Ulcerative Colitis And Bowel Obstruction

What Are Clinical Trials And Are They Right For You

Clinical trials are research studies involving people. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for youExternal NIH Link.

Vitamin And Mineral Supplements For Ibd

A person with IBD who eats a healthy, varied diet does not usually need to take vitamin supplements. But if they have a dietary deficiency, they may need tablets or occasional vitamin B12 injections. For example, a person on a low-fibre diet may need extra vitamin C and folic acid because they dont eat enough fruit and vegetables.A person with Crohns disease who experiences steatorrhoea may need calcium and magnesium supplements. Most children with IBD should take supplements to help them grow and develop normally.

What Causes Crohns Disease

Doctors arent sure what causes Crohns disease. Experts think the following factors may play a role in causing Crohns disease.

Autoimmune reaction

One cause of Crohns disease may be an autoimmune reactionwhen your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohns disease.

Genes

Crohns disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohns disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohns disease.

Other factors

Some studies suggest that other factors may increase your chance of developing Crohns disease:

• Smoking may double your chance of developing Crohns disease.4
• Nonsteroidal anti-inflammatory drugs such as aspirinExternal NIH Link or ibuprofenExternal NIH Link,5 antibiotics,6 and birth-control pillsExternal NIH Link6 may slightly increase the chance of developing Crohns disease.
• A high-fat diet may also slightly increase your chance of getting Crohns disease.7

Stress and eating certain foods do not cause Crohns disease.

4Ghazi LJ. Crohns Disease. Medscape website. http://emedicine.medscape.com/article/172940-overview#a4. Updated February 26, 2015. Accessed May 6, 2016.

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What Are Common Inflammatory Sources Of Pain In People With Ibd

IBD is a condition caused by chronic inflammation in the digestive tract. This inflammation frequently causes symptoms and complications that are sources of pain, including:1

• Gastritis inflammation of the stomach lining
• Enteritis inflammation of the intestine
• Colitis inflammation in the colon, which is entirely different than ulcerative colitis
• Abscess an area of infection that is filled with pus
• Fistula a tunnel that forms between an organ and another part of the body
• Fissure a small tear in the tissues that line the anus

IBD can also cause symptoms and complications that occur outside of the digestive tract. These sources of pain are called extraintestinal, and can include:1

• Peripheral arthritis inflammation of the large joints of arms and legs
• Sacroiliitis inflammation in the area where the lower spine connects to the pelvis
• Ankylosing spondylitis inflammation that causes the vertebrae in the spine to fuse together
• Primary sclerosing cholangitis inflammation that scars and damages the bile ducts in the liver
• Erythema nodosum skin inflammation that causes red, painful lumps
• Pyoderma gangrenosum chronic, deep ulcers on the skin

Symptoms And Signs Of Intestinal Obstruction

Obstruction of the small bowel causes symptoms shortly after onset: abdominal cramps centered around the umbilicus or in the epigastrium, vomiting, andâin patients with complete obstructionâobstipation. Patients with partial obstruction may develop diarrhea. Severe, steady pain suggests that strangulation has occurred. In the absence of strangulation, the abdomen is not tender. Hyperactive, high-pitched peristalsis with rushes coinciding with cramps is typical. Sometimes, dilated loops of bowel are palpable. With infarction, the abdomen becomes tender and auscultation reveals a silent abdomen or minimal peristalsis. Shock and oliguria are serious signs that indicate either late simple obstruction or strangulation.

Obstruction of the large bowel usually causes milder symptoms that develop more gradually than those caused by small-bowel obstruction. Increasing constipation leads to obstipation and abdominal distention. Vomiting may occur but is not common. Lower abdominal cramps unproductive of feces occur. Physical examination typically shows a distended abdomen with loud borborygmi. There is no tenderness, and the rectum is usually empty. A mass corresponding to the site of an obstructing tumor may be palpable. Systemic symptoms are relatively mild, and fluid and electrolyte deficits are uncommon.

Volvulus often has an abrupt onset. Pain is continuous, sometimes with superimposed waves of colicky pain.

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What Are Common Non

Inflammation is not the only source of pain caused by IBD. Non-inflammatory sources of pain in the digestive tract include:1,2

• Strictures narrowing of the intestines
• Adhesions bands of scar tissue that can develop after surgery
• Small-bowel obstruction

Non-inflammatory sources of pain due to IBD that are outside the digestive tract include:1

• Kidney stones
• Gallstones

What Tests Do Doctors Use To Diagnose Crohns Disease

Your doctor may perform the following tests to help diagnose Crohns disease.

Lab tests

Lab tests to help diagnose Crohns disease include:

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for changes in

• red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
• white blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.

