Bowel Disease Information

 

 

 

Inflammatory Bowel Disease (IBD), Ulcerative Colitis and Crohn's Disease

Ulcerative Colitis and Crohn's Disease are two types of Inflammatory Bowel Disease - conditions which causes the bowel (colon) to become inflamed and red. Both conditions can affect parts of the body outside the bowel and may be associated with poor general health.

 

Inflammatory bowel disease is a totally different condition from Irritable Bowel Syndrome (IBS) where the functioning of the bowel is affected but it looks normal in appearance.

 

Ulcerative Colitis and Crohn's Disease are long-term, chronic (ongoing) conditions which can flare up on and off throughout life.

 

Symptoms

  • Abdominal pain
  • Blood, mucus or pus in the stool
  • Diarrhoea
  • Fatigue and tiredness
  • Weight loss
  • Loss of appetite

 

People with Ulcerative Colitis may also develop other symptoms unrelated to the bowel. These can include mouth ulcers, skin problems, joint pains, and eye or liver problems.

 

Most of the time many people with Ulcerative Colitis feel well and don't have symptoms. This means the disease is not 'active' at this time, or can be said to be in remission. However, when the disease flares up and causes symptoms, this is known as a relapse. Most of the time a 'trigger' for a relapse can't be identified, although some people find that stress, infections, some medications or certain foods bring on an attack. It should be remembered that none of these is the cause of the disease itself.

 

Depending on where the inflammation occurs in the large bowel, Ulcerative Colitis can also be called Proctitis (involving the rectum only), Proctosigmoiditis or Distal Colitis (involving the rectum and sigmoid colon), or universal or pan-colitis, which means the entire colon is affected. Doctors don't know why some people's disease spreads to involve their entire colon yet in others the disease is confined to one area of it.

 

Causes of Ulcerative Colitis and Crohn's Disease

Unfortunately the cause is still unknown despite intensive research. Causative factors that have been suggested include:

 

  • Genetic predisposition
  • Infectious agents (bacteria and viruses)
  • Drugs
  • Smoking
  • Psychogenic factors
  • Defects in the immune system
  • Environmental factors

 

Some Doctors suggest a combination of some or all of these factors may be involved. Psychological stress and food allergies are not thought to play a role in development of the disease, but they may aggravate symptoms in some people.

 

Diagnosis

Ulcerative Colitis and Crohn's Disease are sometimes difficult to diagnose because its symptoms can be similar to other conditions such as bowel infections or Irritable Bowel Syndrome. Most people with the disease will generally need a colonoscopy, sigmoidoscopy, and barium meal or barium enema to confirm the diagnosis. Blood tests can reveal whether you have anaemia or any vitamin or mineral deficiencies.

 

Inflammatory Bowel Disease and Cancer

If you have had Ulcerative Colitis for a number of years, your risk of developing Colon Cancer is higher than people who do not have Ulcerative Colitis.

 

Your Doctor will probably advise you to have regular examination by colonoscopy. A biopsy (small tissue sample) will probably be taken during colonoscopy for microscopic examination to detect any changes in bowel tissue that might lead to cancer. Your Doctor will advise you on how often you should have these examinations depending on how long you have had the Ulcerative Colitis.

 

Diverticular Disease

Diverticular Disease is a common condition but only a small percentage of those with the disease have symptoms, and even fewer will ever require surgery.

 

Diverticula are pockets that develop in the colon wall, may involve the entire colon but usually in the sigmoid or the descending colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

 

Symptoms

The major symptoms of Diverticular Disease are abdominal pain (usually in the lower left abdomen), diarrhoea, cramps, alteration of bowel habit and occasionally, severe rectal bleeding. These symptoms occur in a small percentage of patients with the condition and are sometimes difficult to distinguish from Irritable Bowel Syndrome.

 

Diverticulitis - an infection of the diverticula - may cause one or more of the following symptoms: pain, chills, fever and change in bowel habit. More intense symptoms are associated with serious complications such as perforation, abscess or fistula formation.

 

Causes

Exact cause of the Diverticular Disease is not known, but there are indications are that a low-fibre diet over the years creates increased colon pressure and results in pockets or diverticula.

 

Diverticular Disease is unknown in rural Africans who eat a high fibre diet, but is common in western societies where many people have a low fibre intake. It is much less common in vegetarians.

 

Treatment

Diverticulosis and Diverticular Disease are usually treated by diet and occasionally, medications to help control pain, cramps and changes in bowel habits. Increasing the amount of dietary fibre (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressures in the colon, and complications are less likely to arise.

 

Diverticulitis requires more intense management. Mild cases may be managed without hospitalisation, but this is a decision made by your Doctor.

 

Treatment is aimed at resting the bowel, relieving pain and fighting infection. A low-fibre, or fluid-only diet, is recommended to rest the bowel.

 

Severe cases require hospitalisation with intravenous antibiotics and strict dietary restraints. Most acute attacks can be relieved with such methods.

 

Surgery is reserved for recurrent episodes, complications or severe attacks when there's little or no response to medication.

 

Colorectal Cancer

Colorectal Cancer is currently the second most common internal malignancy affecting approximately 1 in 20 Australians; prostate cancer is more common in men and breast cancer more common in women.

