Natural Crohns Disease Cure and Treatment

No More Crohn's Disease

No More Crohn's Disease is a product of Cathy Rubert's personal research and many years of trial and error. This book reveals Cathys powerful 4-step plan against Chron's disease. Inside her book you will discover how to quickly and easily implement the 4-main all-natural steps that will immediately start combating Crohn's Disease (put the simple steps into action and Crohn's Disease will become a problem from the past!) Time to be freed from the pain and discomfort caused by Chron's disease. With the help of Cathy Rubert's No More Crohn's Disease, you can now enjoy an effective cure without the costly trips to the doctor. You will also be safe from any side effects because the entire program is natural.

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Assessment of disease activity in Crohns disease

Objective scoring of disease activity is important in the assessment of severity of disease and response to treatment. The most commonly used activity assessment tool is the Crohn's Disease Activity Index (CDAI), which is summarised in Table 6.2. Symptoms and physical and laboratory manifestations of Crohn's disease are recorded and assigned a weight. Disease activity is determined from the overall score derived, as shown in Table 6.3. The Harvey-Bradshaw Index and Dutch Activity Index are also widely used in clinical studies (Harvey and Bradshaw 1980). The measurement of health-related quality of life in Crohn's disease is discussed in Chapter 14. Table 6.2 Crohn's Disease Activity Index. Table 6.2 Crohn's Disease Activity Index. Symptoms or findings presumed related to Crohn's disease

Complications of Crohns disease

Aphthous ulceration is the most common oral complication of Crohn's disease. Ulcers can be extensive and painful enough to impair nutrition. They often occur in association with intestinal disease and respond to treatment directed at the bowel. In Crohn's disease small bowel obstruction results from strictures due to fibrosis, with superimposed spasm, inflammation or intestinal adhesions. Patients with Crohn's disease present most commonly with partial small bowel obstructions, which usually respond to medical treatment. Intravenous hydration, nasogastric suction, corticosteroids and parenteral nutrition often lead to prompt resolution of symptoms. The transmural inflammatory nature of Crohn's disease predisposes to the formation of a fistula. The presence of fistulae is usually indicative of active disease and this complication may respond to the medical treatment that is aimed at the Crohn's disease. Enterocutaneous fistulae commonly occur after the incision and drainage of a local...

Surgical management of Crohns disease

Eighty per cent of patients with Crohn's disease require at least one operation and some require three or four surgical procedures. It has been reported that between two and four operations are necessary in most patients. Not all surgical operations for Crohn's disease involve major intestinal resection. Surgical management may be required simply to drain an abscess, assess painful disease under anaesthesia, excise a fistulous track, refashion a stoma or construct a stoma without resecting the bowel. Obstructed bowel may be rectified by stricturoplasty. Patients with Crohn's disease face a lifetime disorder, which may have metabolic consequences, in which surgical intervention is common. Patients may have to face the prospect of an intestinal stoma and may be worried about the influence of their disease or the effect of surgical treatment on their social, sexual and family lives. These psychosocial issues are given further consideration in Chapter 13. Surgical treatment, however, is...

Types of Crohns disease

The commonest symptoms of extensive colonic involvement are diarrhoea and general malaise, often associated with anorexia and weight loss. Unlike the pattern in small intestinal Crohn's disease, obstructive symptoms are uncommon, though vague persistent abdominal discomfort is often a feature. Left-sided disease is commoner in older patients and symptoms can mimic diverticular disease, with attacks of pain in the left lower abdominal quadrant and intermittent diarrhoea. Crohn's colitis may be complicated by colonic perforation leading to an acute abdominal emergency. Perianal disease is present in more than two-thirds of patients with Crohn's disease, though it is often painless and asymptomatic. Perianal disease only becomes painful when there is local abscess formation or active anal fissure. Gastroduodenal Crohn's disease Crohn's disease affecting the gastroduodenal region occurs in fewer than 5 of patients and is usually associated with macroscopic disease in other parts of the...

Idiopathic Inflammatory Bowel Disease Crohns Disease

Crohn's disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract involvement of the small bowel may be referred to as Crohn's enteritis. Crohn's disease is comparatively more common in North America and Europe which have the highest incidence the disease is relatively rare elsewhere, particularly in developing countries. To put it in context of all causes of enteropathy, recent data suggests the incidence of all childhood and adolescent Crohn's disease in northern hemisphere countries is estimated to be 2-3.7 cases per 100,000. The cause of Crohn's disease has not been defined, although the pathogenesis is complex involving an interrelation between genetic predisposition and environmental factors (fig. 2). The intestinal manifestations reflect the anatomic site of involvement, with Crohn's enteritis manifested in various combinations as diarrhea, fever, occult or gross blood in the stool, abdominal pain, aphthous ulcers, weight loss and...

Extraintestinal manifestations in Crohns disease

Extra-intestinal manifestations of IBD occur in approximately 15 of all Crohn's disease patients but in up to 30 of those with colonic disease (Jewell 2000b). The extraintestinal features present in Crohn's disease are similar to those experienced in ulcerative colitis. They include erythema nodosum, peripheral arthritis and ocular lesions. Less commonly (< 5 ), patients report pyoderma gangrenosum, primary sclerosing cholangitis, renal complications and anky-losing spondylitis.

Crohn disease

Crohn disease, when associated with extensive ileal disease or loss, conveys a 2 to 3 fold increased risk of developing gallstones.61 Although once believed due to bile acid malabsorption and depletion leading to cholesterol gallstones, recent studies have found an increased frequency of pigment stones. Unabsorbed bile acids that escape into the colon function as a biologic detergent to solubilize bilirubin and thus increase its absorption and enterohepatic cycling. The resultant increased pigment in bile then promotes stone formation.62

Crohns disease

Crohn's disease is a chronic inflammatory condition, characterised by periods of remission and exacerbation. It can affect any part of the gastrointestinal tract but occurs most commonly in the terminal ileum. Patients with Crohn's disease develop classical symptoms of diarrhoea and abdominal pain, often associated with weight loss. Crohn's disease and ulcerative colitis are often grouped together under the term inflammatory bowel disease (IBD). The

Differential Diagnosis

Multiple diseases can present with findings similar to those seen with Adamantiades-Behget's disease and should be considered when a patient presents with recurrent oral or genital ulcers, inflammatory eye disease, or other manifestations of vasculitis. Included in the differential diagnosis are systemic lupus erythematosus (Chapter 1), seronegative spondyloarthropathies, inflammatory bowel disease (Crohn's or ulcerative colitis) (Chapter 20), herpes or other viral infections (Chapter 10), other forms of vasculitis (Chapter 8), and inflammatory skin diseases such as pemphigus vulgaris or pemphigoid lesions (Chapter 37). All patients presenting with oral and genital ulcerations should undergo testing for herpes simplex virus using culture or polymerase chain reaction methods, to ensure that viral infection is not present.

