Dr. Hillary Steinhart - Crohns and Colitis: Understanding and Managing IBD

Crohns & Colitis, Third Edition

Text copyright 2006, 2012, 2018 A. Hillary Steinhart

Illustrations copyright 2006, 2012, 2018 Robert Rose, Inc.

Cover and text design copyright 2006, 2012, 2018 Robert Rose Inc.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without the prior written consent of the publisher or a licence from the Canadian Copyright Licensing Agency (Access Copyright). For an Access Copyright licence, visit www.accesscopyright.ca or call toll-free: 1-800-893-5777.

The author would like to thank Dr. Anne Griffiths of the Hospital for Sick Children, Toronto, Canada, for sharing her knowledge and expertise during the writing of the first edition of this book.

Library and Archives Canada Cataloguing in Publication

Steinhart, Allan Hillary, 1959-, author

Crohns & colitis: understanding & managing IBD / Dr. A. Hillary Steinhart, MD, MSc, FRCP(C), Medical Director, Mount Sinai Hospital, Inflammatory Bowel Disease Centre. Third edition.

Includes bibliographical references and index.

ISBN 978-0-7788-0619-6 (softcover)

ISBN 978-0-7788-0642-4 (epub)

1. Crohns disease. 2. Ulcerative colitis. I. Title. II. Title: Crohns and colitis.

Disclaimer

This book is a general guide only and should never be a substitute for the skill, knowledge, and experience of a qualified medical professional dealing with the facts, circumstances, and symptoms of a particular case.

The nutritional, medical, and health information presented in this book is based on the research, training, and professional experience of the author, and is true and complete to the best of his knowledge. However, this book is intended only as an informative guide for those wishing to know more about health, nutrition, and medicine; it is not intended to replace or countermand the advice given by the readers personal physician. Because each person and situation is unique, the author and the publisher urge the reader to check with a qualified health-care professional before using any procedure where there is a question as to its appropriateness. A physician should be consulted before beginning any exercise program. The author and the publisher are not responsible for any adverse effects or consequences resulting from the use of the information in this book. It is the responsibility of the reader to consult a physician or other qualified health-care professional regarding his or her personal care.

Front Cover & Interior Design: Kevin Cockburn/PageWave Graphics Inc.

Back Cover Design & Production: Daniella Zanchetta/PageWave Graphics Inc.

Proofreader: Kelly Jones

Indexer: Gillian Watts

Illustrations: Kveta/Three in a Box

Cover image: Beige textured background Bill Noll/iStockphoto.com

Back cover image: Balanced white stones Daniel Chetroni/iStockphoto.com

The publisher gratefully acknowledges the financial support of our publishing program by the Government of Canada through the Canada Book Fund.

Published by Robert Rose Inc.

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Preface

Living with inflammatory bowel disease (IBD) can be a challenge, not only for those of you who have Crohns disease or ulcerative colitis, but also for those of you who have a family member or close friend afflicted with one of these disorders. Meeting this challenge requires the help of knowledgeable health-care professionals. Knowing what impact Crohns disease and ulcerative colitis may have on your life and what management strategies are available is also very important. A well-informed patient will have the best chance for recovery and remaining healthy.

However, the amount of information you can find when trying to learn about inflammatory bowel disease can be overwhelming. There are so many possible sources of information doctors, nurses, books, pamphlets, websites, patient associations, Internet chat rooms, friends, and relatives. Often this information is confusing and contradictory. The quality of the information varies greatly from source to source. This information overload can leave you confused and frustrated, thus making it even more difficult to deal with these chronic diseases.

We have written this book in order to provide patients, families, friends, and health-care professionals with a clear, current, and concise account of the possible underlying causes, clinical features, and effective treatments of Crohns disease and ulcerative colitis. Rather than simply presenting a list of facts about the disorders, we have given them an applied clinical context based on our years of experience with many hundreds of patients who have been evaluated, followed, and treated at the Mount Sinai Hospital IBD Centre. We have also tried to make this information directly relevant to IBD sufferers and their families by recounting case histories and answering the questions patients frequently ask. We hope to provide another means for dealing with these diseases, which we are only now really beginning to understand.

CHAPTER 1

What Is This Disease?

CASE STUDY Kelly

Kelly, a 22-year-old university student, developed symptoms of abdominal cramping, urgency to move her bowels, diarrhea, and blood in the stool. The symptoms came on gradually and were at first intermittent. They began during the month before her first-term exams, and, although they seemed to improve after she finished the exams, the symptoms continued into the second term. She went to the university health clinic, where she was examined and referred to a specialist. The specialist carried out some tests and told Kelly that she had inflammatory bowel disease, specifically, ulcerative colitis.

Kelly was really upset ulcerative colitis sounded like a serious disease. Besides, the doctor told her there is no cure, other than surgery. It wasnt fair. Im young, she protested, and no one in my family has had this disease. Ive always been very health conscious I eat a healthy diet, including milk and dairy products. Im physically active and I dont smoke. She couldnt stop asking questions in her effort to understand why. What is inflammatory bowel disease? Is colitis an infection? Can I take antibiotics to cure it? Did the stress of my exams cause it? What if I eat a different diet? Could the ibuprofen I take for headaches have an impact?

Her doctor calmed her down and began answering Kellys questions

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What Is Inflammatory Bowel Disease?

Inflammatory bowel disease is not a single disease or medical condition. The term describes, in a general way, any condition or disease that results in inflammation of the gastrointestinal tract. Strictly speaking, this definition would include infections of the intestine for example, infection caused by salmonella bacteria. However, the term inflammatory bowel disease (IBD) is usually reserved for two similar disorders, Crohns disease and ulcerative colitis. Specific causes for these disorders are not yet entirely known.