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Inflammatory Bowel Disease Inflammatory bowel disease (IBD) involves inflammation of the intestines and is a chronic (long-lasting) illness. The two major types of IBD are ulcerative colitis and Crohn's disease. Ulcerative colitis affects the lining of the large intestine (colon) and/or the rectum. Crohn's disease affects deeper layers of tissue and can occur in any part of the digestive system, although it occurs most commonly in the lower part of the small intestine (ileum). KEYWORDS for searching the Internet and other reference sources Colitis Digestive system Enteritis Gastroenterology Gastrointestinal system Ileitis Inflammation Proctitis * inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth. What Is Inflammatory Bowel Disease? Inflammatory Bowel Disease (IBD) encompasses several diseases caused by inflammation * of the intestinal tract. The different types of IBD have many symptoms in common, including abdominal pain, frequent diarrhea Why some people get IBD is not clear. What is known is that IBD is not passed from person to person. However, up to 25 percent of people with IBD have a relative with the disease, suggesting that genetic factors play a role in its development. Some researchers believe that IBD occurs because a virus or bacterium triggers an inappropriate response from the immune system in people who have a genetic tendency for the disease. This response causes the digestive tract to become inflamed. What Are the Different Types of IBD? The two major types of inflammatory bowel disease are ulcerative colitis and Crohn's disease. Ulcerative Colitis Ulcerative colitis is sometimes referred to as colitis or proctitis. Ulcerative colitis is a disease that occurs when the lining of the large intestine and/or rectum become inflamed. Usually tiny open sores, or ulcers, develop on the intestine or rectum wall. These sores often result in bloody diarrhea. Substantial blood loss can occur. People with ulcerative colitis often have symptoms that affect other areas of the body. These may include inflammation of the joints (arthritis) or the eye, skin rashes and mouth ulcers, liver disease, osteoporosis * , and anemia * caused by blood loss. * osteoporosis (os-te-o-por-O-sis) is the loss of material from the bone. This makes the bones weak and brittle. * anemia (an-E-me-ah) is the condition of having too few red blood cells. People with anemia often feel tired and weak. Most people who develop ulcerative colitis are between the ages of 15 and 40. The severity of the disease varies from person to person. Some people seldom have an attack of symptoms. Others have almost continuous attacks that interfere with their daily activities. Experts agree that having ulcerative colitis increases the risk of getting colon cancer. The longer a person has ulcerative colitis and the larger the part of the digestive system involved, the greater the risk of developing colon cancer. Crohn's Disease Crohn's disease is sometimes referred to as ileitis or enteritis. Crohn's disease is an inflammation that extends deep into the tissues of the digestive system. Although this inflammation can be found anywhere in the digestive tract, most often it is found in the lower end of the small intestine where the small intestine connects to the large intestine. Ulcers often appear in patches separated by stretches of normal tissue. There are many conflicting theories about what causes Crohn's disease. Men and women seem to get Crohn's disease in equal numbers, and about 20 percent of people with the disease have a relative who also has it. Many people with Crohn's disease have abnormalities in their immune system, but it is not known if these abnormalities are the cause of the disease or the result of it. Crohn's disease is a chronic condition that varies from person to person in severity. In severe cases, the disease can cause major loss of blood, and it can interfere with food intake and absorption of nutrients * from the intestine. Children with Crohn's disease may develop slowly and not reach their full growth potential because their bodies do not get enough nourishment for normal growth. Adults also may have problems with getting adequate nutrition because of the disease. The most common complication of Crohn's disease is a blockage of the intestine. Crohn's disease causes the intestinal walls to swell and thicken with scar tissue that may eventually prevent the movement of materials through the intestine. In some people, the ulcers expand into the tissues that surround the digestive