Total Parental Nutrition

Total parental nutrition (TPN) is a well-known risk factor for developing microlithiasis (biliary sludge) and gallstone disease, along with acalculous cholecystitis in critically ill patients.40 In an intensive care setting, biliary sludge appears after 5 to 10 days of fasting. After 4 weeks of TPN, half of those on TPN develop gallbladder sludge after 6 weeks all show evidence of sludge. Most are asymptomatic. Fortunately, sludge resolves within 4 weeks of discontinuing TPN and resuming an oral intake, a pattern similar to sludge appearing during pregnancy and rapid weight loss sludge disappearing after the inciting event resolves.41 A possible explanation for this relates to loss of the enteric stimulation of the gallbladder in the absence of eating, leading to gallbladder stasis.40 Additionally, ileal disorders, such as Crohn disease or ileal resection, in which TPN is frequently required, can affect the enterohepatic cycling of bile acids and thus augment bilirubin absorption and...

Screening experiments for antiinflammatory properties

This chapter describes some examples of screening experiments aimed at identifying antiinflammatory constituents of plants. A large number of plants and herbs are known for their anti-inflammatory properties. Well-known examples are willow bark (contains salicin, from which aspirin is derived), Boswellia serrata (boswellic acids) and turmeric (curcumin). In addition to these, many other herbs have been suggested to be anti-inflammatory. Inflammation plays a role in many different clinical disorders. In addition to the obvious inflammatory diseases such as arthritis, asthma, Crohn's disease, psoriasis and so on, inflammation also plays an important role in diseases such as atherosclerosis, diabetes, Alzheimer's and many other diseases. In many of these, a disordered immune system contributes to the onset and or progression of the disease. et al., 2003). Adhesion molecules that are involved in the translocation of immune cells from the circulation into the sites of inflammation are also...

Dietary Fiber Obesity and the Etiology of Diabetes

Inflammatory bowel diseases (colitis and Crohn's disease) Clearly, inflammatory conditions have an immune component. In the case of Crohn's disease, there appears to be no established therapeutic or etiological role for fiber. The situation is slightly different for distal ulcerative colitis, in which fiber intake seems unrelated to incidence. However, rectal infusion of SCFAs (especially butyrate) has been reported to lead to remission, so it appears that either the generation of these acids or their delivery to the distal colon may be the issue.

Indications Frankincense

Abscess (f HAD) Alzheimer's (1 COX FNF) Anxiety (f BOW) Arthrosis (1 COX FNF) Asthma (f1 HHB X12244881) Backache (f HAD) Bilharzia (f BIB) Bleeding (f BIB HAD) Boil (f DEP) Bronchosis (f1 BIB DEP X12244881) Bruise (f HAD) Callus (f BIB) Cancer (1 COX FNF JLH) Cancer, anus (1 BIB COX) Cancer, breast (1 BIB COX) Cancer, eye (1 BIB COX) Cancer, penis (1 BIB COX) Cancer, spleen (1 BIB COX) Cancer, teat (1 BIB COX) Cancer, testicle (1 BIB COX) Carbuncle (f DEP JLH) Cerebrosis (1 X12244881) Chest ache (f BIB) Colitis (1 FNF X12244881) Congestant (f HAD) Corn (f JLH) Cough (f HAD) Crohn's Diseases (1 X12244881) Dermatosis (f GMH) Dysentery (f BIB) Dysmenorrhea (f BOW) Dyspepsia (f HAD) Edema (1 FNF) Fever (f BIB) Gingivosis (f BOW) Gonorrhea (f BIB) Hemorrhoid (f HAD) Hepatosis (1 PR14 510) Infection (f BOW) Laryngitis (f BIB DEP) Leprosy (f BIB) Leukemia (1 FNF) Mastosis (f GHA JLH) Meningioma (1 FNF) Myelosis (f HAD) Neurosis (f BIB GHA HAD) Ophthalmia (f GHA JLH) Orchosis (f JLH) Pain (f...

Pathophysiology Of The Small Bowel

Important pathological conditions of the small intestine that will be considered in this section include duodenal ulcer disease, bacterial and viral infections, Crohn's disease, vitamin B12 deficiency, small bowel carcinomas and malabsorptive conditions, including coeliac disease.

Secondary Deficiency

This is caused by compromised absorption, increased excretion or increased demands or losses. Inadequate absorption can occur in malabsorption syndromes such as coeliac and Crohn's disease, with long-term use of certain medications such as phenytoin, sulfasalazine, cimetidine, antacids and OCP, in congenital malabsorption states and in blind loop syndrome (Beers et al 2003), especially when combined with suboptimal dietary intake (Carmel 2006). Significantly impaired absorption has also been observed in HIV patients (Revell et al 1991).

Amy L Halverson Indications

Complete removal of the colon and rectum is indicated in patients with Crohn's colitis involving the colon and the rectum. It may also be appropriate for selected individuals with ulcerative colitis or familial adenomatous polyposis (FAP) who are not candidates for reconstruction with an ileal pouch-anal anastomosis. Indications for proctocolectomy in patients with Crohn's disease or ulcerative colitis include symptoms not responding to medical therapy or dysplasia identified on surveillance biopsy.

Inflammatory bowel disease Introduction

Crohn's disease and ulcerative colitis are idiopathic chronic diseases. Although they are generally recognised as distinct clinical syndromes they are very closely related illnesses and are commonly grouped together under the term inflammatory bowel disease (IBD). In this section nursing care will be examined without distinction between Crohn's disease and ulcerative colitis. Current best practice in IBD has been published by the BSG (1996). The prevalence of Crohn's disease varies between geographical locations. It affects 5 in 100 000 of the population in Northern Europe, the United States of America and Australia but appears less common in other areas of the world. It is likely that 20 000-30 000 individuals are affected in the UK (www.bsg.org.uk accessed 8 May 2000). Crohn's disease occurs more frequently among Caucasians than those of Asian and African origins. The incidence of Crohn's disease in British Asians is higher than in natives from the Indian sub-continent. Similarly,...

Defining Chronic Enteropathy

For the present discussion, chronic enteropathy is defined as chronic functional derangement of the small bowel. The primary consequence of chronic enteropathy is persistent diarrhea which is loose or watery stools at least 3 times per day of more than 14 days' duration, with change in stool consistency more meaningful than stool frequency. Depending on the specific pathophysiology, other symptoms may dominate the clinical picture for example, Crohn's disease may present with bloody stool or the child with celiac disease (CD) who, able to partially compensate for reduced absorptive capacity by increasing dietary intake, may present with stunting.

