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Could your digestive problems be inflammatory bowel disease?

Inflammatory bowel disease, or IBD, is an umbrella term that encompasses Crohn's disease and ulcerative colitis, two conditions that are characterized by inflammation in the gastrointestinal (GI) tract.

IBD is a chronic, interruptive disease of the GI tract. Crohn's disease may occur anywhere in the GI tract, from the mouth to the anus, while ulcerative colitis manifests in the colon or large intestine.

If you have symptoms of IBID. such as diarrhea, abdominal cramping and/or pain, or blood in your stool, it's important to be evaluated by a doctor. If you do have IBD, effective treatment may slow the progression of the disease, lower the risk of complications, and delay or prevent the need for surgical treatment.

Causes and potential consequences.

The inflammation that characterizes IBD has been linked to the overgrowth of certain types of bacteria in the GI tract. Inflammation occurs when your immune system tries to fight off the bacteria. Genetics also is believed to play a role.

"Patients with IBD may need surveillance for abnormal cells, or dysplasia, depending on what type of IBD they have and the duration of the disease," says Eric Esrailian, MD, a gastroenterologist at UCLA Health System. "Chronic inflammation can be a risk factor for cancer. Therefore, as gastroenterologists we strive to both improve patient symptoms and achieve what we call 'mucosal healing."

More than 100 genes have been linked to IBD. People who are genetically vulnerable have an internal environment that is more susceptible to factors that produce uncontrolled inflammation.

Also, a condition called "leaky gut" may contribute to IBD. In patients who have "leaky gut," large spaces develop between the cells lining the intestinal wall, allowing bacteria to grow and spread more easily.

If IBD is not treated and the disease progresses, complications including fistulas (abnormal connections between the intestine and other organs or blood vessels), strictures (narrowed areas), and abscesses (pockets of infected fluid and pus) can form. Ultimately, if non-surgical treatments are ineffective, the intestines may be either partially or completely removed surgically.

"IBD patients should speak with their doctors to see if they are due for dysplasia surveillance," Dr. Esrailian advises. "This type of evaluation is different than screening colonoscopy during which we look for polyps. In dysplasia surveillance, random biopsies must be taken throughout the colon even if the tissue looks normal to look for microscopic abnormalities."

Dietary strategies.

Proper nutrition and appropriate dietary modifications are essential parts of the overall treatment of both Crohn's disease and ulcerative colitis. Some foods are thought to fight inflammation, while others are believed to increase it.

Fatty acids, especially omega-3s, may have an anti-inflammatory effect. However, the American diet tends to be higher in omega-6s than omega-3s. Foods high in omega-3s include fatty fish, such as salmon, tuna, herring, and mackerel. Plant foods that contain omega-3s include walnuts, flaxseed, canola and soybean oils, grape leaves, and Chinese broccoli. Foods high in omega-6s include safflower, sunflower, corn, and grapeseed oils, ingredients often found in mayonnaise and bottled salad dressings.

Certain foods are suspected to reduce the risk and duration of IBD flares. Fruits and vegetables are full of anti-inflammatory agents called phytochemicals. However, many people cannot tolerate raw fruits and vegetables during moderate to severe IBD flares. Cooked produce is usually better tolerated than raw, while peeled is often better tolerated than unpeeled. A low-fiber diet that eliminates most raw vegetables, fruits, nuts, and seeds is often recommended during flares to minimize diarrhea and abdominal pain and in patients who have strictures to prevent bowel obstructions.

Pro-inflammatory foods are thought to increase risk and duration of MD flares when consumed in large quantities. Foods high in sugar, or saturated or trans fats, make this list and should be limited or avoided ed. If you choose whole foods rather than packaged, processed foods, you will eliminate the major sources of added sugar and trans fat. Saturated fat is found in red meat (beef, pork, and lamb) and full-fat dairy products.

The balance of bacteria in the GI tract sometimes can be altered significantly with probiotics, which are sources of "good" bacteria. Yogurt and other cultured dairy foods contain probiotics, and probiotics also are available in supplement form (Florastor. Culturelle, and Align are popular brands). "Patients with IBD should follow up regularly with their doctors to make sure they have a proper management plan in place," Dr. Esrailian adds.

RELATED ARTICLE: WHAT YOU SHOULD KNOW

Medications for IBD include:

* Antibiotics, including rifaxmin (Xifaxan), ciprofloxacin (Cipro) and metronidazole (Flagyl).

* Anti-inflammatory drugs, such as sulfasalazine (Azulfidine) and mesalamine (Apriso, Asacol). However, over-the-counter anti-inflammatories, such as aspirin, ibuprofen (Advil) and naproxen (Aleve), can cause problems in the GI tract.

* Steroids, including prednisone, hydrocortisone and prednisolone.

* Biologic agents that target the immune system, such as methotrexate, azathioprine (Azasan), infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia).

RELATED ARTICLE: DIETARY TRIGGERS OF IBD

Foods that may exacerbate IBD symptoms include:

* Milk products.

* Foods associated with inflammation (alcohol, simple sugars, and caffeine).

* Dried fruits or high-sugar fruits, such as grapes, watermelon, or pineapple.

* Common allergenic foods, such as soy, eggs, peanuts, and tomatoes.

* Saturated fats, found in animal and dairy products.

* Products containing corn or gluten (those made from wheat, oats, or barley).

* Foods that may irritate the intestine, particularly vegetables like cabbage, Brussels sprouts, broccoli, cauliflower, and kale.

You may want to try an elimination diet to help control your IBD symptoms. This involves removing possible trigger foods from your diet and then adding them back in one by one and monitoring how your body reacts. Keep a journal so you can track your symptoms and how they relate to the foods you eat.
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Title Annotation:DIGESTIVE HEALTH
Publication:Healthy Years
Date:Nov 1, 2013
Words:939
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