system, creating a high risk of additional infection. As with ulcerative colitis, Crohn's disease can affect other parts of the body with symptoms such as arthritis, skin rashes, mouth sores, eye problems, kidney stones, anemia, or liver diseases. How Is IBD Diagnosed? A medical history, physical examination, and diagnostic tests are problems required to diagnose IBD. Blood samples may be taken to look for evidence of anemia and infection. Examination of stool samples for the presence of blood also may help the doctor make a diagnosis. Often the colon is examined through a procedure called a colonoscopy. An endoscope (a lighted flexible tube and camera attached to a television monitor) is inserted through the anus. This allows the doctor to see the inside lining of colon and rectum. Sometimes during the colonoscopy a tissue sample (called a biopsy) is taken from the intestine lining for further examination under a microscope. * nutrients are the components of food (protein, carbohydrate, fat, vitamins, and minerals) needed for growth and maintenance of the body. Another diagnostic procedure a physician can use is a barium study. A person drinks a mixture of barium that is flavored with another liquid, and then the person is x-rayed. Because barium shows up on x-rays, the doctor can detect abnormalities as the mixture flows through the person's intestines. CT scans * may be useful in evaluating the progress of the disease once it has been diagnosed. How Is IBD Treated? Medication and diet are the two primary approaches to controlling IBD. They do not cure the disease, but are effective in reducing symptoms in the majority of people. In severe cases of IBD, surgery may be necessary. Anti-inflammatory drugs often are used to help control the inflammation caused by the disease. In some cases, immunosuppressant drugs may be helpful in controlling symptoms that do not respond to anti-inflammatory drugs. Antibiotics often are used to treat Crohn's disease. In addition, several experimental drug therapies are under investigation. Many of the drugs used to treat IBD are powerful and may have undesirable side effects. The physician must balance the undesirable side effects against the positive benefits of the drugs, sometimes trying several different drug combinations before a successful balance is reached. Diet In addition to drug therapy, a special diet may be prescribed by the physician. Since IBD interferes with the absorption of nutrients from the intestines, people with the disease often must increase the amount of calories, vitamins, and minerals they consume. Some individuals find that they must avoid specific foods that aggravate their symptoms. Other people find a bland, low-fiber diet offers some relief. Because there is no cure for IBD, people with any form of the disease should receive regular medical examinations that include a review of their treatment and diet. Surgery In severe cases of IBD, when damage has occurred to parts of the intestinal tract, a person may need surgery to remove damaged sections of the intestines. About 20 percent of people with ulcerative colitis require surgery at some point in their lives. If necessary, ulcerative colitis may be treated by surgery that removes the entire colon and rectum. After this procedure, normal bowel movements are not possible, so the small intestine is given a surgically created opening (ostomy) through the lower abdomen. This opening is covered with a bag that collects waste and must be emptied several times a day. About 70 percent of people with Crohn's disease eventually need to have damaged areas of the colon removed. Removing the damaged parts does not cure Crohn's disease, because the inflammation may return in other places in the colon. Many people with Crohn's disease need additional surgery because the symptoms reappear. * CT scans or CAT scans are the shortened names for computerized axial tomography (to-MOG-ra-fee), which uses x-rays and computers to view structures inside the body Endoscopy The word endoscopy means "peering within." Endoscopes allow a physician to see inside the human body. An endoscope is a long, flexible, viewing instrument that contains lenses and a light source. It is called a fiberoptic instrument because it contains thousands of thin glass fibers that carry light into body cavities and reflect an image back to the viewer by way of a video screen. This system makes it possible for the physician to examine the inside of the body in the area of interest. Endoscopes also contain an opening through which the doctor can maneuver tiny surgical