The ABC’s of Crohn’s & UC: “I”
Next up in the alphabet series is the letter I. I never thought I’d be saying that when 20 years ago I would run out of the room when the letter I came on during Sesame Street. But I digress.
There are a lot of really important I’s, so read up!
IBD: IBD stands for Inflammatory bowel disease. IBD is the class of inflammatory diseases of the colon and small intestines. The main diseases that IBD refers to are Crohn’s Disease and Ulcerative Colitis. However, Collagenous colitis (inflammation of the colon that occurs often in the fifth decade of life and more frequently in women) and lymphocytic colitis (a rare condition characterized by non–bloody watery diarrhea) are sometimes categorized as IBD.
IBS: Also known as irritable bowel syndrome. Sometimes the wrong diagnosis before Crohn’s or Colitis is determined. It’s important to note that IBS is NOT the same as IBD.
Ileal Pouch-Anal Anastomosis: Also referred to as IPAA, it is a procedure that eliminates the need for a permanent stoma. During the IPAA surgery, the large bowel is removed and the small bowel is connected directly to the anus. According to the Boston Medical Center’s IPAA Center,
“During the ileal pouch-anal anastomosis (IPAA) procedure, a pouch is created from the end of a patient’s small intestine and attached to the anus. This restores continuity and control of stool passage for patients who have had their large intestines removed. It is referred to as an ileal pouch because it is made out of a portion of the small intestine, or ileum. An anastomosis is a surgically-created connection between tubular structures in the body, such as intestines.”
Ileocolitis: This is the most common type of Crohn’s Disease. It affects the ileum and the colon and is characterized by symptoms like weight loss, diarrhea, and cramps.
Ileitis: Another type of Crohn’s Disease that affects the ileum. It has the same symptoms as ileocolitis but also present are fistulas, which can develop in the lower right part of the stomach.
Ileostomy: This is a common procedure for those with IBD. During an ileostomy, an external opening in the abdomen is made during surgery by bringing the end of the small intestines out onto the surface, creating a stoma. A pouch is then connected to the stoma where intestinal waste passes into.
Ileum: The medical name for the final part of the small intestines. It is where Crohn’s Disease is commonly located and where my husband has the disease.
Immune System: The immune system is the part of the body that protects it from disease and illness. In a healthy body, the immune system attacks and kills foreign objects and viruses but leaves the normal bacteria found in our gut alone. However, in a person with IBD, the body senses that the bacteria in our gut is a foreign invader, and attacks it, ultimately attacking the body itself and causing inflammation.
Immunomodulators: One class of medication commonly used to treat Crohn’s Disease and Ulcerative Colitis, immunomodulators treat the diseases by weakening the activity of the immune system and thus, decreasing the inflammation found in IBD patients. According to CCFA, immunomodulators are used to treat patients who
- do not respond to aminosalicylates, antibiotics, or corticosteroids
- have steroid-dependent disease or frequently require steroids
- have experienced side effects with corticosteroid treatment
- have perineal disease that does not respond to antibiotics
- have fistulas (abnormal channels between two loops of intestine, or between the intestine and another structure—such as the skin)
- need to maintain remission
Commonly used immunomodulators include mercaptopurine (6-MP, Purinethol), azathioprine (Imuran, Azasan), methotrexate (Rheumatrex, Trexall), cyclosporine A (Neoral, Sandimmune), and tacrolimus (Prograf).
Imuran: One of the aforementioned immunomodulators. Imuran works slowly and can take three months or more before any changes are felt. Because of that, it is sometimes paired with a corticosteroid to help treat the disease or a flare.
Iron: Many patients with Crohn’s and UC are iron deficient. Because the body has trouble absorbing nutrients, the body doesn’t absorb iron from food. Additionally, patients who have had part of the small intestine removed may have a harder time absorbing iron. If you are extremely iron deficient, your doctor may recommend you take an iron supplement. In extreme cases, you may need an infusion of iron.
Isotretinoin: If you have cable, you’ve seen lots of commercials recently about the possible tie between the use of isotretinoin and the onset of Crohn’s or UC. Isotretinoin is most commonly known as Accutane and used to treat acne or cystic acne among other things. There is conflicting information about whether or not there is actually a link between the medication and IBD. According to the Mayo Clinic,
“The question of whether or not there is a link is further complicated by research that suggests a possible connection between the use of tetracycline class antibiotics and the development of IBD. Many people who have been treated with isotretinoin for acne also have received tetracyclines as part of their acne therapy. Studies that have examined the possible link between isotretinoin and IBD have not addressed the question of whether antibiotics used for acne may have played a role in increasing risk.”
Stay tuned for the next installment of the ABC series in the coming days!