Posted on: January 12, 2016
Something to Cheer About
By Dr. Elie Abemayor
I remember the day when an 18-year-old cheerleader came to see me, she knew something was dramatically wrong—but she didn’t want to talk about it. The normally bouncy high school student was becoming less social, and she was losing weight. She was having bowel issues, and she really didn’t want to talk about it.
After discussing her symptoms, I checked for blood in her stool, and then confirmed her diagnosis with a colonoscopy and a biopsy. She had ulcerative colitis, a form of inflammatory bowel disease (IBD). Luckily, her condition was still in the mild to moderate stage; after she started medications she had a complete reversal within a few weeks. She was able to get back to a healthy weight and her symptoms subsided.
IBD, which includes Crohn’s disease and ulcerative colitis (the cheerleader’s condition), plagues as many as 1.4 million Americans, according to the Centers for Disease Control and Prevention (CDC). Given the nature of the symptoms, many people wait too long to seek treatment. Treating IBD early can make such a big difference in being able to manage the disease successfully.
Both Crohn’s and colitis can be characterized by persistent diarrhea, abdominal pain, cramping, fatigue, and blood in the stool. The reason for these symptoms is chronic inflammation in the digestive tract, which interferes with normal digestion. Crohn’s disease can target any part of the gastrointestinal (GI) tract, from the mouth to the anus, and it can penetrate the intestine walls to affect nearby organs. Ulcerative colitis, on the other hand, only involves the colon or rectum and irritates only the inner wall of the intestine.
If you’re seeing a GI specialist about IBD, expect to be questioned in depth about your symptoms. If your doctor believes you may be suffering from Crohn’s disease or colitis, he or she may order a colonoscopy, endoscopy, or other imaging such as a CT scan to check for inflammation. A biopsy of the inflamed area may also be necessary to confirm the diagnosis. Although it’s not possible to cure these conditions with medications, there are many effective drugs that can control symptoms, as was the case with the cheerleader. Anti-inflammatory drugs can calm a severe attack; immune system modulators can also quell symptoms. Often we find that a combination of medications works best.
For more severe cases, surgery may be required. Not too many years ago, surgeons would remove the entire colon and rectum in patients with ulcerative colitis. A patient would have to use a colostomy bag for the rest of his or her life. No more: New techniques such as ileal pouch anal anastomosis can create part of the rectum. In a two- or three-stage procedure, the surgeon can fashion a new rectum using healthy intestine, and reconnect to the anus so that the patient’s daily life is minimally affected.
Although about half of people with Crohn’s disease will require surgery at some point, the procedure won’t be curative unlike ulcerative colitis. In some cases a patient may need more than one operation. The goal of the procedure is to remove the damaged portions of the digestive tract and reconnect the healthy sections. With the right medications and a careful eating plan, patients may be able to avoid a return of their symptoms.
People with IBD can find excellent information and support through groups such as the Crohn’s and Colitis Foundation of America www.ccfa.org. Just remember that it’s key to seek treatment early, no matter how unpleasant it may seem to discuss your symptoms. You’ll have many more options for treatment and much greater success.
Editor’s Note: Elie Abemayor, MD is the Chief of Gastroenterology at Northern Westchester Hospital.