tools, such as scissors, forceps, and suction devices. This enables the doctor to do surgery or to take tissue samples without cutting through the wall of the abdomen or chest. In 1957, at the University of Michigan, Dr. Basil Hirschowitz figured out how to light the interior of the body for examination using a fiberoptic tube. This was the first fiberoptic endoscope. Today, endoscopes are used routinely in examinations and surgical procedures. Living with IBD There is no cure for inflammatory bowel disease, but people with IBD often go for substantial periods of time when they feel well and have few symptoms. During these times they are able to hold jobs, raise families, and participate in normal daily activities. Throughout the United States, there are support groups for people with IBD that help them learn to cope with their illness and maintain a normal, happy life. See also Anemia Colitis Colorectal Cancer Constipation Diarrhea Diverticulitis/Diverticulosis Irritable Bowel Syndrome Resources U.S. National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD 20892-3570. The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It publishes brochures and posts fact sheets about Crohn's disease and ulcerative colitis at its website. http://www.niddk.nih.gov/health/digest/pubs/colitis/colitis.htm http://www.niddk.nih.gov/health/digest/pubs/crohns/crohns.htm Crohn's and Colitis Foundation of America, 386 Park Avenue South, 17th floor, New York, NY 10016-8804. http://www.ccfa.org Pediatric Crohn's and Colitis Association, P.O. Box 188, Newton, http://pcca.hypermart.net United Ostomy Association, 19772 MacArthur Boulevard, Irvine, CA http://www.uoa.org
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Upalna bolest crijeva – uzroci, simptomi i liječenje Upalna bolest crijeva (IBD – Inflammatory bowel disease) uključuje kroničnu upalu cijelog ili samo dijela probavnog trakta. Upalna bolest crijeva prvenstveno uključuje ulcerozni kolitis i Crohnovu bolest. Ona obično uključuje težak proljev, bol, umor i gubitak težine. Osim što čini osobu vrlo slabom, ponekad dovodi do po život opasnih komplikacija. Ulcerozni kolitis je upalna bolest crijeva koja uzrokuje dugotrajne upale i čireve u sluznici debelog crijeva i rektumu. Crohnova bolest je upalna bolest crijeva koja uzrokuje upalu sluznice probavnog trakta. Upala može uključivati različite dijelove probavnog trakta – debelo ili tanko crijevo, iako se može razviti u bilo kojem dijelu probavnog sustava uključujući želudac, jednjak, anus pa čak i usta. Uzroci upalne bolesti crijeva Točan uzrok upalne bolesti crijeva ostaje nepoznat. Prije su se glavnim krivcima smatrali prehrana i stres, ali danas liječnici znaju da su to čimbenici koji mogu pogoršati postojeće stanje, ali ne i uzrokovati ga. Jedan od mogućih uzroka jest kvar imunološkog sustava. Normalno, vaš imunološki sustav se bori protiv virusa i bakterija. Abnormalni imunološki odgovor izaziva imunološki sustav da napadne stanice u probavnom traktu. Izgleda da i nasljeđe također igra ulogu obolijevanju od upalne bolesti crijeva. IBD je češća kod osoba koje imaju članove obitelji s tom bolesti. Međutim, većina ljudi s upalnom bolesti crijeva nema takvu obiteljsku povijest bolesti. Simptomi upalne bolesti crijeva Simptomi upalne bolesti crijeva variraju, ovisno o ozbiljnosti upale i mjesta na kojima se javlja. Simptomi mogu varirati od blagih do teških. Vjerojatno je da će bolest biti aktivna, nakon čega će uslijediti razdoblje remisije. Znakovi i simptomi koji su zajednički za ulcerozni kolitis i Crohnovu bolest uključuju: - Proljev – čest problem kod ljudi s upalnom bolesti crijeva. - Temperatura i umor – izazivaju nisku energiju kod osoba s IBD. - Bolovi u trbuhu i grčevi – upala može utjecati na normalno kretanje sadržaja kroz probavni trakt i može dovesti do bolova i grčeva. Također mogu dovesti do mučnine i povraćanja. - Krv u stolici – možda ćete primijetiti jarko crvenu boju u zahodskoj školjci ili pak tamniju krv u samoj stolici. Također, možete imati krvarenje koje se golim okom ne može vidjeti (okultna krv). - Smanjeni apetit – bolovi u trbuhu, grčevi, kao i upala, mogu utjecati na vaš apetit. - Nenamjeran gubitak težine – uključuje nemogućnost pravilne apsorpcije i probave hrane. Posjetite liječnika ako imate trajnu promjenu u radu crijeva ili ako imate bilo koji od znakova i simptoma upalnih bolesti crijeva. Iako one obično nisu smrtonosne, one su ozbiljne bolesti koje u nekim slučajevima mogu uzrokovati po život opasne komplikacije. Liječenje upalne bolesti crijeva Cilj liječenja upalne bolesti crijeva jest smanjiti