Aetiology and pathogenesis

Notwithstanding the genetic and environmental predisposing factors, the aetiology of both Crohn's disease and ulcerative colitis remains unknown. It is still debated whether Crohn's disease and ulcerative colitis are separate diseases or whether they represent a continuous spectrum of inflammatory bowel disease. There is continuing speculation that Crohn's disease may be related in some way to mycobacterial infection, although immunological and therapeutic studies do not show evidence of mycobacterial infection in the majority of cases.

Abdominoperineal Resection

Indications for abdominoperineal resection (APR) of the rectum can be categorized into absolute and relative. Absolute indications include malignancy of the rectum with sphincter involvement, carcinoma of the anal canal in an individual with prior pelvic radiation for an unrelated malignancy, carcinoma of the anal canal that is persistent or has recurred after combined modality chemotherapy and radiation, and anorectal Crohn's disease with uncontrolled local septic complications. Relative indications for APR include malignancy of the rectum not involving the sphincter when continence is already impaired preoperatively, ulcerative colitis or Crohn's proctitis requiring surgical intervention in an individual not desiring a sphincter-preserving procedure, and radiation-induced proctitis not responding to nonoperative measures or fecal diversion alone.

Irritable Bowel Syndrome IBS

IBS is one of the most common co-morbidities in FM, affecting 30 to 80 percent of FM patients. Previously, IBS has been known by names such as irritable colon, spastic colon, nervous indigestion, and functional colitis. Sometimes IBS is predominated by constipation, at other times by diarrhea, but it can also occur as constipation alternating with diarrhea. Symptoms include chronic constipation or frequent diarrhea associated with abdominal pain, tenderness, bloating, and gas. Sometimes symptoms are exacerbated by meals or stress and relieved by bowel movement. A smaller percentage of patients also have nausea, vomiting, and loss of appetite. Additionally, pain from bowel stretching is amplified by central sensitization. Although the pathophysiology is not completely understood, some believe that the syndrome is associated with altered gastrointestinal mobility and permeability. Fortunately, there is agreement that IBS is not associated with structural problems in the bowel and does...

What are genes What genes cause MS

Crohn's disease Mutations have occurred at a higher rate in the MHC region than in the rest of the human genome. Several mutations or alterations in this region that are more common in MS have been identified. These are sometimes referred to as polymorphisms. As you have undoubtedly heard the human genome project has deciphered our genetic code but many details regarding genes remain to be discovered. The human genome project is presently looking for a pattern of single nucleotide polymorphisms (SNPs pronounced as snips ) (i.e., a signature group of gene alterations in MS). Once an individual SNP is identified a search for the identity and function of the actual gene follows. A number of SNPs are anticipated to be associated with a predisposition to MS, as has been established for Crohn's disease, another autoimmune illness. Separately, in a recent Swedish study funded by the Montel Williams Foundation, the MHC2TA gene

Inflammatory Bowel Disease

Patients with Crohn's disease have widespread and intermittent gastrointestinal inflammation. Some patients with inflammatory bowel disease may require complete bowel rest for several days or even a few weeks to allow time for mucosal healing. In order to provide nutrition during this period, parenteral nutrition may be needed. Numerous studies have shown that patients with Crohn's disease may safely and effectively achieve clinical remission with primary nutritional therapy. Early literature in the field highlighted the use of protein hydrolysate formulas that, due to unpalatability, often required supplementation with a nasogastric or gastrostomy tube. Recent data have confirmed that intact protein formulas, termed 'polymeric' formulas when describing formulas designed for adults, may work as well as protein hydrolysates, and these formulas can feasibly be given by mouth.

The Reverse Paradigm Underlying Pathology Revealed by Detection of Abnormal Nutrition

Classically, in type 2 diabetes, unexplained weight loss is a presenting complaint when polyuria is mild or absent. Moreover, with common forms of childhood gastrointestinal disorders, such as celiac sprue or Crohn's disease, arrested linear growth is often the first clue that something is clinically awry. It provokes the diagnostic inquiry that leads to the recognition of the bowel lesions. In milder presentations of cystic fibrosis, a similar growth failure occurring in infancy, can indicate an underlying pathological disorder.

Potential Effects Requiring Further Clinical Work

Inflammatory bowel disease Inflammatory bowel disease (IBD) comprises a heterogeneous group of diseases of unknown etiology (Crohn's, ulcerative colitis, and pouchitis), but here also factors related to the intestinal microflora seem to be involved, providing a rationale for the application of probio-tics. From reviewing studies on the use of probiotics in IBD it can be concluded that, although there are some promising preliminary findings, more well-planned long-term studies are needed before any firm conclusions can be drawn.

Target Nutrient Intake Achievement Failed or Impossible

To disease and malnutrition), neurological impairment preventing oral feeding, substantially increased requirements with relative anorexia (e.g., in burn cases), or chronic obstructive lung disease with severe dyspnea. However, for diseases of the pharynx, esophagus, or stomach or in cases of surgery of the esophagus, stomach, or pancreas, patients usually require intubation of the stomach or intestine by percutaneous gastrostomy or operative jeju-nostomy to allow feeding beyond the site of obstruction. If there is an abnormality of the intestinal tract, such as short bowel with more than 60 cm of available small intestine, IBD, or chronic partial bowel obstruction, diets must be delivered carefully with the aid of a pump to avoid surges of delivered fluid diets and consequent distension of the bowel. Despite careful selection, a proportion of patients expectantly fed via the nasogastric or nasoenteral route will show intolerance, complications, or inability to meet target nutrient...

Presentday Cultivation And Usage

Both in vitro and in vivo studies have resulted in a wide array of pharmacological actions attributed to nutmeg seeds, including antioxidant, antifungal, antibacterial (Takikawa et al., 2002), aphrodisiac (Tajuddin etal., 2003), anti-inflammatory (Olajide etal., 1999), and hepatoprotective activities. Nutmeg seeds are used to control diarrhea and Crohn's disease, as they inhibit prostaglandin activity in the intestine. Nutmeg seeds also improve Alzheimer's disease, as they directly affect acetylcholinesterase activity in the brain. Nutmeg seed essential oil is used in aromatherapy, because the three main constituents of nutmeg (myristicin, elemicin, and isoelemicin) act as stress relievers.

Antiinflammatory And Analgesic

In vitro data has shown that nettle leaf extract (IDS 30) reduces the induction of primary T-cell responses and TNF-alpha in T-cell mediated diseases such as RA (Broer & Behnke 2002). Faecal IL-1 -beta and TNF-alpha concentrations were significantly reduced in mice with induced Crohn's disease treated with IDS 30 (Konrad et al 2005). Mice treated with nettle extract displayed fewer histological changes and general disease symptoms. The authors conclude that the effect may be due to a decrease in Th1 response and may constitute a new treatment option for prolonging remission in inflammatory bowel disease.

