Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
Ulcerative colitis (UC) and Crohn's disease (CD) are known as the
inflammatory bowel diseases (IBD). The precise cause of IBD remains unknown.
These diseases are believed to be caused by a combination of genetic and
non-genetic, or environmental factors (for example, infections) that interact
with the body's immune (defense) system. When the intestinal immune system does
not function properly, many white blood cells accumulate in the inner lining (mucosa)
of the gut. The white cells then release chemicals that lead to tissue injury
(inflammation). This inflammation of the mucosa can cause diarrhea, which is the
most common symptom of ulcerative colitis and Crohn's disease, with or without the intestinal complications.
The intestinal complications of IBD occur when the intestinal inflammation is
severe, extends beyond the inner lining (mucosa) of the intestines, is
widespread, and/or is of long duration (chronic). For example, severe mucosal
inflammation can cause ulcers, bleeding, and toxic megacolon (a condition in
which the colon widens, or dilates, and loses its ability to properly contract).
Inflammation that extends beyond the inner lining and through the intestinal
wall is responsible for strictures (scarring that causes narrowing of the
intestinal wall) and fistulas (tubular passageways originating from the bowel
wall and connecting to other organs or the skin). Strictures, in turn, can lead
to bacterial overgrowth of the small intestine (SIBO). If the inflammation of
the small bowel is widespread, malabsorption of nutrients can be a complication.
Chronic inflammation can also be associated with colon cancer.
The majority of
IBD patients experience periods during which their disease intensifies (flares)
or subsides (remissions). Although most patients require medication for IBD,
they are able to live normal, productive lives. Some patients, but certainly not
all, will develop intestinal complications of IBD. When these complications
occur, they should be recognized and usually treated. Some patients with IBD
develop complications outside of the intestine (extraintestinal), such as
certain kinds of arthritis,
skin rashes, eye problems, and liver disease. These
extraintestinal complications are discussed in other articles on IBD.
review will describe the various types of intestinal complications that are
associated with IBD, and will also summarize methods for their diagnosis and
treatment. Please note that the terms bowel, intestine, and gut are used
synonymously. The small bowel, or intestines, includes from top to bottom, the
duodenum, jejunum, and ileum. The large bowel is also called the colon.
No special eating plan has been proven effective for treating inflammatory
bowel disease (IBD). But for some people, changing the foods they eat may help
control the symptoms of IBD.
There are no blanket food rules. Changes that help one person with IBD may
not relieve symptoms in another. Talk to your doctor and maybe a dietitian about
which foods you should and should not be eating. Their suggestions will depend
on the part of your intestine that is affected and which disease you have.
Your doctor may suggest some of the following changes:
Taking specific nutritional supplements, including possibly vitamin and
Avoiding greasy or fried foods
Avoiding cream sauces and meat products
Avoiding spicy foods
Avoiding foods high in fiber, such as nuts and raw fruits and vegetables
Eating smaller, more frequent meals
Even though you may have to limit certain foods, you should still aim to eat
meals that give you all the nutrients you need.