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.
Malabsorption means abnormal intestinal absorption. Crohn's disease usually affects the
small intestine, which is the part of the gut that absorbs most nutrients.
Remember that Crohn's disease involves the small bowel and/or the colon, while
ulcerative colitis involves
only the colon. Crohn's disease of the upper part (duodenum) and middle part (jejunum) of the
small intestine may interfere with the absorption of proteins, sugars, iron,
vitamins, and fats. This widespread malabsorption in Crohn's disease, which does not occur in
ulcerative colitis, may lead to weight loss and malnutrition. In addition, some unabsorbed
nutrients can cause the small or large intestine to secrete increased amounts of
liquid, which worsens the diarrhea in Crohn's disease. (As previously mentioned, diarrhea is
the most common symptom in patients with IBD, with or without the intestinal
complications.) The lower end (ileum) of the small intestine is the part of the
bowel most commonly involved in Crohn's disease. In ulcerative colitis, however, the function of the ileum is
normal. When the ileum is involved in patients with Crohn's disease (or surgically removed),
a decreased absorption of vitamin B12 may occur. If a deficiency of B12
develops, a particular type of anemia called pernicious anemia can result.
The ileum is also the major area for intestinal absorption of bile acids. The bile
acids are compounds that are secreted in the bile by the liver into the
duodenum. The major function of bile acids is to help transport and absorb fats,
mostly in the jejunum. Bile acids that are not absorbed by a diseased or removed
ileum pass into the colon. The bile acids then induce the colon to secrete
liquid, which aggravates the diarrhea. If the bile acids are not sufficiently
absorbed in the colon and consequently become deficient, fat malabsorption and
more diarrhea can result.
Extensive Crohn's disease, usually involving the surgical removal
of several intestinal segments over the years, can lead to a debilitating
condition known as short bowel syndrome. In this condition, the patients have
many of the intestinal complications of Crohn's disease, including severe malabsorption. They
can also suffer from the previously mentioned complications not directly
affecting the intestinal tract (extraintestinal). Additionally, these patients
frequently have certain other extraintestinal complications, such as
osteoporosis (thin or porous bones), osteomalacia (soft bones), gallstones, and
kidney stones.
How is malabsorption in IBD treated?
The treatment of malabsorption in patients with IBD includes medications to
treat the underlying intestinal inflammation. Decreasing the inflammation can
improve the intestinal absorption of the nutrients that were malabsorbed. The
malabsorption or deficiency of B12 may need to be treated by administering the
vitamin in the vein or into the muscle. Diarrhea that is induced by bile acids
can be treated with cholestyramine, a compound that works by binding the bile
acids.
Supplemental calories and nutrients may be administered as special liquid
diets. These so-called elemental diets are composed of proteins, carbohydrates,
vitamins, and fats that are broken down into smaller particles that are easier
for the intestine to absorb. Unfortunately, however, these diets often do not
smell or taste very good. Nevertheless, they can be administered through a small
tube inserted through the nose (enteral feeding). For patients who are unable to
tolerate any food or liquid by mouth or by enteral feeding, nutrition may need
to be given solely through the veins (total parenteral nutrition). Finally, a
small bowel transplant can now be done for patients with severe Crohn's disease or otherwise
unmanageable short bowel syndrome.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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