TNF Blockade An Inflammatory Issue

Tumor necrosis factor (TNF), initially discovered as a result of its antitumor activity, has now been shown to mediate tumor initiation, promotion, and metastasis. In addition, dysregulation of TNF has been implicated in a wide variety of inflammatory diseases including rheumatoid arthritis, Crohn's disease, multiple sclerosis, psoriasis, scleroderma, atopic dermatitis, systemic lupus erythematosus, type II diabetes, atherosclerosis, myocardial infarction, osteoporosis, and autoimmune deficiency disease. TNF, however, is a critical component of effective immune surveillance and is required for proper proliferation and function of NK cells, T cells, B cells, macrophages, and dendritic cells. TNF activity can be blocked, either by using antibodies (Remicade and Humira) or soluble TNF receptor (Enbrel), for the symptoms of arthritis and Crohn's disease to be alleviated, but at the same time, such treatment increases the risk of infections, certain type of cancers, and...

Historical perspective of psychological influences in IBD

Crohn made several links between psychological variables and Crohn's disease. Since the first recognition of Crohn's disease in the 1930s, gastroenter-ologists, surgeons, psychologists and psychiatrists have striven to find a relationship between psychological variables and physical symptoms. This link has been examined in four ways

Personality associations in IBD

Certain personality traits have been shown to be present in patients with IBD. For example, Crohn's disease sufferers were viewed as constantly wishing to 'be rid of ' events in their lives and were described as 'obsessive compulsive' in nature and in a state of dependency. Personality traits such as repressed rage, suppression of feelings and anxiety are closely associated with Crohn's disease. These early psychological studies in IBD must be viewed with caution many of the described personality traits are common in any chronic physical illness and are probably not specific to IBD.

Psychopathology in IBD

Using validated criteria produced by the American Psychiatric Association, it has been shown that patients with Crohn's disease have a high prevalence of psychiatric conditions but there is no association between the degree of physical morbidity and the presence of psychiatric disorders. The prevalence of psychiatric illness is similar in ulcerative colitis and non-ulcerative colitis, with no evidence of an association between psychiatric illness and physical morbidity. There are limited links between physical morbidity and psychiatric illness in ulcerative colitis. In contrast, patients with Crohn's disease have been shown to have a significantly increased incidence of psychopathy and a clear association between the presence of psychiatric illness and degree of physical morbidity (Helzer et al. 1984). One-third of studies undertaken have shown that Crohn's disease causes significant psychiatric morbidity. Affective symptoms, such as anxiety, predominated. Most studies indicate that...

Relationships with interpersonal factors in IBD

Sources of anxiety in IBD patients include concern about surgery, lethargy, perceptions of body-image and hygiene. These concerns may have a significant influence on an individual's psychological health. Patients with ulcerative colitis and Crohn's disease have different worries. Crohn's disease patients appear more concerned with the impact of their disease upon lifestyle, whereas ulcerative colitis patients more commonly report fears of cancer. In terms of educational attainment and employment prospects, IBD patients may lose time from their studies due to their disease, but this does not appear to affect their academic achievements, as measured by exam success. Many more Crohn's disease patients, compared to healthy controls, experience long spells of unemployment, although relatively few lose their job because of their disease. Many patients actively concealed their illness from their employer because it has been shown that employers can practise discrimination against IBD...

Clinical nurse specialists in IBD

Clinical nurse specialists in IBD are valuable and cost-effective members of gastroenterology teams. IBD nurse specialists have well-defined roles in delivering clinical care, such as specialised care, medication monitoring, patient education and psychological support. Research undertaken to date on IBD clinical nurse specialists has been very general in its nature and there is limited evidence to highlight the specific benefits that an IBD nurse specialist may have upon specific sub-groups of IBD patients (i.e. patients with stoma, patients on specific medications such as methotrexate or infliximab, or patients who receive nurse counselling). The chronicity of IBD and the effects of treatments (surgical and medical) have an impact on the daily life of IBD patients and therefore must influence health-related quality of life (HRQoL). Chapter 14 highlights impaired quality of life in patients with IBD. Patients with Crohn's disease appear more affected by their disease in terms of HRQoL...

Diseasespecific measures in gastroenterology

Inflammatory bowel disease (IBD) has been exposed to extensive evaluation in the HRQoL literature. IBD encompasses both ulcerative colitis and Crohn's disease and is a significant chronic disease affecting primarily young individuals. There is little doubt that inflammatory bowel disease can have a major adverse impact upon many patients' lives. The manifestations of IBD are often severe and affect multiple aspects of a patient's life. Patients with IBD have also been characterised as having psychological problems, such as anxiety and maladaptive coping mechanisms. The disease processes of both Crohn's disease and ulcerative colitis are characterised by cycles of remission and exacerbation of physical symptoms such as altered bowel habit, bowel urgency, abdominal pain, rectal bleeding, weight loss and malnutrition, which in conjunction with psychosocial factors may contribute to overall impairment of quality of life. Emphasis in care is clearly focused on the control of physical...

Nonskeletal Consequences of Vitamin D Deficiency

20ngml 1 and preferably 30ngml 1 is necessary for various organs including colon, breast, and prostate to convert it to 1,25(OH)2D, which in turn can help regulate various genes responsible for cell growth and differentiation. This could be the explanation for how vitamin D sufficiency is protective against most common cancers. The immune cells also recognize 1,25(OH)2D3. This may explain why children who at 1 year of age had received 2000 IU of vitamin D a day decreased their risk of developing type I diabetes by 80 . Increasing intake of vitamin D and sun exposure has now been associated with decreased risk of developing multiple sclerosis, rheumatoid arthritis, and even Crohn's disease.

Drug Delivery to the Colon

Abstract The colon is a challenging target for drug delivery, as reaching the distal regions of the gastrointestinal tract presents significant physiological challenges and environmental barriers. Many approaches have been used to surmount these, with mixed success rates. Colonic delivery has historically been limited to treatment of local conditions such as inflammatory bowel disease. Latterly, efforts have also concerned delivery for treating colon cancer and for systemic delivery of selected compounds. Such approaches have concerned use of enteric coatings, sustained release systems, bacterially triggered treatments, or combinations of these. Possibilities are discussed in this chapter, along with historical experiences with systems for treating ulcerative colitis and Crohn's disease.

