Alternate Names: Inflammatory bowel disease; Regional enteritis; Ileitis; Granulomatous ileocolitis

Causes and Risks:

The cause is unknown, but genetic factors seem to play a role. Chronic ulcerative colitis occurs in the same families. Inflammation frequently occurs at the end of the small intestine where it joins the large intestine, but it may affect any area of the digestive tract. The intestinal wall becomes thick, and deep ulcers may form.

The disease may occur at any age, but adolescence and early adulthood are the prevalent age groups. Risk factors are family history of Crohn’s disease or Jewish ancestry. The incidence is 7 out of 100,000 people.

Prevention: There is no known way to prevent this disorder.

Symptoms:

• abdominal pain
• fever
• diarrhea
• loss of appetite
• weight loss
• abdominal mass
• abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine)
• clubbing of the fingers or toes
• gastrointestinal bleeding
• stools - foul smelling
• tenesmus (painful stools)

  Additional symptoms that may be associated with this disease:

• stools, bloody
• joint pain
• incontinence
• gums, swollen
• constipation
• abdominal fullness, gaseous

Signs and Tests:

An abdominal examination may reveal a mass (aggregation of cells) or tenderness.

• tests that show findings of Crohn’s disease
• endoscopy, colonoscopy, or sigmoidoscopy with small bowel biopsy
• small bowel follow through
• barium enema
• upper GI series
• positive stool guaiac

A stool culture may be done to rule out other possible causes of the symptoms.

This disease may also alter the results of the following tests:

• fecal fat
• lactose hydrogen breath test
• albumin

Treatment:

Medications may control the inflammatory process. Initial therapy is usually with the oral 5-aminosalicylates. If this is not effective or if the case is severe, treatment may require corticosteroids and and immunomodulators (azathioprine, 6-mercaptopurine).

Antibiotics are often prescribed to treat abscesses and fistulas, if present. Infliximab (antibody to tumor necrosis factor alpha) is effective for patients with fistulous disease and moderate to severe disease.

If medical therapy is not effective, patients may require surgery to resect a diseased or strictured segment or to drain an abscess. Unlike ulcerative colitis, resection of a diseased portion of the intestine is not curative.

Changes in the diet may improve symptoms (consult your health care provider or dietician). An adequate intake of calories, vitamins, and protein is important.

Foods that worsen the diarrhea (or other symptoms) should be avoided--specific food problems may vary from person to person. People who have blockage of the intestines may need to avoid raw fruits and vegetables. Some people have difficulty digesting lactose (milk sugar) and need to avoid milk products.

Prognosis:

This is a chronic disease characterized by periods of improvement followed by the deterioration of symptoms. There is an increased risk of small bowel or colorectal carcinoma, but to a lesser degree than patients with ulcerative colitis.

Complications:

• fistulas may occur to the bladder, vagina, or the skin
• bowel obstructions
• abscess
• nutritional deficiencies
• vitamin B12 deficiency
• complications of corticosteroid therapy
• inflammation of the joints
• erythema nodosum
• pyoderma gangrenosum
• lesions in the eye
• impaired growth and sexual development in children

Call for an appointment with your health care provider if symptoms worsen or do not improve with treatment or if new symptoms develop.