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INFLAMMATORY BOWEL DISEASE (IBD)
My child aged 12 years old has bloody stools since past 2 months. He had been treated for diarrhea, dysentery, but to no avail. What to do?
A. The bloody stools which have remained since two months in a 12 year old child is a matter of concern, particularly so because he has clearly been treated for diarrhea and dysentery. In such a situation one should make a determined effort to make the diagnosis.
One of the common conditions that mimic this would be POLYP. Rectal examination will definitely give the diagnosis.
If truly the bloody stools have not subsided inspite of routine treatment, child must be examined (by sigmoidoscopy) to exclude inflammatory bowel disease.
What is Inflammatory Bowel disease?
A. Inflammatory bowel disease is a chronic condition where there is inflammation of the large and or small intestine without a definite cause, which has a tendency to recur. The commonest finding on sigmoidoscopy is granularity, and tendency to bruise and bleed to touch.
What are the various types of IBD?
A. The various type of IBD are
Ulcerative colitis (UC)
Crohn’s disease (CD)
What are the causes of IBD?
A. The exact cause of IBD is not known. However are the pointers towards these hypothesis. It may be that, there is no single cause, and there may be more than one cause, acting in unison.
The cause of IBD are
A. ULCERATIVE COLITIS
1. Infection
2. Food allergy
3. Environment
B. CROHN’S DISEASE
1. Infections
2. Diet
3. Genetics
4. Psychosocial
When do you suspect a child has IBD?
A. One should suspect a patient to have IBD:
UC : Child will complain of diarrhea, rectal bleeding, passage of mucus and abdominal pain. Child can also have nausea, anorexia and in severe cases may even vomit. There may also be fever, anemia and weight loss.
Crohn’s disease : Child may have pain in right sided pain which is recurrent and colicky in nature. There may also be pain during defecation and pain may increase after defecation. Diarrhea, fever, weight loss, bleeding per rectum may be other manifestations.
Q. How often does a patient require to undergo endoscopy (colonoscopy/ sigmoidoscopy)?
A. After the initial endoscopy (sigmoidoscopy or colonoscopy), patient would require undergoing repeat endoscopies in the initial stages every 3-6 months or depending on the clinical course (improvement of the disease).
Q. What is the treatment of IBD?
A. The treatment of IBD consists of using 5-ASA and if necessary steroids. These drugs have had excellent results and have saved the lives of thousands of patients.
Q. Can IBD be cured? Does it require life long treatment?
A. The word "cured" may not apply. However, the patient remains symptom free or in remission for a long time. Theoretically patient would require life long treatment.
Q. How serious is IBD? What are its complications?
A. Normally Inflammatory Bowel Disease is not a serious condition. However, occasionally it can land up in life threatening complications.
The commonest minor complications are:
1) Anemia
2) Nutritional deficiency
3) Weight loss.
The major complications are severe bleeds or toxic megacolon.
Q. When is surgery required? What is the surgery done?
A. Surgery is necessary if the disease does not come under control with medical treatment and or there are life-threatening complications.
Surgical treatment consists of removing Large intestine in Ulcerative colitis and or affected part of large or small intestine in Crohn’s disease.
Q. If the intestine is removed, can the patient survive?
A. Patient can survive very well when the large intestine is removed and can also survive if small portion of small intestine removed.
Q. Does a special diet help in IBD?
A. There is no special diet that can help IBD. However, it is prudent to avoid chillies, fried feeds and outside food.
Q. What is the prognosis of a patient with IBD?
A. By and large prognosis of IBD is reasonably good. If patient understands the illness and accepts the illness, they remain happy.
Last created on 24-06-2002
Last updated on 18-11-2006