Pathogenesis Of Pigment Gallstones

Phenomenon explains the high prevalence of black pigment stones in chronic hemolytic disorders, such as sickle cell anemia, hereditary spherocytosis, and Gilbert syndrome. Concomitant presence of Gilbert syndrome is associated with increased gallstone prevalence in sickle cell disease.66 Evidence from experimental animal models indicates that enterohepatic cycling of bilirubin may contribute to high frequency of pigment stones in patients with ileal Crohn disease, especially in case of ileal resection. The proposed mechanism is that increased amounts of bile salts reach the cecum and solubilize unconjugated bilirubin, allowing their reabsorb-tion with subsequent hyperbilirubinobilia.67-69 A similar mechanism could contribute to increased incidence of pigment stones in patients with cystic fibrosis.70 Interestingly, prevalence of Gilbert syndrome is increased in patients with cystic fibrosis and gallstones, suggesting that hemolysis could also contribute to pigment stone formation in...

Infectious parotitis See mumps

Inflammatory bowel disease (IBD) The general name for diseases that cause inflammation of the bowels, including ulcerative colitis and Crohn's disease. Although these two diseases are similar, there are also some important distinctions. Ulcerative colitis is an inflammatory disease of the inner lining of the large intestine, which becomes inflamed and ulcerates. Ulcerative colitis is often most severe in the rectal area and can cause frequent bloody diarrhea. Crohn's disease, on the other hand, affects the last part of the small intestine, although it can also affect any part of the digestive tract. Moreover, Crohn's disease tends to Scientists do not yet know what causes inflammatory bowel disease, although they suspect that a number of factors may be involved, including the environment, diet, and heredity. Smoking appears to increase the likelihood of developing Crohn's disease. A new theory suggests that Crohn's disease may be caused by infection (similar to cat scratch disease).

Dietary and Nutritional Management of Secondary Undernutrition

The syllogism for dietary and nutritional management is to get enough nutrients into the body to restore nutritional adequacy and balance, taking any chronic barriers to uptake and retention into consideration. The blend of nutrients must be tailored to the specific absorptive or utilization problems, e.g., compensatory fat-soluble vitamins in water-miscible forms with severe fat malabsorption, and extra doses of highly available iron with chronic blood loss. These can be delivered within a dietary context with supplements and fortified vehicles in nonacute conditions. Even nondietary routes have been devised as in the treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation.

Indications Generic

Abscesses (f CAN FAD) Adenopathy (f CRC DEM PH2) Bleeding (f CEB DEM) Blepharosis (f VAD) Boils (f1 APA CRC GMH PNC) Bronchosis (f CRC) Bruise (f FEL) Burn (f1 APA FAD GMH PH2 WAM) Cancer (f CRC FEL JLH) Carcinoma (f CRC) Cardiopathy (f GMH) Caries (f CRC) Catarrh (f CRC DEM GMH) Chilblain (f CEB) Childbirth (f CRC DEM) Cholera (f CEB) Cold (f SKY) Cold Sore (1 APA) Colitis (f1 APA CAN CRC GMH) Conjunc-tivosis (f CRC DEM) Constipation (f CRC) Corneosis (f VAD) Cough (12 APA FAD HHB WAM) Cramp (f CEB CRC) Crohn's Disease (1 SKY) Cuts (f FAD) Cystosis (f1 GMH WAM) Dermatosis (f1 APA PH2 PNC VAD WAM) Diarrhea (f1 APA CAN FAD) Diverticulosis (1 FNF) Duodenosis (f PH2) Dysentery (f CRC FAD) Dyspepsia (f1 FAD) Dysuria (f CRC) Eczema (f CRC) Enterosis (12 APA CEB GMH) Erysipelas (f FEL) Esophagitis (2 APA) Felon (f CRC JLH) Fever (f CRC DAW) Fistula (f FEL) Fracture (f CRC DEM) Gangrene (f CRC) Gastrosis (12 APA GMH PHR PH2 SKY) Gleet (f FEL) Gonorrhea (f DEM) Gout (f CRC HH2 PH2) Heartburn...

Inflammatory Autoimmune

Crohn's disease is an inflammatory disease of the GI tract, of unknown etiology. It is characterized by mucosal ulceration that extends through all layers of the digestive tract wall and is not limited to any one area of the GI system from mouth to anus. Approximately 10 of patients with Crohn's disease have pharyngeal involvement. Most commonly, ulcerative lesions are seen on the pharyngeal walls. The epidemiology, pathogenesis, diagnosis, treatment, and prognosis are discussed in more detail in Chapter 20.

Immunological Inflammatory Diarrheal Disorders

Regulator Cell Activation

If a child presents with an AIE, the onset is often within the first 3 or 4 months in the form of severe diarrhea which can be bloody 15 . The majority of boys with AIE present in addition with severe atopic skin disease, hema-tological abnormalities along with endocrinopathy, such as insulin-dependent diabetes mellitus or thyroiditis. This association was described as IPEX (immune dysregulation, polyendocrinopathy, autoimmune enteropathy, X-linked) syndrome 15, 17, 18 . It is interesting to note that boys with IPEX also show severe immunoallergic symptoms with a strong Th2 response and hyper-IgE syndrome having some similarities with extremely severe food allergy. Isolated or oligosymptomatic forms of severe AIE exist in both, boys and girls. Prior to the onset of AIE IPEX, these children develop completely normal, and no antenatal or neonatal particularities exist 19 . It is important to stress that the family history is most often positive for various autoimmune diseases. This...

Hepatobiliary Disorders

Primary sclerosing cholangitis This disorder most commonly presents in association with ulcerative colitis and less commonly with Crohn's disease or as an isolated entity. The nutritional management of the disorder is essentially like that of other cholestatic disorders in patients with Crohn's disease of the small bowel, aggressive administration of an elemental diet rich in medium-chain triglycerides may be beneficial. It is accepted, however, that endoscopic interventions should be used as needed in the case of significant biliary obstruction. For prevention of severe osteoporosis, supplementation with vitamin D and calcium is needed. Vitamin K and alendronate may be beneficial in increasing bone mineral density. Serum levels of the fat-soluble vitamins should be monitored in high-risk patients and vitamins replaced as appropriate.

Carbohydrate Malabsorption

Lactose intolerance Lactose intolerance is defined by the occurrence of symptoms due to the inability to digest lactose, the main carbohydrate in milk. These symptoms may include abdominal pain, bloating, diarrhea, or flatulence. Lactose malabsorption is attributed to a relative deficiency of the di-saccharidase lactase. Primary lactase deficiency is a condition in which lactase activity declines after weaning. Secondary lactose intolerance is usually due to mucosal injury associated with a condition or disease such as infectious diarrhea, Crohn's disease, or short bowel syndrome.

Hypercholesterolemia high blood cholesterol

Orlistat A lipase inhibitor used for weight loss. Lipase is an enzyme found in the bowel that assists in lipid absorption by the body. Orlistat blocks this enzyme, reducing the amount of fat the body absorbs by about 30 percent. It is known colloquially as a fat blocker. Because more oily fat is left in the bowel to be excreted, Orlistat can cause an oily anal leakage and fecal incontinence. Orlistat may not be suitable for people with bowel conditions such as irritable bowel syndrome or Crohn's disease.

