Inflammatory Bowel Disease

This group of conditions are generally Ulcerative Colitis (Colitis - inflammation of the colon) and Crohns Disease and sometimes colitis cannot be classified and is termed Indeterminate Colitis. These are inflammatory conditions of the colon and in the case of Crohns disease can also affect the small bowel and even stomach. The condition affects both sexes at all ages with peak between 2nd and 4th decades. Aggregation within families can occur.

Cause:

The causes of these conditions is unknown. Many theories have been persued with no definitive answer.

What is it?:

Inflammation can lead to bleeding, ulceration and fistula (tunnel) or perforation (hole). Also scarring can lead to pain and blockage.

Symptoms:

Loose stool with blood and mucus is common in colitis. Small bowel disease can also cause diarrhoea and pain due to blockage. Weight loss may occur

Investigations:

  • Bedside examination and sigmoidoscopy can give indications of ulcerative colitis or anorectal Crohns disease.
  • Colonoscopy (generally not in the acute stage) and biopsy.
  • Barium Enema.
  • CT Scan
  • Small bowel contrast studies

Treatment: Medical treatment can be effective in both Ulcerative colitis and Crohns disease. Drug therapy is generally given in consultation with a Gastroenterologist.

Surgical Treatment:

(i) Urgent: Surgery for perforation, bleeding, obstruction, and severe colitis unresponsive to medical therapy is performed in a Major Hospital setting. Operations performed involve removal of the colon in most cases where these complications affect the colon. Often the rectum can be spared to allow for further surgery. In small bowel disease (Crohns) often resection of the affected segment with joining the small bowel together, but sometimes a ileostomy (stoma) is required. Widening of a stricture (strictureplasty) can also be performed for strictures of the small bowel.

(ii) Non-Urgent: Restorative Proctectomy (Pouch procedure) is the operation of choice in general for those patients with Ulcerative Colitis that have recovered from urgent colectomy.

Cancer Risk:

In long standing colitis cancer risk can increase after 7-10 years of inflammation particularly if the inflammation has been severe.

Follow Up:

Follow up is stongly recommended particularly in colitis where some or all of the colon remains.

Related Links:

www.fascrs.org/patients/Conditions_Videos/
www.cssanz.org/index.php/patients/crohns-disease
www.cssanz.org/index.php/patients/ulcerative-colitis