 

Symptoms

  • Rectal bleeding
  • Altered bowel habit
  • Iron deficiency anaemia
  • Abdominal pain
  • Unexplained weight loss

 

Colonoscopy is the most appropriate investigation in terms of diagnosis and treatment as nearly all Bowel Cancers start out as polyps. If these are removed the risk of cancer developing in that polyp is also removed.

 

Reflux

Reflux occurs when the acid in your stomach rises up into your oesophagus (the tube that connects your mouth to your stomach). Your stomach has a thick mucous lining that protects it from the acid inside, but because the oesophagus doesn’t, it can become irritated and painful leading to heartburn.

 

Heartburn is a burning sensation that rises from your stomach or lower chest up to your throat. It may even feel like food is coming back up, and you may get an acidic or bitter taste in the back of the mouth. Heartburn is often worse after eating, or when lying down, straining or bending over. Heartburn is very common – up to 1 in 5 adult experience heartburn at least once a week. Heartburn is the most common symptom of reflux and gastro-oesophageal reflux disease.

 

Symptoms

  • Heartburn
  • Excessive burping
  • Regurgitation
  • Sudden filling of the mouth with saliva
  • Difficulty swallowing
  • Sore throat
  • Persistent dry cough
  • Chest pain (If you are experiencing chest pain contact your Doctor immediately)

 

Tips for managing reflux

  1. Particular foods can make reflux and heartburn worse. These food may differ from person to person.
    Common trigger foods include –

    • Fatty and fried foods
    • Spicy foods and onions
    • Citrus fruits and juices
    • Chocolate and full-fat dairy products
    • Alcohol
    • Coffee & tea
    • Carbonated and/or caffeinated drinks
    • Tomatoes and tomato juice/sauce
    • Pepper
    • Peppermint

    Try to identify and avoid the foods that make your symptoms worse.

  2. Smoking can aggravate heartburn, so it’s a good idea to consider quitting.
  3. Being overweight puts extra pressure on your stomach so try to lose any excess weight.
  4. Avoid clothing with tight waistbands, especially after meals.
  5. Raise the head of your bed by 20cm or use a wedge pillow to keep your head higher than your stomach.
  6. Try to reduce stress as much as possible.

 

Coeliac Disease

What is Coeliac Disease?

In people with Coeliac Disease the immune system reacts abnormally to gluten (a protein found in wheat, rye, barley and oats), causing small bowel damage. The tiny, finger-like projections which line the bowel (villi) become inflamed and flattened. This reduces the surface area of the bowel available for nutrient absorption, which can lead to various gastrointestinal and malabsorptive symptoms.

 

A number of serious health consequences can result if the condition is not diagnosed and treated properly.

 

Who gets Coeliac Disease?

Coeliac Disease affects people of all ages, both male and female.

 

You must be born with the genetic predisposition to develop Coeliac Disease. A first degree relative (parent, sibling or child) of someone with Coeliac Disease has about a 10% chance of also having the disease. If one identical twin has Coeliac Disease there is an approximate 70% chance that the other twin will also have Coeliac Disease (but may not necessarily be diagnosed at the same time).

 

Environmental factors play an important role in triggering Coeliac Disease in infancy, childhood or later in life.

 

How common is the condition?

Coeliac Disease effects on average approximately 1 in 70 Australians. However, approximately 80% currently remain undiagnosed. This means that approximately 330,000 Australians have Coeliac Disease but don’t yet know it.

 

More and more people are being diagnosed with Coeliac Disease. This is due to both better diagnosis rates and a true increase in the incidence of Coeliac Disease.

 

Can Coeliac Disease be cured?

People with Coeliac Disease remain sensitive to gluten throughout their life, so in this sense they are never cured. However, a strict gluten free diet does allow the condition to be managed effectively.

 

A strict, lifelong gluten free diet is currently the only recognised medical treatment for Coeliac Disease. By removing the cause of the disease, a gluten free diet allows the small bowel lining to heal and symptoms to resolve. As long as the gluten free diet is strictly adhered to, problems arising from Coeliac Disease should not return. Relapse occurs if gluten is reintroduced into the diet.

 

What are the long term risks of undiagnosed and untreated Coeliac Disease?

The long term consequences of untreated Coeliac Disease are related to chronic systemic inflammation, poor nutrition and malabsorption of nutrients. Fortunately, timely diagnosis of Coeliac Disease and treatment with a gluten free diet can prevent or reverse many of the associated health conditions.

 

Symptoms

The symptoms of Coeliac Disease vary considerably. Some people experience severe symptoms while others are asymptomatic (they have no obvious symptoms at all).

 

Symptoms can include one or more of the following:

 

  • Gastrointestinal symptoms e.g. diarrhoea, constipation, nausea, vomiting, flatulence, cramping, bloating, abdominal pain, steatorrhea
  • Fatigue, weakness and lethargy
  • Iron deficiency anaemia and/or other vitamin and mineral deficiencies
  • Failure to thrive or delayed puberty in children
  • Weight loss (although some people may gain weight)
  • Bone and joint pains
  • Recurrent mouth ulcers and/or swelling of mouth or tongue
  • Altered mental alertness and irritability
  • Skin rashes
  • Easy bruising of the skin

 

People who experience any of the following should also be screened for Coeliac Disease

 

  • early onset osteoporosis
  • unexplained infertility
  • family history of Coeliac Disease
  • liver disease
  • autoimmune disease e.g. type 1 diabetes, autoimmune thyroid condition
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