upalu koja aktivira znakove i simptome. U najboljem slučaju, to može dovesti ne samo do ublažavanja simptoma, već i do dugoročne remisije i smanjenja rizika od komplikacija. IBD tretman obično uključuje lijekove ili operaciju. Ne postoji lijek za upalnu bolest crijeva. Protuupalni lijekovi Protuupalni lijekovi su često prvi korak u liječenju upalne bolesti crijeva. Oni uključuju: - Aminosalicilati – mogu biti učinkoviti u smanjenju simptoma ulceroznog kolitisa i kod nekih ljudi s Crohnovom bolesti koja je ograničena na debelo crijevo. Ima niz nuspojava, uključujući probavne smetnje i glavobolje. Rijetko su ovi lijekovi povezani s problemima bubrega i gušterače. - Kortikosteroidi – ovi lijekovi, uključujući prednizon i hidrokortizon, općenito su rezervirani za umjerene do jake slučajeve ulceroznog kolitisa i Crohnove bolesti koji ne reagiraju na druge tretmane. Daju se oralno, intravenozno ili klistirom, ovisno o zahvaćenom dijelu probavnog trakta. Kortikosteroidi imaju brojne nuspojave, uključujući dlakavost lica, noćno znojenje, nesanicu i hiperaktivnost. Ozbiljnije nuspojave uključuju visoki krvni tlak, dijabetes, osteoporozu, frakturu kostiju, glaukom i povećane šanse za infekcije. Obično se ne daju dugoročno. Imunosupresori U liječenju upalne bolesti crijeva koriste se imunosupresori, odnosno „prigušivači“ imunološkog sustava. Takvi lijekovi također smanjuju upalu, ali oni utječu direktno na imunološki sustav, a ne izravno na liječenje same upale. Umjesto toga, oni sprječavaju imunološki odgovor otpuštajući kemikalije u crijevnu sluznicu. Za neke ljude, kombinacija ovih lijekova djeluje bolje od samo jedne vrste. Imunosupresori uključuju: - Azatioprin (Azasan, Imuran) i merkaptopurin (Purinethol, Purixan) – to su najčešće korišteni imunosupresivi za liječenje upalne bolesti crijeva. Uzimanje ovih lijekova zahtijeva redovitu kontrolu krvi kao i praćenje nuspojava, uključujući i praćenje učinaka na jetru i gušteraču. Dodatne nuspojave uključuju smanjenu otpornost na infekcije i šanse za razvoj raka, poput limfoma i raka kože. - Ciklosporin – ovaj lijek je obično rezerviran za ljude koji ne reagiraju na druge lijekove. Njegova je uporaba uglavnom ograničena na ulcerozni kolitis. Ovaj lijek ima potencijal za ozbiljne nuspojave povezane s bubrezima i jetrom, zatim napadajima i infekcijama te samim time nije za dugoročnu primjenu. Postoji i mali rizik od raka. Danas se koristi rjeđe jer su dostupne sigurnije alternative. - Infliximab (Remicade), adalimumab (Humira) i golimumab (Simponi) – TNF – blokatori, alfa inhibitori. Ovi lijekovi su za osobe s umjerenim do teškim ulceroznim kolitisom ili Crohnovom bolesti, a ne reagiraju na druge tretmane ili ih pak ne mogu podnijeti. Antibiotici Osobe koje imaju ulcerozni kolitis i česte temperature, vjerojatno će koristiti antibiotike kako bi se spriječila ili kontrolirala infekcija. Antibiotici mogu smanjiti količinu odvodnje, a ponekad i izliječiti fistule i apscese kod osoba s Crohnovom bolesti. Znanstvenici također vjeruju da antibiotici pomažu u smanjenju štetnih crijevnih bakterija i potiskuju imunološki sustav crijeva. Mogu se koristiti kao dodatak drugim lijekovima. Ostali lijekovi Osim kontrole upale, neki lijekovi mogu pomoći u ublažavanju znakova i simptoma, ali uvijek razgovarajte s liječnikom prije uzimanja bilo kojeg lijeka. On vam može preporučiti neke lijekove protiv bolova, zatim željezo kao dodatak prehrani, vitamin B12, vitamin D kao i kalcij. Kirurgija Ukoliko dijeta i promjena načina života, terapija lijekovima ili drugi tretmani ne ublažavaju znakove i simptome upalne bolesti crijeva, liječnik vam može preporučiti operaciju. Ulcerozni kolitis – kirurgija često može eliminirati ulcerozni kolitis, ali to obično znači uklanjanje cijelog debelog crijeva i dijela rektuma (proktokolektomija). U većini slučajeva, to uključuje postupak koji se zove ileoanalna anastomoza – spajanje ileuma s anusom, od tankog crijeva se napravi mali rezervoar (vrećica) koji se pričvrsti na preostali dio rektuma. Taj postupak omogućuje relativno normalnu probavu. Crohnova bolest – polovica ljudi s Crohnovom bolesti zahtijeva barem jednu operaciju. Međutim, operacije ne liječe bolest. Tijekom operacije, liječnik uklanja oštećeni dio probavnog trakta, a zatim spoji zdrave dijelove. Kirurgija se također može primjenjivati za liječenje fistula i apscesa. Prednosti operacije su obično privremene. Bolest se često ponavlja. Najbolji je pristup, uz operaciju, koristiti lijekove koje vam je propisao liječnik. Bulardi Pomaže kod proljeva već 80 godina! Butifar Regulira poremećaje crijevne flore. 91 kn 72 kn