Crohn's & Colitis For Dummies

339 Pages·2022·8.181 MB·English

by  Tauseef Ali

Crohn’s &
Colitis
2nd Edition
by Tauseef Ali, MD.
SSM Health IBD Center, Oklahoma
foreword by David T. Rubin, MD
The University of Chicago Medicine
Inflammatory Bowel Disease Center
Crohn’s & Colitis For Dummies®, 2nd Edition
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Library of Congress Control Number: 2022944886
ISBN 978-1-119-87577-2 (pbk); ISBN 978-1-119-87578-9 (epdf); ISBN 978-1-119-87579-6 (epub)
Contents at a Glance
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Part 1: The Who, What, and Why of Crohn’s and Colitis . . . . 5
CHAPTER 1: Crohn’s and Colitis One Step at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
CHAPTER 2: Defining Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CHAPTER 3: How the Digestive System Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . 1
CHAPTER 4: Who Gets Crohn’s and Colitis and Why . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Part 2: Getting Medical Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
CHAPTER 5: Assembling Your Healthcare Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
CHAPTER 6: Getting a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
CHAPTER 7: Achieving Remission with Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
CHAPTER 8: Considering Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Part 3: Healing and Dealing with the Disease . . . . . . . . . . . . . . 143
CHAPTER 9: Paying Attention to What You Eat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
CHAPTER 10: Preventing Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
CHAPTER 11: Alternative and Complementary Therapies . . . . . . . . . . . . . . . . . . . . . . . 187
Part 4: Living and Coping with Crohn’s and Colitis . . . . . . . . . 203
CHAPTER 12: Living with Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
CHAPTER 13: Avoiding Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
CHAPTER 14: Working and Traveling with Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . 233
Part 5: Considering Special Populations with
Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
CHAPTER 15: Kids with Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
CHAPTER 16: Having Sex and Getting Pregnant with Crohn’s and Colitis . . . . . . . . . . 265
Part 6: The Part of Tens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
CHAPTER 17: Ten Myths about Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . 283
CHAPTER 18: Ten Reliable Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Table of Contents
FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
About This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Foolish Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Icons Used in This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Beyond the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Where to Go from Here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
PART 1: THE WHO, WHAT, AND WHY OF
CROHN’S AND COLITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CHAPTER 1: Crohn’s and Colitis One Step at a Time . . . . . . . . . . . . . . . 7
Defining Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Getting the Treatment You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Recognizing That You’re Not Powerless . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Living a Full Life with the Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Managing Special Cases: Advice for Pregnant Women and Kids . . . . . 11
CHAPTER 2: Defining Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figuring Out What Crohn’s and Colitis Are . . . . . . . . . . . . . . . . . . . . . . . 13
Looking at the big picture: Inflammatory bowel disease . . . . . . . . . 14
Zeroing in on Crohn’s and colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Noticing the Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Blood in stool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Abdominal pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Urgency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Tenesmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Other symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Identifying Other Parts of the Body Involved in Crohn’s and Colitis . . . 25
Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Liver and gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Kidneys and bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Eyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Complicating Things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Intestinal complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Nutritional complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
The cancer connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Table of Contents v
CHAPTER 3: How the Digestive System Works . . . . . . . . . . . . . . . . . . . . . 41
Tracking the Journey of Food inside the Gastrointestinal Tract . . . . . . 42
The oral cavity (or mouth) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
The esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
The stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
The small intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The large intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
The anus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Getting Help from the Liver, Pancreas, and Gallbladder . . . . . . . . . . . . 46
Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Understanding How Inflammation Affects the Digestive Process . . . . 48
Gastritis: Inflammation of the stomach . . . . . . . . . . . . . . . . . . . . . . . 48
Enteritis: Inflammation of the small intestine . . . . . . . . . . . . . . . . . . 49
Colitis: Inflammation of the large intestine . . . . . . . . . . . . . . . . . . . . 50
Proctitis: Inflammation of the rectum . . . . . . . . . . . . . . . . . . . . . . . . 51
CHAPTER 4: Who Gets Crohn’s and Colitis and Why . . . . . . . . . . . . . . 53
Who Gets Crohn’s and Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
The Role of the Immune System in Crohn’s and Colitis . . . . . . . . . . . . . 54
An immune system primer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
When your gut’s immune system goes awry . . . . . . . . . . . . . . . . . . . 57
Environmental Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Other environmental factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Genes Gone Bad: The Role of Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Considering family history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Calling out key genes for Crohn’s and colitis . . . . . . . . . . . . . . . . . . . 64
