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.
The risk of developing colon cancer is 20 times higher for patients with IBD
than it is for the general population. The association with colon cancer is more
clearly established in ulcerative colitis than in Crohn's disease. An increased risk most likely also exists,
however, for patients with Crohn's disease that affects the colon. In ulcerative
colitis, the risk of
acquiring colon cancer increases according to how much of the colon is involved
and the duration of colitis. Thus, after about 8 to 10 years of ulcerative
colitis, especially
if the entire colon is involved, the risk of developing colon cancer
substantially increases. Other risk factors for colon cancer in IBD patients
include a liver disease called primary sclerosing cholangitis (PSC), a family
history of colon cancer, and a history of liver transplantation. Additional
possible risk factors include the use of concurrent immunosuppressive
medications and a deficiency of the vitamin, folic acid.
How does colon cancer develop in IBD?
The way in which colon cancer develops in IBD patients is thought to be
different from the way in which it develops in other people. In individuals
without IBD, usually a benign (not malignant) polyp initially forms in the
colon. Then, depending on the type of polyp and the genetic makeup of the
patient, the polyp may eventually become cancerous. In IBD, the constant process
of inflammatory injury and repair of the lining of the colon (colonic mucosa) is
believed to make the individual more susceptible to the cancer. The idea is that
the mucosal cells are dividing so rapidly that they are liable to make mistakes
in their DNA (mutations). These mutated cells can then become pre-cancerous (dysplastic)
cells, which later can turn into cancer.
Additionally, pre-cancerous cells in
IBD develop in ways other than in a polyp. In fact, pre-cancerous cells can
develop in tissue that appears completely normal or exhibits only mild
irregularities. For this reason, a colon cancer may not be discovered in IBD
patients until the cancer has progressed to a later stage. In later stages, the
cancer can invade tissues beyond the colon or spread (metastasize) to other
parts of the body.
How can colon cancer in IBD be prevented?
As already mentioned, patients with IBD, especially ulcerative colitis, have an increased
risk of developing colon cancer. Performing a colectomy (removal of the colon)
before the cancer develops in these patients is a sure way to prevent colon
cancer. Actually, the concept is to remove the pre-cancerous cells (dysplasia)
in the colon before they can turn into cancer. Accordingly, inspection for
dysplasia and cancer by yearly colonoscopies with multiple colonic biopsies is
recommended for patients with ulcerative colitis. The monitoring is suggested to begin after the
patient has had ulcerative colitis for 8 to10 years. Many physicians recommend a similar
monitoring program for Crohn's disease patients who have inflammation of the colon (colitis),
even though the association with colon cancer is less well established in
Crohn's disease.
Remember that ulcerative colitis involves only the colon, whereas Crohn's
disease, which involves the small
bowel, colon, or both, often does not affect the colon.
Colonoscopy clearly is
the best method for monitoring colon cancer. An otherwise negative colonoscopy
in ulcerative colitis, however, does not guarantee that the colon is free of cancer or
pre-cancerous cells. The reason for this is that the multiple biopsies that are
done during the colonoscopy still make up only a tiny percentage of the entire
lining of the colon. However, if pre-cancerous cells are found on a microscopic
examination of the biopsies, a colectomy (surgical removal of the colon) may be
recommended to prevent cancer from developing. One caution here is that the
diagnosis of dysplasia should be made only in the absence of concurrent, active,
inflammation of the colon. The reason for this caveat is that inflammation
sometimes can mimic the microscopic appearance of dysplasia.
Does small bowel cancer occur in IBD?
In patients with Crohn's disease, there is an increased risk of developing lymphoma or
adenocarcinoma of the small intestine. Since the small intestine is not involved
in ulcerative colitis, there is no increased risk of this cancer in ulcerative
colitis patients. Even though
there is a higher risk of these cancers in Crohn's disease, the percentage of patients
actually contracting them is very small. Still, certain conditions predispose
Crohn's disease
patients to an even higher cancer risk. These conditions include bypassed
segments of the bowel and chronic fissures, fistulas, or strictures. Even so,
routine monitoring for small bowel cancer in Crohn's disease patients by X-ray or enteroscopy
is not currently recommended because these diagnostic procedures are difficult,
time-consuming, and not very effective for this purpose. If however, after many
years of Crohn's disease, the disease suddenly changes its course or becomes difficult to
treat, the possibility of a small bowel cancer should be investigated.
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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