Acquired immunity to foodborne pathogens

Inappropriate and unregulated TH1 cytokine production is associated with the chronic inflammatory condition, Crohn's disease (Russell et al., 2004). This condition is linked to mutations in the gene encoding NOD2, an intracellular pattern recognition receptor that plays a role in sensing a component of peptido-glycan, muramyl dipeptide (Cario, 2005). A regulated inflammatory response mediated through NOD2 is essential for resistance to both Salmonella and L. monocytogenes (Cario, 2005). However, mutation of NOD2 in mice leads to an inappropriate reaction to commensal bacteria and an increase in TH1 cytokines (TNF-a and IFN-7) that result in the symptoms of chronic inflammation (Netea et al., 2004 Cheroute and Kronenberg, 2005). Cells from mice with NOD2 T cell priming in the presence of IL-4 and absence of IL-12 results in development of a TH2 T cell response in which T cells are induced to secrete IL-4, IL-5 and IL-13 (Mosmann, 1986 Murphy and Reiner, 2002 Finkelman et al., 2004)....

Pathophysiology of Stone Formation

Small bowel diseases Crohn's disease Terminal ileum resection Drugs Estrogens Ceftriaxone Other conditions predisposing to gall bladder disease Insulin-resistant diabetes predisposes to cholelithiasis. A Swedish study showed that the prevalence of gall stones in Crohn's disease was twice that seen in the general population. Cirrhosis is another major risk factor for gall stones. The incidence of gall stone formation in cirrhosis is 10 times that seen in the general population. The incidence increases with the severity of cirrhosis, being worse in Child's class B and C disease and in patients with higher body mass index. High estrogen level and reduced hepatic synthesis and transport of bile salts are reasons for the increased risk in cirrhosis. The Physicians' Health Study showed that 30 minutes of endurance-type exercise five times per week prevents approximately one-third of cases of symptomatic gall stones in men. The Nurses' Health Study confirmed the same trend in women.

Inflammatory Diseases

Numerous clinical trials have investigated the effects of fish oil supplementation in several inflammatory and autoimmune diseases, such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, lupus erythematosus and migraine headaches (Belluzzi 2002, Belluzzi et al 1996, Miura et al 1998, Simopoulos 2002). Although not all trials have produced positive results, many of the placebo-controlled trials reveal significant benefit in chronic disease, including decreased disease activity and sometimes, reduced requirement for anti-inflammatory medicines (Adam et al 2003). Rheumatoid arthritis Of the inflammatory diseases, the use of fish oil supplementation is most widely seen in RA. According to multiple randomised, controlled studies, fish oil supplements have been consistently shown to reduce symptoms in RA, such as the number of tender joints on physical examination and the amount of morning stiffness (Adam et al 2003, Cleland et al 2003, Kremer 2000, Ulbricht & B sch 2006,...

Pathophysiology and Symptoms

The most common cause of protein malabsorption is so-called protein-losing enteropathy. Etiologies include diffuse mucosal disease such as celiac disease or Crohn's disease, elevated right heart pressure with resultant dilatation of lymphatics and leakage of lymph into the lumen, and colitides such as Shigella or Salmonella infections. Since protein is a relatively minor component of dietary energy compared with carbohydrate and fat, symptoms of protein malabsorption can sometimes be minimal. However, infectious colitis or exacerbations of inflammatory bowel disease often present with frequent loose stools, which may be bloody. Rare, congenital etiologies of protein malabsorption include enterokinase and trypsinogen deficiencies (Table 1).

Other Causes Of Musculoskeletal Symptoms Inflammatory Bowel Disease

Approximately 2 of all patients with inflammatory bowel disease (IBD) present before the age of 10 years, but 30 present between the age of 10 and 19 years (117). Diagnosis is easy when patients present with the classical triad of bloody diarrhea, abdominal pain, and weight loss, but not infrequently, young people will present with extraintestinal manifestations such as arthritis, cutaneous disease, uveitis, depression, and growth or pubertal delay. These extraintestinal expressions are more common in Crohn's disease, but are also well recognized in ulcerative colitis. Rarely, these manifestations, particularly arthritis, can be the only initial symptom for months to years in children with IBD (117). Usually, arthritis develops after diagnosis of bowel disease and is seen in 7 to 21 of children with IBD (118,119). The most typical pattern of disease is peripheral polyarticular presentation particularly affecting lower limbs (118,119). This form of arthritis tends to improve with...

Infections Food Poisoning

The vitally important area of food poisoning is dealt with in more detail elsewhere. This section outlines the principal infections affecting the small intestine. Bacteria such as Campylobacter jejuni, enteroinva-sive Escherichia coli (EIEC), shigella, salmonella, and yersinia can cause food poisoning, which is dominantly colitic (dysentery) with a bloody, pus-containing diarrhea, by invading the mucosal surface. Enterohemorrhagic E. coli produce a bloody diarrhea secondary to adherence in the colon and toxin production. These then dominantly affect the colon. Yersinia and (non-typhoid) salmonella domi-nantly invade the lower small bowel (ileum), producing low abdominal pain and diarrhea. Yersinia infection can be acute or occasionally more chronic, mimicking Crohn's disease. Tuberculosis is another chronic infection that can affect especially the terminal ileum and mimic Crohn's disease. Other infective agents, such as enterotoxigenic E. coli (ETEC)

Artificial Nutritional Support

For feeding over longer time periods, a PEG tube inserted under local anesthetic offers greater comfort, toleration, ease of use, and reported improvements in nutritional status. However, costs are greater and this more invasive procedure carries a technique-related fatality of 1-2 . Minor complications include sto-mal sepsis, leaking, and outlet blockage. Peritonitis, perforation, gastrointestinal bleeding, and intestinal obstruction can occur, but are rare. Most enter-ostomy catheters are made from nonacid-hardening polyurethane or silicone and can be left in situ for up to 6 months. No consensus exists concerning the time period within which gastrostomy feeding should be initiated following stroke, but it should he considered where dysphagia is likely to persist beyond 14 days, and earlier for those intolerant of nasogastric tube feeding. In a small number of cases, enteral nutrition may be contraindicated following stroke owing to gastrointestinal bleeding resulting from severe...

Are there treatments to prevent attacks and lessen risk of disability

Ized by 6 weeks of treatment and the accompanying reduction of sustained disability, the drug has been withdrawn from the market. The withdrawal was necessary because, unfortunately, 2 of the 589 patients who had received Avonex and Tysabri (one for 23 and the other for 37 months) developed PML, a fatal opportunistic viral disease of the brain. In addition, a patient with Crohn's disease who had received multiple drug therapies also developed this disease. Of the approximately 3,000 patients with MS, Crohn's disease, or rheumatoid arthritis, the only patients who developed PML were those two MS patients on combined Tysabri and Avonex therapy and the Crohn's disease patient who had received multiple immuno-suppressants as well as Tysabri. The drug has been withdrawn from the market pending a full review of the relevant facts.