Getting a genetic test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
PART 2: GETTING MEDICAL HELP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
CHAPTER 5: Assembling Your Healthcare Team . . . . . . . . . . . . . . . . . . . 69
Finding the Right Doctor for You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Why you need a specialist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
How to choose among the specialists in your area . . . . . . . . . . . . . 70
When you get to your first visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Rounding Up Other Key Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Your primary care physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Physician assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
vi Crohn’s & Colitis For Dummies
Registered dietitians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Psychiatrists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Surgeons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Friends and family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
CHAPTER 6: Getting a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Preparing for Your First Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Charting your signs and symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Assembling your medical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Talking to Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Getting over the embarrassment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Communicating your symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Being realistic about your expectations . . . . . . . . . . . . . . . . . . . . . . . 86
Knowing What to Expect during a Physical Exam . . . . . . . . . . . . . . . . . . 86
General physical exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Focused physical exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Rectal exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Being Poked and Prodded for Medical Tests . . . . . . . . . . . . . . . . . . . . . 88
Blood tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Stool tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Identifying Other Diseases That Mimic Crohn’s and Colitis . . . . . . . . . 93
CHAPTER 7: Achieving Remission with Medications . . . . . . . . . . . . . .95
Rejoicing for Remission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Types of Remission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
The role of symptom control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Using Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Types of steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Side effects of steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
Turning to Aminosalicylates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Types of aminosalicylates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Side effects of aminosalicylates . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Getting Involved with Immunomodulators . . . . . . . . . . . . . . . . . . . . . . 104
Types of immunomodulators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Side effects of immunomodulators . . . . . . . . . . . . . . . . . . . . . . . . . 105
Battling Your Disease with Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Types of biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Side effects of biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Loss of response to anti-TNF therapy . . . . . . . . . . . . . . . . . . . . . . . 110
Benefits of biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Table of Contents vii
Targeting Crohn’s and Colitis with Small Molecules . . . . . . . . . . . . . . . 112
Types of small molecules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Side effects of small molecules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Attacking Your Illness with Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Types of antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Side effects of antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Considering Other Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Antidiarrheals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Bile salt binders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Calcium and vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Vitamin B12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
CHAPTER 8: Considering Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Determining When You May Need Surgery . . . . . . . . . . . . . . . . . . . . . .119
For Crohn’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
For ulcerative colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Understanding the Types of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Resectioning the small intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Repairing a stricture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Treating fistulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Draining abscesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Resecting the colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Pouch surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Considering Complications from Surgery . . . . . . . . . . . . . . . . . . . . . . . 130
Short-term complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Long-term complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Defining Ostomy: What It Is and How to Deal with It . . . . . . . . . . . . . .135
Types of ostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
When you may need ostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
How to care for your stoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Your ostomy pouch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Coming to terms with Ostomy complications . . . . . . . . . . . . . . . . . 139
Listing Some Ostomy Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
PART 3: HEALING AND DEALING WITH THE DISEASE . . . . 143
CHAPTER 9: Paying Attention to What You Eat . . . . . . . . . . . . . . . . . . . 145
Considering the Impact of Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
The impact on your immune system . . . . . . . . . . . . . . . . . . . . . . . . 146
The impact on wound healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Identifying the Nutrients You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Macronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
viii Crohn’s & Colitis For Dummies