symptoms of abdominal cramping, urgency to move her bowels, diarrhea, and blood in the stool. The symptoms came on gradually and were at first intermittent. They began during the month before her first-term exams, and, although they seemed to improve after she finished the exams, the symptoms continued into the second term. She went to the university health clinic, where she was examined and referred to a specialist. The specialist carried out some tests and told Kelly that she had inflammatory bowel disease, specifically, ulcerative colitis.
Kelly was really upset — ulcerative colitis sounded like a serious disease. Besides, the doctor told her there is no cure, other than surgery. It wasn’t fair. “I’m young,” she protested, “and no one in my family has had this disease. I’ve always been very health conscious… I eat a healthy diet, including milk and dairy products. I’m physically active and I don’t smoke.” She couldn’t stop asking questions in her effort to understand why. “What is inflammatory bowel disease? Is colitis an infection? Can I take antibiotics to cure it? Did the stress of my exams cause it? What if I eat a different diet? Could the ibuprofen I take for headaches have an impact?”
Her doctor calmed her down and began answering Kelly’s questions…
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease is not a single disease or medical condition. The term describes, in a general way, any condition or disease that results in inflammation of the gastrointestinal tract. Strictly speaking, this definition would include infections of the intestine — for example, infection caused by salmonella bacteria. However, the term “inflammatory bowel disease” (IBD) is usually reserved for two similar disorders, Crohn’s disease and ulcerative colitis. Specific causes for these disorders are not yet entirely known.
Inflammation Location
In Crohn’s disease, inflammation occurs most often in the lower part of the small intestine, called the ileum, and the large intestine, also known as the colon. Crohn’s disease can also affect the esophagus, stomach, and upper parts of the small intestine (duodenum and jejunum).
Crohn’s Disease
Crohn’s disease probably dates back to the early 19th century, based on descriptions of cases of similar ailments in the medical literature of that era. In 1932, Drs. Crohn, Ginzburg, and Oppenheimer at the Mount Sinai Hospital in New York first described the condition as a specific disease entity. The form of the disease they originally described focused on inflammation of the ileum, the last part of the small intestine. They called the condition regional ileitis, with “ileitis” indicating inflammation of the ileum. Several years after Dr. Crohn and colleagues described the condition, it was given the name Crohn’s disease. In the early 1950s, it was recognized that Crohn’s disease did not necessarily affect just the ileum, but that other parts of the gastrointestinal tract, such as the colon or large intestine, could be affected.
Ulcerative Colitis
Like Crohn’s disease, ulcerative colitis had probably been with us for some time before it was fully described in the late 19th century. Ulcerative colitis is sometimes referred to as ulcerative proctitis, ulcerative proctosigmoiditis, or ulcerative pancolitis. These names relate primarily to the extent of the inflammation of the colon rather than to any fundamental differences in the presumed causes of ulcerative colitis. In the first half of the 20th century, the treatment of ulcerative colitis was surgical, and many patients ended up dying of complications of the disease or the surgery. Since the 1940s, there has been a consistent improvement in the surgical and medical management of ulcerative colitis, and death due to complications of the disease or its treatment is now exceedingly rare.
Limited Inflammation
In ulcerative colitis, the inflammation is limited to the large intestine, which includes the rectum. The rest of the gastrointestinal tract is not involved.
Irritable Bowel Syndrome
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are often confused since their names are so alike. IBS is a poorly understood condition of the gastrointestinal tract. Although IBS is characterized by chronic abdominal discomfort or pain and an alteration in the normal bowel habit, it is quite a different condition from Crohn’s disease and ulcerative colitis (IBD).
In IBS, it is thought that the problems arise from a change in the way the bowel functions or the way in which the brain senses the bowel functioning. In IBS, there has been no clear or consistent evidence that inflammation plays a role in causing the symptoms in humans. This is different from IBD, where inflammation is the main defining characteristic of the disease, and where treatment against inflammation will help treat the disease and alleviate its symptoms. In IBS, treatment is usually aimed at modifying the motility of the gastrointestinal tract or the transmission of the pain impulses from the intestine to the brain.
Glossary of Inflammatory Bowel Disease
Gastroenterologists use several technical terms to describe IBD. You can start to use the language of this disease in discussions with your health-care providers. These terms are defined more thoroughly in their context later in the book.
Abscess: a localized collection of dead and infected tissue (pus), which typically becomes liquid. The consequences may be