Medical management of ulcerative colitis

Azathioprine and 6-mercaptopurine have been used extensively in IBD. They have been mostly used in Crohn's disease but have also been shown to be effective in the treatment of active ulcerative colitis. They act by damping down immune reactions, probably by indirectly blocking the synthesis of DNA and by direct action on types of white blood cells associated with inflammation. However, their action is slow and they have to be taken for over three months for benefit. Immunosuppresive therapies are particularly helpful in producing remission and preventing relapse in IBD. Antibiotics have long been viewed as a potential treatment option in inflammatory bowel disease in specific clinical situations. Metronidazole is a useful agent for managing peri-anal disease and may also suppress Crohn's disease activity. Other antibiotics have a role in treating septic complications.

The Hap Map Project

In 2005, the first phase was completed with the identification of > 50 disease-associated genes. On October 17, 2007, the second phase linked type 2 diabetes, Crohn's disease, elevated blood cholesterol, rheumatoid arthritis, multiple sclerosis, and prostate cancer to mutated genes. The project has catalogued > 2.8 million SNPs in individual human genes.

Discussion

Wahn As I said many people are developing wild ideas. One candidate is Trichuris suis which is known to gastroenterologists and is involved in Crohn's disease and chronic inflammatory disease. We are about to start a placebo-controlled trial on both the prevention and intervention of atopic phenotypes in hay fever.

Arthritis

2002) and a double-blind study of 89 subjects with rheumatic complaints using powdered devil's claw root (2 g day) for 2 months, which also provided significant pain relief, whereas another double-blind study of 100 people reported benefit after 1 month (Bone & Walker 1997). A case report suggests that devil's claw relieved strong joint pain in a patient with Crohn's disease (Kaszkin et al 2004).

Bowel Disorders

In inflammatory bowel disease (IBD) high fiber diets have no special part to play in the management of Crohn's disease where enteral feeding (with formula low-residue, low-fiber preparations) is especially beneficial where there is acute extensive small bowel disease. In ulcerative colitis specific dietary advice is usually unnecessary though fiber supplements may be of benefit in patients whose disease is limited to proctitis (inflammation of the rectum).

Gut Repair

L-glutamine enemas, twice daily for 7 days, have been shown to reduce mucosal damage and inflammation in experimental models of colitis in rats (Kaya et al 1999) however, preliminary trials in humans have not confirmed benefit. A 4-week study on 18 children with active Crohn's disease fed a glutamine-enriched polymeric diet (Akobeng et al 2000) and another 4-week study on 14 patients taking 7 g glutamine three times daily (Hond et al 1999a) showed similarly negative results. Longer term studies may provide more convincing results however, it is possible that glutamine only stabilises gut barrier function under certain conditions and more research is required to elucidate these.

Diarrhea

Diarrhea can be caused by bacteria, viruses, or parasites antibiotics, allergies or food sensitivities, milk, caffeine, fructose and sorbitol from fruit juices especially apple, pear, and grape dietetic foods that contain sorbitol stress, large amounts of supplemental vitamin C or magnesium or health conditions such as irritable bowel syndrome and Crohn's disease. If the illness lasts for more than several weeks or is accompanied by fever, severe cramps, or blood or mucus in the stool, call a physician. Because of diarrhea, beneficial bacteria are flushed out of the intestine and need to be replaced with acidophilus.

Predisposing factors

Since IBD tends to develop in young adults, factors occurring in childhood have been proposed breast feeding exerts a protective influence, but whether protection is a direct consequence of breast feeding or whether it arises from associated factors is unknown. One factor may be smoking and there is a large body of evidence indicating that patients with ulcerative colitis are likely to be non-smokers, whereas those with Crohn's disease tend to be smokers. Patients with Crohn's disease who do smoke have more relapses, hospital admissions, surgery and higher blood leukocyte counts than non-smokers. Thus smoking may be a risk factor for the development of Crohn's disease and is associated with more severe disease. Studies have shown that both Crohn's disease and ulcerative colitis occur more commonly than expected by chance within families. For example, a study in Wales showed that the prevalence of IBD in siblings of patients affected by Crohn's disease was almost 30 times greater than...

Drug therapy

Drugs used in the treatment of Crohn's disease can be broadly grouped into anti-inflammatory compounds, drugs that may act by affecting immune responses, anti-bacterial drugs and symptomatic treatments. Sulphasalazine has been widely used in the medical therapy of Crohn's disease. Unfortunately, sulphasalazine is less than ideal as many patients suffer side-effects (abdominal discomfort, nausea, vomiting and headache). Today there are newer aminosalicylates, particularly Pentasa , which are released in the ileum as well as the colon and that may have some value in preventing relapse of small bowel disease. The main role of corticosteroids in the medical mangement of Crohn's disease is to suppress acute inflammation of the gut. Currently hydrocortisone, prednisolone or methylprednisolone are used for severely ill patients in high doses equivalent to 60-80 mg of prednisolone a day. Oral prednisolone in doses of 40-60 mg a day is effective at achieving remission in less severely ill...

Nutrition

Total parenteral nutrition (TPN) has been demonstrated to be effective in controlling the disease activity and complications of Crohn's disease. Elemental diets have also been shown to alleviate disease activity in addition to improving nutritional status. Elemental diets are liquid diets that contain all the nutrients that the human body requires. These nutrients come in a digested form to place minimal stress on the digestive system. Elemental diets supply complete nutritional needs whilst resting the digestive system. The lower cost and reduced risk of complications with elemental diet favour its use over TPN in patients with Crohn's disease. The only circumstances in which TPN therapy is favoured are limited to patients with a very short gut or when there is near complete obstruction. Elemental diet has been found to be less effective in treatment of patients with ulcerative colitis. The mechanisms by which such nutritional therapies improve disease activity are unclear but may...

Downsides Cumin

Health hazards or side effects following the proper administration of designated therapeutic dosages are not known (PH2). A very weak oxidative mutagenic action has been revealed by cumin (X14531636). Spaniards (VAD) are more cautious but it may be generic for essential oils. Except for specified VAD indications, not for pregnant nor lactating women not for not children less than 6 years old. Not for patients with Crohn's, epilepsy, gastritis, hepatosis, IBS, neuroses, Parkinson's, and ulcers. There is a canned contraindication that could apply to every herb Do not prescribe alcoholic tinctures to recovering alcoholics (VAD).