Blood test

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.

Intestinal endoscopy

Intestinal endoscopies are the most accurate methods for diagnosing Crohns disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include the following:

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum to look for signs of Crohns disease.

During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.

Upper GI series

CT scan

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What Clinical Trials Are Open

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.govExternal Link Disclaimer.

Intestinal Obstruction Causes And Risk Factors

According to a global study by the National Center for Biotechnology Information in 2015, approximately 3.2 million cases of intestinal obstruction were diagnosed. The condition can affect both males and females, regardless of age, and the most common causes of intestinal obstruction include:

• adominal adhesions caused by prior abdominal or pelvic surgery
• Hernias

• Inflammatory bowel diseases such as Crohns disease or ulcerative colitis
• Foreign bodies such as gallstones
• Twisted bowel
• Telescoping of one segment of the bowel into another .Common in children, telescoping occurs when one segment of the bowel slides inside of another segment.
• Fecal impaction a hard piece of stool stuck in the colon or rectum

Intestinal blockages can occur even in those who live otherwise healthy lifestyles. However, there are certain factors that can increase your risk of intestinal obstruction, including:

• Chronic constipation from a high-fat, low-fiber diet
• Prior abdominal or pelvic surgery
• Inflammatory bowel disease, such as Crohns disease or ulcerative colitis

vA prior bowel obstruction

• History of hernia or cancer

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What Are The Symptoms Of Crohns Disease

The most common symptoms of Crohns disease are

• nausea or loss of appetite
• skin changes that involve red, tender bumps under the skin

Your symptoms may vary depending on the location and severity of your inflammation.

Some research suggests that stress, including the stress of living with Crohns disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.

My Journey With Ulcerative Colitis

I have lived with a colon ),a Jpouch, a temporary ileostomy, five continent ileostomies, and now a permanent ileostomy.

In addition, I no longer have a rectum or anus. I share this and especially the latter not to be TMI but to give anyone reading this who is trying to understand more about their own disease and body, or for someone who might be trying to gain more insight for a loved one, some context behind it.

Quite often, I find people share what they have gone through during a particular situation, but leave out some of the back story. For example, if a person is sharing their experiences with how a medication is working for them, wouldnt it be helpful to know what type of IBD they have? Or, what medications they have tried? Or, if they have had any surgeries? Do they have an ostomy or a Jpouch? I think you get it. It is for this reason that I try to share more of who I am and what my body is like right now so that anyone reading this might be able to tell if what I am saying has anything to do with them or a loved one.

I hope that makes sense.

Anyway, I recently suffered from another partial blockage and it got me wanting to share some of my thoughts and some tips I have learned along the way.

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Complications Of Ulcerative Colitis

UC increases your risk of developing colon cancer. The longer you have the disease, the higher your risk of this cancer.

Because of this increased risk, your doctor will perform a colonoscopy and check for cancer when you receive your diagnosis.

Repeat screenings are recommended thereafter, according to the American Cancer Society. Regular screenings help lower your risk of colon cancer. Follow-up screenings can detect precancerous cells early.

Other complications of UC include:

• thickening of the intestinal wall
• intestinal bleeding

Inflammation In Other Areas

Some people with IBD have painful inflammation in other areas of the body, including:

• joints of the fingers, hands, feet, ankles and knees
• joints of the spine, including vertebrae and sacroiliac joints
• eyes

Two specific skin problems that can occur as a result of IBD are:

• pyoderma gangrenosum small, sunken ulcers on the skin
• erythema nodosum painful, small, reddened nodules on the skin .

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How Can People With Ibd Manage Their Pain

The first step in developing a pain management approach for a patient with IBD is to determine what is causing the pain. If active IBD is causing the pain, then the first strategy is generally for healthcare providers to change or increase the medication that the patient is taking to manage the disease, such as aminosalicylates, corticosteroids, antibiotics, immunosupressants, or biologics. In many cases, treating the disease and its symptoms can be effective in reducing pain.1

However, some people may continue to experience pain despite the change in medication, or they may have pain that is not due to active IBD but some other cause. In those cases, healthcare providers may recommend trying some kind of pain relievers.

How Is It Diagnosed

Your doctor will ask you questions about your symptoms, other digestive problems you’ve had, and any surgeries or procedures you’ve had in that area. He or she will check your belly for tenderness and bloating.

Your doctor may do:

• An abdominal X-ray, which can find blockages in the small and large intestines.
• A CT scan of the belly, which helps your doctor see whether the blockage is partial or complete.

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Q: Which Is The Role Of Interventional Radiology In The Management Of Intra

Statement 3.1

Percutaneous drainage associated with antimicrobial treatment should be considered as a first-line treatment in the management of abscesses related to Crohns disease, in stable patients .

