Inflammatory Bowel Disease

Inflammatory Bowel Disease Definition:


Inflammatory Bowel Disease is a general term used for an inflammatory disease of the colon. There are two types of IBD: Crohn’s Disease and Ulcerative Colitis.

UC_and_CD.jpg

Picture from: John Hopkins Medicine Gastroenterology and Hepatology

Signs and symptoms of IBD include:
  • Abdominal pain
  • Diarrhea
  • Fever
  • Weight loss
  • Anemia
  • Food intolerance
  • Malnutrition
  • Growth failure
  • Extraintestinal manifestations (such as arthritis, swelling of the liver and bile ducts, and skin related complications)


What is Crohn's Disease?



Crohn's Disease is a chronic state of inflammation within your gastrointestinal tract. Crohn's Disease can effect any part of the GI tract (Mouth, Esophagus, Stomach, Small Intestine, Large Intestine/Colon, Anus) but more than half effect the distal ileum and colon (very last segment of small intestine and colon).


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University of Maryland Medical Center.
http://www.mayoclinic.com/health/crohns-disease/DS00104


Crohn's Disease may only effect a segment of the bowel leaving healthy segments separate. It also affects all layers of the mucosa (as seen below).

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mdguidelines.com

Crohn's Disease Signs & Symptoms

There are several signs & symptoms associatd with Crohn's Disease including
  • Diarrhea
  • Fever
  • Weight Loss
  • Abdominal Pain/Cramping
  • Lack of Appetite/Anorexia
  • Growth Failure
  • Malnutrition
  • Extraintestinal Manifestations (ie. abcess)
  • Risk of Cancer Increases with the duration of the Disease


Crohn's Disease Causes

The exact cause of Crohn's disease is not known however there is a known interaction of the Immune System of the GI (which is why it becomes inflammed) and Genetic and Environmental Factors which can cause relapses of IBD.

  • Genetic Factors:
    • Mutation (C677T) causing inappropriate inflammatory response to GI microflora and inability to suppess the inflammatory response.
    • NOD2/CARD15 gene mutation failure to produce necessary peptide for proper immune function
    • Regulatory mechanisms are defective

  • Environmental Factors
    • Microorganisms in the GI Tract
    • Diet
      • Particular Foods (Can vary depending on person)
      • Nutrients (Can vary depending on person...ie. dietary lipids)
      • Microbes
      • Contaminants
      • Food Allergy (More common in persons with IBD)

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AIE Pharmaceuticals

Unfriendly bacteria would be an example of an environmental component which might cause a relapse into IBD.

Crohn's Disease Medical Treatment

The primary of an IBD is to reduce the incidences of a relapse and prolong the amount of time between in order to improve nutritional status. There have been some medical advances to help relieve symptoms of Chrohn's Disease including:
  • Corticosteroids (ie. Cortisol, Prednisone)
  • Anti-inflammatory Agents (NSAIDS ie. Ibuprofen)
  • Immunosuppressants (ie. Azasan, Imuran, or Azathiprine)
  • Antibiotics (ie. Metronidazole)
  • Anticytokine Medications (ie. Infliximab)

Surgery may also be necessary when medical management fails which involves the removal of intestinal segments. Removal of too many segments can result in short-bowel syndrome which requires parenteral nutrition to receive adequate nutrients required for life.
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bupa.co.uk


Crohn's Disease Nutrition Treatment

Nutrition becomes even more extremely important for an individual who is suffering from Crohn's Disease as their body is unable to absorb the vitamins and minerals it requires nor the fluid to maintain hydration status. Supplementation becomes essential for the goal of restoring and maintaing nutrition status of the individual. Some important nutritional highlights are:
  • Timely nutrition support-malnutrition can further compromise the digestive tracts
  • Relatively Normal Caloric Needs
  • Increased Protein Needs
  • Vitamin Supplementation due to malabsorption/maldigestion and drug-nutrient interactions
    • Especially-Folate, B-6 & B-12
    • Zinc, Potassium & Selenium
  • Simple Sugars & Caffeine should be avoided/limited
  • Increase Fiber
  • Be minderful of Food Allergies
  • Probiotics & Prebiotics can be beneficial


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What is Ulcerative Colitis?


Ulcerative Colitis is a form of IBD that affects the mucosa of rectum and continues up the lining of the colon. It can lead to chronic inflammation and ulcers. If not treated, it can lead to life-threatening complications.

UC.jpg


Causes of Ulcerative Colitis


Though it is not definite what causes Ulcerative Colitis, it is believed that a virus or bacteria triggers a immune response that leads to inflammation of the affected area. Stress is known to aggravate symptoms. Family history of this disease increases the change of developing the disease.


Ulcerative Colitis Signs & Symptoms


- Inflammation of the rectum which may cause rectal bleeding
- Rectal pain
- Urgency to urinate
- Bloody diarrhea
- Abdominal pain and cramps, especially on the left side of the body
- Inability to move the bowels
- Unintended weight loss
- Fatigue
- Prolonged fever


Ulcerative Colitis Recommended Medical Therapy






Ulcerative Colitis Recommended Nutrition Therapy

People with Ulcerative Colitis should consume a well-balanced, nutrient-rich diet and get plenty of physical activity. If you find that certain foods trigger your ulcerative colitis symptoms or inflammation, avoid eating those foods.

When experiencing symptoms, sufferers of ulcerative colitis are encouraged to follow a low-residue diet. A low-residue diet is one which consists of easily digestible foods, and restricts fiber to help reduce symptoms of ulcerative colitis such as diarrhea or stomach cramping.

Low-residue diet - Foods to eat:
  • Cold cereals
  • White rice
  • White breads
  • Fruits and vegetables with the skins and seeds removed
  • Milk
  • Chicken
  • Fish
  • Ice cream and plain puddings

Low-residue diet - Foods to avoid:
  • Seeds
  • Raw vegetables
  • Dried fruits
  • Whole grain products
  • Beans
  • Popcorn
  • Juice with pulp
  • Popcorn
  • Hot sauce or peppers
  • Carbonated beverages
  • Products containing sorbitol

Note: A low-residue diet is for short-term use during ulcerative colitis flare-ups or following surgery to help with recovery, but should not be followed long-term.

Sample menu for ulcerative colitis:
Breakfast:
  • 2 scrambled eggs
  • White bread toast with grape jelly
  • Orange juice without pulp
Lunch:
  • Grilled chicken
  • White rice
  • Cooked carrots
  • Milk
Dinner:
  • Pasta with butter or olive oil
  • White dinner roll
  • Cooked spinach


References

Mahan, L.Kathleen. Escott-Stump, Sylvia. (2008). Krause’s Food and Nutrition Therapy (12th ed.). St. Louis, MO. Saunders.

Mayo Clinic. 2011. Crohn's Disease. Retrieved from: mayoclinic.com/health/crohns-disease/DS00104

Mayo Clinic. 2011. Ulcerative colitis. Retrieved from: http://www.mayoclinic.com/health/ulcerative-colitis/DS00598

Zaneta M. Pronsky & Sr. Jeanne P. Crowe. Food Medication Interactions 16th Edition. 2010.

Drugs.com. 2000-2012. Non-Steroidal Anti-Inflammatory Agents. Retrieved from: http://www.drugs.com/drug-class/nonsteroidal-anti-inflammatory-agents.html

John Hopkins Medicine Gastroenterology and Hepatology. 2012. Ulcerative Colitis. Retrieved from:
http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Disease_ID=2A4995B2-DFA5-4954-B770-F1F5BAFED033&GDL_DC_ID=D03119D7-57A3-4890-A717-CF1E7426C8BA