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.
Fissures are tears in the lining of the anus. They may be superficial or
deep. Fissures are especially common in Crohn's disease. They differ from fistulas in that
fissures are confined to the anus and do not connect to other parts of the
bowel, other internal organs, or the skin. Still, fissures can cause mild to
severe rectal pain and bleeding, especially with bowel movements. The most
common treatment for anal fissures is periodic sitz baths or topical creams that
relax the muscle (sphincter) around the anus. Injections of tiny amounts of
botulinum toxin into the muscles around the anus have been reported to be
helpful in relaxing the sphincter, thereby allowing the fissures to heal. The
benefit of this type of therapy, however, is still controversial. Sometimes,
surgery is needed to relieve the persistent pain or bleeding of an anal fissure.
For example, the surgeon may cut out (excise) the fissure. Alternatively, the
muscle around the anus can be cut (sphincterotomy) to relax the sphincter so
that the fissure can heal. However, as is the cases with any surgery in patients
with Crohn's disease, post-operative intestinal complications can occur frequently.
What is small intestinal bacterial overgrowth (SIBO)?
Small intestinal bacterial overgrowth (SIBO) can occur as a complication of
Crohn's disease but not of ulcerative colitis since the small intestine is not involved in
ulcerative colitis. SIBO can
result when a partially obstructing small bowel stricture is present or when the
natural barrier between the large and small intestines (ileocecal valve) has
been surgically removed in Crohn's disease. Normally, the small bowel contains only few
bacteria, while the colon has a tremendous number of resident bacteria. If a
stricture is present or the ileocecal valve has been removed, bacteria from the
colon gain access to the small bowel and multiply there. With SIBO, the bacteria
in the small bowel begin to break down (digest) food higher up than normal in
the GI tract. This digestion produces gas and other products that cause
abdominal pain, bloating, and diarrhea. In addition, the bacteria chemically
alter the bile salts in the intestine. This alteration impairs the ability of
the bile salts to transport fat. The resulting malabsorption of fat is another
cause of diarrhea in Crohn's disease. (As previously mentioned, inflammation of the
intestinal lining is the most common cause of diarrhea in patients with IBD.)
SIBO diagnosis
SIBO can be diagnosed with a hydrogen breath test (HBT). In this test, the
patient swallows a specified amount of glucose or another sugar called lactulose.
If bacteria have reproduced in the small bowel, the glucose or lactulose is
metabolized by these bacteria, which causes the release of hydrogen in the
breath. The amount of hydrogen in the breath is measured at specific time
intervals after the ingestion of the sugar. In a patient with SIBO, the hydrogen
is eliminated into the breath sooner than the hydrogen that is produced by the
normal bacteria in the colon. Accordingly, the detection of large amounts of
hydrogen at an early interval in the testing indicates the possibility of SIBO.
Another test, which may be more specific, uses a sugar called xylose. In this
test, the swallowed xylose is tagged with a very small amount of radioactive
carbon 14 (C14). The C14 is measured in the breath and interpreted by applying
the same principles as used for hydrogen in the HBT.
SIBO treatment
The best treatment for
bacterial overgrowth is antibiotics for approximately 10 days using, for
example, neomycin, metronidazole, or ciprofloxacin. After this treatment, the
breath test may be repeated to confirm that the bacterial overgrowth has been
eliminated. SIBO may recur, however, if the stricture itself is not treated, or
if the bacterial overgrowth is due to the surgical removal of the ileocecal
valve.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your healthcare provider prior to tapering off steroid medications.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Scleritis is inflammation of the white part of the eye. It may be caused by a serious underlying condition, such as an autoimmune disease. Symptoms include redness, pain, tearing, sensitivity to light, and decreased visual acuity. Treatment may include eye drops as well as treatment for any underlying disease process. Scleritis cannot be prevented.
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