Inflammatory bowel disease (second of two parts)

Article Abstract:

In the second half of a two-part review article, the author continues his discussion of inflammatory bowel disease. The two most common inflammatory bowel diseases are Crohn's disease and ulcerative colitis; these ailments share common features, but are also distinct is several ways. There is no longer any doubt that patients with ulcerative colitis are at tremendously increased risk of colorectal cancer. The risk begins to increase about 15 years after the first symptoms of colitis develop. After 35 years, about 30 percent of patients have developed colorectal cancer. For patients who developed colitis under the age of 15, the risk is as high as 49 percent. The evaluation of patients for signs of cancer is complicated by the disease itself. Blood in the stools, an early warning sign for cancer, is common among colitis patients. Crohn's disease also confers an increased risk of colorectal cancer. Although the total risk is less that associated with ulcerative colitis, there is also less inflammation of the colon in Crohn's disease. It has been suggested that if these differences are taken into account, the effect of colonic inflammation on the risk of cancer may be the same for both conditions. It is suspected that the cycles of inflammation increase the likelihood that individual cells lining the colon may undergo malignant transformation. Despite the differences between Crohn's disease and ulcerative colitis, the disorders are managed in similar ways. One medical treatment for some cases of Crohn's disease and mild to moderately severe ulcerative colitis is sulfasalazine. This drug inhibits enzymes that participate in the inflammatory process, and may also reduce the rate at which inflammatory cells are recruited into the bowel. In addition, sulfasalazine acts as a scavenger of free radicals, which may also contribute to tissue damage in inflammatory conditions. Unfortunately, over 20 percent of patients may prove to be hypersensitive to the drug. The effectiveness of sulfasalazine has led to the development of newer drugs using the same physiological principles to combat the effects of inflammatory bowel disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Risk factors, Drug therapy, Sulfasalazine

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Inflammatory bowel disease: (First of two parts)

Article Abstract:

A review is presented of the symptoms, pathogenesis, histopathology, and clinical features of inflammatory bowel disease, a term that includes ulcerative colitis and Crohn's disease. The latter condition may be further described as Crohn's ileitis, regional enteritis and granulomatous colitis. The causes of most kinds of inflammatory bowel disease are unknown; therefore, diagnosis is empiric and based on clinical, X-ray, laboratory, and other findings. Since these disorders are complex, it is hard to identify essential and nonessential features. Rates of Crohn's disease have increased in recent years in Western Europe and the US in all age groups and in both sexes. While Crohn's disease appears to be related to smoking, the incidence of ulcerative colitis is lower among smokers. Genetic factors are undoubtedly involved in both diseases, but the important gene products have not been identified. These could include genes that code for abnormalities of the gastrointestinal tract and make it more vulnerable to infection, toxins, or autoimmune responses (occurring when the body manufactures antibodies to its own proteins). A role for infectious agents has long been suspected, but no clearly pathogenic organism has been found. One important line of research has been that which focuses on the immune response of the bowel; this may be abnormal in patients with inflammatory bowel disease. The natural history of both conditions is reviewed. Ulcerative colitis is characterized by bloody diarrhea, while patients with Crohn's disease experience abdominal pain and diarrhea. Both conditions are chronic and recurring. Ulcerative colitis is confined to the large bowel and usually includes the rectum, while Crohn's disease can affect any part of the digestive tract. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Going the distance -- the case for true colorectal-cancer screening

Article Abstract:

Guidelines for detecting colorectal cancer should be changed so they recommend colonoscopy instead of flexible sigmoidoscopy. Both of these techniques involve inserting an optical instrument at the end of a tube into the rectum so the colon, or large intestine, can be examined. The only difference is that sigmoidoscopy only examines the part of the colon closest to the rectum, whereas colonoscopy examines areas farther away. Two studies published in 2000 show that colonoscopy can detect cancer that sigmoidoscopy misses. If colonoscopy does not find cancer, the patient could go 5 or 10 years before having the procedure again.

Editorial, Diagnosis, Medical examination, Colonoscopy, Colon (Anatomy), Colon

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