Adalimumab

Fewer side effects, and the body's immune system is less likely to produce human antichimeric antibodies (HACAs) that attack the adalimumab molecule and block its effect than is the case with infliximab. Adalimumab has also proven effective in the treatment of Crohn's disease and seems particularly effective in children with psoriatic arthritis. Although adalimumab acts by directly binding to TNF-a rather than being a fake receptor, because it also serves to block the activity of TNF-a it shares with etanercept the increased risk of infection and possible future development of malignancy. Adalimumab and etanercept have a similar frequency of side effects, but adalimumab requires less frequent injections that etanercept. Children receiving adalimumab should be cautioned that the injections sting children who know to expect this seem to tolerate them without difficulty. The efficacy of adalimumab in children who have conditions that do not respond well to etanercept is sufficient to...

Antibiotics

Antibiotics are prescribed in gastroenterology for severe cases of infectious diarrhoea, Crohn's disease and treatment for bacterial infections, including Helicobacter pylori. Bacterial infectious organisms that respond to antibiotics include Escherichia coli, Shigella, Helicobacter, Vibrio cholerae and Clostridium difficile.

What is the futureI

The surprising new findings in Crohn's disease of a new genetic mutation in 80 of a subset of patients that provides a rational explanation for the illness seemed unlikely just a year ago. This is now is a reality however, no one really anticipates finding an MS gene. However, this new finding in Crohn's disease exemplifies now that good genetic and biological research can provide unanticipated new discoveries in medicine. Research is the key to the future in MS, as it is for all of the biological sciences and in medicine.

Bowel Rest

PN is often used when continued use of the gastrointestinal tract may not be advisable. PN may be selected for inflammatory bowel disease patients with severe acute exacerbations or for perioperative care. For patients with Crohn's disease, PN may aid the management of complications such as intestinal obstruction, fistula formation, short bowel syndrome, and severe diarrhea. Otherwise, enteral nutrition support is frequently used for nutrition support in inflammatory bowel disease with comparable efficacy. Bowel rest may also be indicated for selected enterocutaneous fistulas, which can occur as a result of complicated Crohn's disease, gastrointestinal or abdominal abscesses, abdominal surgery or trauma, ischemia, or tumors or their accompanying treatment regimens such as chemoradiation. Bowel rest can help to promote potential closure of fistulas and can improve nutritional status of these patients. Depending on the output of the fistulas, many of these patients are at risk for...

Stomatitis

Geographical Tongue Homoeopathy Remedies

Stomatitis refers to an inflammatory process involving the mucous membrane of the mouth that may manifest itself through a variety of signs and symptoms including erythema, vesiculation, bulla formation, desquamation, sloughing, ulceration, pseudomembrane formation, and associated discomfort. Stomatitis may arise due to factors that may be of either local, isolated conditions or of systemic origin. For example, a solitary oral ulcer with a history of a recurrent pattern may be classified as recurrent aphthous stomatitis, a purely local phenomenon. Another clinically-similar-appearing lesion, on the other hand, may represent an oral mucosal manifestation of a more generalized disease process such as Crohn's disease. Stomatitis may involve any site in the oral cavity, including the vermillion of the lips, labial buccal mucosa, dorsal ventral tongue, floor of mouth and hard soft palate, and gingivae. Patients will generally relate a history of recurrence of similar lesions. One of the...

Epidemiology

IBD presents in a bimodal manner as pertains to age, first in late adolescence or early adulthood and a smaller peak in the fifth decade of life. The sexes are equally affected by ulcerative colitis in adults, the incidence of Crohn's disease is 20-30 higher in women. In terms of trends in disease over time, the incidence of ulcerative colitis remained stable during the second half of the twentieth century Crohn's disease has demonstrated a marked increase across all age groups since 1950. Although IBD can affect all races, Caucasians are affected significantly more than Africans or people of African origin. Colonic risk of cancer from inflammatory bowel disease (Crohn's disease and ulcerative colitis) A high rate of concordance among Swedish mono-zygotic twins versus dizygotic twins has been reported for Crohn's disease (44 vs 3.8 ). In the same study, the incidence rate observed in monozy-gotic twins for ulcerative colitis was 6.3 . These data, although supportive of a genetic role,...

Complaints

Ulcerative colitis and regional enteritis are collectively referred to as inflammatory bowel disease (IBD). It is well known that some children with these diseases have arthritis that typically takes the form of a spondyloarthropathy and which may become evident before the IBD. Studies have demonstrated that many individuals with spondyloarthropathy have an unusual appearance to their gastrointestinal mucosa (lining). Exactly how this relates to developing arthritis is uncertain.

Outcome

The most important predictor of outcome in patients receiving home artificial nutritional support (enteral or parenteral) is the underlying disease. Therefore, mortality statistics strongly depend on the initial indications. Nevertheless, a few conclusions can be made. First, the complications associated with artificial nutritional support vary but are reported to be responsible for less than 3-5 of deaths. Second, the outcome is dependent not only on the type of disease but also on the stage of the disease (e.g., patients with advanced HIV who start HPN are only expected to survive a few months, whereas patients with less advanced disease are expected to survive longer). Third, the outcome of patients receiving HPN and HETF for a variety of conditions is available from the British Artificial Nutrition Survey (Table 6). For patients on HPN, overall mortality at lyear is 11 , with 16 returning to oral feeding and the majority continuing with HPN. Patients with Crohn's disease often...

Indications

Home parenteral nutrition The main indications for HPN are Crohn's disease, ischaemic bowel disease, motility disorders, or bowel and malignant disease. Patients receiving HPN are usually younger than those who receive HETF, although there is an overlap. There are also differences between the practice of HPN in different countries. One of the main differences concerns malignant disease. In the United States, 40-50 of patients receiving HPN have been reported to have cancer, and similar if not higher percentages have been reported in some European countries, such as Italy. Early reports from the United Kingdom and Denmark suggested that only a small proportion of HPN ( 5 ) involved patients with cancer, although this has increased with time. For example, in the United Kingdom it has steadily increased so that by 2003, one in seven patients starting HPN had cancer.

Influenza 273

However, an accurate diagnosis of ulcerative colitis may require an examination of the colon by inserting a colonoscope, which allows doctors to see the degree of damage. A biopsy of the colon may help confirm the diagnosis. To diagnose Crohn's disease, barium X rays can reveal characteristic signs of inflammation in the lining of the intestine. An upper gastrointestinal endo-scopy and colonoscopy may be performed to check for evidence of bowel damage caused by inflammation. If a child with IBD does not respond to these medicines, surgery may be considered, although the recurrent nature of Crohn's disease makes surgery a last-ditch effort. An aggressive surgical approach to Crohn's disease also can cause other complications, such as short bowel syndrome (which reduces the ability to absorb nutrients and also may cause growth failure).

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