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Inflammatory bowel disease (IBD) is a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Most often IBD is classified as ulcerative colitis or Crohn’s disease but may be referred to as colitis, enteritis, iletis, and proctitis.

Ulcerative colitis causes ulceration and inflammation of the inner lining of the colon and rectum, while Crohn’s disease is an inflammation that extends into the deeper layers of the intestinal wall.

Ulcerative colitis and Crohn’s disease cause similar symptoms that often resemble other conditions such as irritable bowel syndrome (spastic colitis). The correct diagnosis may take some time. Crohn's disease usually involves the small intestine, most often the lower part (the ileum). In some cases, both the small and large intestine (colon) are affected. In other cases, only the colon is involved. Sometimes, inflammation also may affect the mouth, esophagus, stomach, duodenum, appendix, or anus. Crohn's disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for year, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

What are the symptoms?

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. There also may be rectal bleeding, weight loss, and fever. Bleeding may be serious and persistent, leading to anemia (low red blood cell count). Children may suffer delayed development and stunted growth.

What causes Crohn's disease and who gets it?

There are many theories about what causes Crohn's disease, but none has been proven. One theory is that some agent, perhaps a virus or a bacterium, affects the body's immune system to trigger an inflammatory reaction in the intestinal wall, Although there is a lot of evidence that patients with this disease have abnormalities of the immune system, doctors do not know whether the immune problems are a cause or a result of the disease. Doctors believe, however, that there is little proof that Crohn's disease is caused by emotional distress or by an unhappy childhood. Crohn's disease affects males and females equally and appears to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child.

How does Crohn's disease affect children?

Women with Crohn's disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children. Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohn's disease. Even so, it is a good idea for women with Crohn's disease to discuss the matter with their doctors before pregnancy. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases.

How is Crohn's disease diagnosed?

If you have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia, the doctor will examine you for signs of Crohn's disease. The doctor will take a history and give you a thorough physical exam. This exam will include blood tests to find out if you are anemic as a result of blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process in your body. Examination of a stool sample can tell the doctor if there is blood loss, or if an infection by a parasite or bacteria is causing the symptoms.

The doctor may look inside your rectum and colon through a flexible tube (endoscope) that is inserted through the anus. During the exam, the doctor may take a sample of tissue (biopsy) from the lining of the colon to look at under the microscope. Later, you also may receive x-ray examinations of the digestive tract to determine the nature and extent of disease. These exams may include an upper gastrointestinal (GI) series, a small intestinal study, and a barium enema intestinal x-ray. These procedures are done by putting the barium, a chalky solution, into the upper or lower intestines. The barium shows up white on x-ray film, revealing inflammation or ulceration and other abnormalities in the intestine.
If you have Crohn's disease, you may need medical care for a long time. Your doctor also will want to test you regularly to check on your condition.

What is the treatment?

Several drugs are helpful in controlling Crohn's disease, but at this time there is no cure. The usual goals of therapy are to correct nutritional deficiencies; to control inflammation; and to relieve abdominal pain, diarrhea, and rectal bleeding. Drugs may help abdominal cramps and diarrhea. The drug sulfasalazine often lessens the inflammation, especially in the colon. This drug can be used for as long as needed, and it can be used along with other drugs. Side effects such as nausea, vomiting, weight loss, heartburn, diarrhea, and headache occur in a small percentage of cases. Patients who do not do well on sulfasalazine often do very well on related drugs known as mesalamine or 5-ASA agents. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system such as azathioprine or 6-mercaptopurine (6-MP).

Can diet control Crohn's disease?

No special diet has been proven effective for preventing or treating this disease. Some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. But there are no hard and fast rules for most people. Follow a good nutritious diet and try to avoid any foods that seem to make your symptoms worse. Large doses of vitamins are useless and may even cause harmful side effects.

Your doctor may recommend nutritional supplements, especially for children with growth retardation. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who temporarily need extra nutrition, those whose bowels need to rest, or those whose bowels cannot absorb enough nourishment from food taken by mouth.