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Crohn's and colitis - complications

Crohn'sdiseaseandulcerativecolitisarecollectivelyknownasinflammatoryboweldisease(IBD). Bothconditionsaffectthebowel,butinslightlydifferentways.Crohn'sdiseasecauses inflammationofthefullthicknessofthebowelwallandcantargetanypartofthedigestivetract, frommouthtoanus.Ulcerativecolitisisinflammationofthelargebowel(colonandrectum).The causesofIBDareunknown,butresearcherssuspecteitheranautoimmunereactionorsomekind ofinfection. SinceIBDtargetsthedigestivetract,commonsymptomsincludeabdominalpain,diarrhoea, nauseaandweightloss.ApersonwithIBDhastopaycloseattentiontodiet,sincemalnutritionis arealpossibility.Othercomplicationsofthedigestivetractincludefistulas(skinulcersthatmay connecttothebowel,orconnectionsbetweenthebowelandotherorgans)andintestinal obstruction.Sometimes,apersonwithIBDexperiencessymptomsinotherareasofthebody. Theseareoftenreferredtoas'extra-intestinalmanifestations'. Complications caused by nutritional deficiencies IBDimpairsabsorptionoffoodnutrients,whichcanleadtonutritionaldeficiencies.Someofthe complicationsofmalnutritioninclude: Dehydration-peoplewithulcerativecolitis,andsomepeoplewithCrohn'sdisease, experiencediarrhoea.Thelossoffluidfromthebodycanleadtodehydration.Insevere cases,thiscandamagethekidneys. Anaemia-acombinationofreduceddietaryironintakeandlossofbloodfromthebowel canleadtoanaemia,aconditioncharacterisedbytheblood'sreducedabilitytocarry oxygen. Weight loss-reducedappetiteandmalabsorptionoffoodnutrientscanresultinweight loss. Reduced growth (in children)-inadequatenutritionduringchildhoodandadolescence canimpairgrowthandphysicaldevelopment.

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Inflammation in other areas SomepeoplewithIBDhavepainfulinflammationinotherareasofthebody,including: Jointsofthefingers,hands,feet,anklesandknees Jointsofthespine,includingvertebraeandsacroiliacjoints(locatedatthepelvis) Eyes Skin.

Skin problems TwospecificskinproblemsthatcanoccurasaresultofIBDare: Pyoderma gangrenosum-small,sunkenulcersformontheskin. Erythema nodosum-painfulsmallreddenednodulesappearontheskin(typically,on thelegs).

Fistulas are abnormal holes Fistulasareabnormalopeningsinthebody.PeoplewithCrohn'sdiseasearemorelikelytodevelop fistulasthanarepeoplewithulcerativecolitis.Thesurfaceofthechronicallyinflamedbowelcan becomeroughandsticky,causingitto'glue'toanearbystructure,suchasaneighbouringloopof intestineoranabdominalorgan.Thistriggersadditionalinflammation,andmayleadtosmallholes (fistulas)betweenthestructures.Sometimes,fistulasbecomeblockedcausingabscessestoform. Intestinal obstruction

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SomepeoplewithCrohn'sdiseasemayexperienceintestinalobstruction.Foodcannolongermove throughtheintestine,whichresultsinsevereabdominalpain,bloatingand(insomecases) vomiting. Toxic megacolon Toxicmegacolonisararecomplication.Mildabdominaldistension(bloating)isacommonand harmlessevent,eveninpeoplewithoutIBD.However,theirritatedandinflamedlargeintestine (largebowel)ofapersonwithIBDcansuddenlyandseverelydistend.Asectionoftheintestinal wallmayballoontothepointofrupture.Arupturedbowelspillsitscontentsintotheabdominal cavity,causinginfection(peritonitis).Toxicmegacolonisalifethreateningemergency.Seekurgent medicalattentionifyouexperiencesymptoms,including: Hard,swollenabdomen Severeabdominalpain Fever Bloodydiarrhoea Acceleratedheartrate.

Treatment options Treatmentdependsonthecomplication,butmayincludethefollowing: Complications caused by nutritional deficiencies-optionsincludevitaminandmineral supplements(orallyorbyinjection),alterationstodiet(suchasconsumingalowfibrediet) orliquiddiets,inseverecases. Inflammation in other body areas-thesecomplicationsusuallyeasewhenthebowel inflammationisbroughtundercontrolwiththeappropriatemedications. Fistulas-smallopeningsoftenhealbythemselves,withtreatmenttoeasethe inflammation.Largerfistulasmayneedtobesurgicallyclosed.Antibioticsandsurgical drainagearenecessaryinthecaseofabscesses. Intestinal obstruction-insomecases,medicaltreatmenttoeasetheinflammationwill cleartheobstruction.Inseverecases,surgeryisrequired. Toxic megacolon-thepersonishospitalised,andgivenfluidsandnutrientsintravenously insteadofbymouth.Antibioticsandsteroidsareusedtoreduceinflammation.Sometimes, itmaybenecessarytodrawoffthestomachcontentswithaslendertube(gastric suctioning).Arupturedbowelneedssurgicalrepairorremoval.Inseverecases,thewhole ofthelargebowelmayneedtobesurgicallyremoved.

Where to get help Yourdoctor Gastroenterologist AustralianCrohn'sandColitisAssociation(ACCA)Tel.(03)98151266ortollfree1800138 029.

Things to remember

Crohn'sdiseaseandulcerativecolitisarecollectivelyknownasinflammatoryboweldisease (IBD). Sometimes,apersonwithIBDexperiencessymptomsinotherareasofthebody(extraintestinalmanifestations). Mostcomplicationseasewhenthebowelinflammationisbroughtundercontrolwiththe appropriatemedications. Complicationsincludeconditionscausedbymalnutrition;inflammationofthejoints,eyes andskin;fistulas;intestinalobstructionandtoxicmegacolon.

This page has been produced in consultation with, and approved by:

AustralianCrohn's&ColitisAssociation(ACCA)

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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