Statement 3.2

Small abscesses could be treated with intravenous antibiotics with a risk of recurrence, especially if associated with enteric fistula

Statement 3.3

Percutaneous drainage of abscesses > 3 cm could avoid immediate surgery and should be used as a bridging procedure before elective surgery to reduce the need for stoma creation and limit intestinal resection in malnourished and high-risk patients .

Statement 3.4

Surgery should be considered in the case of failure of percutaneous drainage and in patients with signs of septic shock .

Statement 3.5

Surgery should be considered for patients with enteric fistulae and if clinical evidence of sepsis persists despite the initial treatment plan .

Recommendations

We recommend performing radiological percutaneous drainage of intra-abdominal abscesses > 3cm related to Crohns disease associated with early empiric administration of antibiotics, to adapt these as soon as possible to microbiological culture results. Antimicrobial therapy should be re-evaluated according to patients clinical and biochemical features .

We recommend administering an early empiric antimicrobial therapy in stable patients presenting with abscess < 3cm, with close clinical and biochemical monitoring .

Summary of evidence and discussion

What Are The Symptoms

Symptoms of a bowel obstruction include:

• Cramping and belly pain that comes and goes. The pain can occur around or below the belly button.
• Vomiting.
• Bloating and a large, hard belly.
• Constipation and a lack of gas, if the intestine is completely blocked.
• Diarrhea, if the intestine is partly blocked.

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Crohns Disease And Ulcerative Colitis And Digesting Food

Your mouth and stomach break down food by mechanical and chemical means. When the food has reached a pulp-like consistency, it is slowly released into the first part of the small intestine . The food is then massaged along the length of the small intestine. Organs like the pancreas and the gall bladder make digestive enzymes to further break down the food into its simpler components.

The small intestine is lined with microscopic , finger-like projections that lie close to tiny blood vessels . Nutrients pass into the bloodstream through these villi. The rest of the food is pushed into the large bowel, which absorbs excess water. The waste is then temporarily stored in the colon before it is eliminated from the anus.The two ways in which Crohns disease and ulcerative colitis disturb the digestion and absorption processes are:

• Crohns disease an inflamed ileum impairs absorption of vitamin B12 and bile salts. Inflammation along the length of the small intestine impairs absorption of all food nutrients. Inflammation of the large bowel impairs water absorption, causing diarrhoea.
• Ulcerative colitis digestion and absorption are generally not affected. Inflammation of the large bowel impairs water absorption, causing diarrhoea.

Other factors that may affect your nutritional status include:

Symptoms Of A Bowel Obstruction Or A Small Bowel Obstruction

Bowel obstruction symptoms of a bowel obstruction can be painful and distressing. You may experience the following symptoms:

• Severe abdominal pain, cramps and bloating
• Nausea and/ or vomiting
• Inability to pass gas or stool
• Constipation or diarrhoea
• Abdominal swelling

A bowel obstruction becomes an emergency if your abdominal pain increases and you start to experience a fever. This could be a sign of intestinal rupture, which can become life threatening.

How is a bowel obstruction diagnosed? Your doctor may feel around your stomach to feel for any obvious signs of swelling or a lump. You may be sent for x-rays or a CT Scan to see if there is anything causing an obstruction. You may also have a colonoscopy, which is a camera inserted via the rectum to view the inside of the colon to check for any abnormalities.

To find out about treatments for a bowel obstruction and further resources, click the links above to navigate to the pages.

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Types Of Ulcerative Colitis

UC can be categorized according to the parts of the GI tract that it affects.

• Ulcerative proctitis. In ulcerative proctitis, only the rectum is inflamed. Its considered a mild form of UC.
• Left-sided colitis. Left-sided colitis causes inflammation in the area between the splenic flexure and the last section of the colon. The last section of the colon, known as the distal colon, includes the descending colon and sigmoid colon. Left-sided colitis is also known as distal ulcerative colitis.
• Proctosigmoiditis. Proctosigmoiditis is a form of left-sided colitis. It causes inflammation in the rectum and sigmoid colon.

Different tests can help a doctor diagnose UC. UC mimics other bowel diseases such as Crohns disease. A doctor will order multiple tests to rule out other conditions.

Tests to diagnose UC often include:

Outlook For People With Ulcerative Colitis

If you have UC, a doctor will need to monitor your condition, and youll need to carefully follow your treatment plan throughout your life.

The only true cure for UC is removal of the entire colon and rectum. Your doctor will usually begin with medical therapy unless you have a severe complication that requires surgery. Some people will eventually require surgery, but most do well with nonsurgical therapy and care.

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