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Crohn's Disease. St. Albans, England: National Association for Colitis and Crohn's Disease (NACC). 2000. 20 p.

Crohn's disease (CD) is an illness that can affect any part of the digestive system, although the small and large bowel are the most common sites. CD is not infectious and it is not a form of cancer. At present there is no cure for the illness, but drugs and sometimes surgery usually bring about prolonged relief from symptoms. This booklet, written for people newly diagnosed with CD, offers an overview of the disease and its treatment. The booklet first describes how the digestive system works, the discusses how CD affects the working of the digestive system, the symptoms of the disease, how Crohn's can affect other parts of the body, how CD is diagnosed, the causes of CD, the role of stress in CD, treatment options, drug therapy (antiinflammatory agents, symptomatic drugs, and antibiotics), and surgical options (strictureplasty, resection, proctocolectomy and ileostomy, ileorectal anastomosis, partial colectomy, and temporary ileostomy or colostomy). The booklet then discusses the use of medically supervised diets to help manage Crohn's disease. Other topics include coping with a chronic disease, pregnancy and CD, special problems encountered by children with Crohn's disease, and the impact of Crohn's on the patient's lifestyle. Many people with CD never have more than mild and infrequent symptoms of diarrhea and pain, and these people are likely to find their life is not unduly affected by the illness. Some people do have continuous and severe symptoms in spite of intensive medical and surgical treatment and have to adapt their lifestyle considerably. The booklet concludes with a list of British resource organizations. 2 figures. 3 tables.

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Diabetes Can Affect Your Stomach. Clinical Diabetes. 18(4): 152. Fall 2000.

This patient education fact sheet describes the interplay between diabetes mellitus and the gastrointestinal (GI) tract. The authors stress that because diabetes can affect many parts of the GI tract in different ways, symptoms may vary greatly, which often leads to difficulty in diagnosing and treating the specific problem(s). Common complaints in this population may include dysphagia (difficulty swallowing), early satiety (fullness after eating), reflux (return of gastric acid from the stomach up the esophagus, resulting in heartburn or sore throat), constipation, abdominal pain, nausea, vomiting, and diarrhea. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems. Included in the fact sheet is an eight item questionnaire for screening patients for GI problems associated with their diabetes. Patients are advised to consult with their health care provider if they answer 'yes' to any of the eight questions. The fact sheet is published in the same issue as an article for health care providers on the same topic.

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Crohn's Disease: Current Surgical Options. Ostomy Quarterly. 37(4): 50-52, 54-57. Summer 2000.

Crohn's disease is an inflammatory disease of the gastrointestinal tract. Optimal management of this chronic condition requires close coordination between the patient, surgeon, and primary care provider or gastroenterologist. This article brings readers up to date on current surgical options, in order to help individualize therapy. The author provides information on preoperative evaluation, surgical management techniques, and results of surgical therapy. A complete medical history and physical examination, in conjunction with diagnostic tests can usually confirm the diagnosis of Crohn's disease and the disease pattern. A Crohn's disease activity index (CDAI) grades eight symptoms: number of bowel movements, abdominal pain, general well being, patient conditions (arthritis, anal fissure, fistula, fever, skin conditions, or eye inflammation), the use of Lomotil or opiates for diarrhea, presence of abdominal mass, hematocrit, and body weight. Surgery is indicated when the symptoms or complications interfere with the patient's lifestyle to the point where these outweigh the morbidity (discomfort and risk) of an operation. Obstruction, fistulas, and the failure of medications to control the disease or their side effects are the most common reasons for surgery. Surgical options include removing a section of bowel (segmental resection), a bypass, or a proctocolectomy and Brooke ileostomy. Since Crohn's disease can involve the entire gastrointestinal tract, bowel that is not removed has the potential for recurrent disease. 9 figures. 3 tables. 13 references.

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Dealing with Difficult Situations. In: Bolen, B.B. Breaking the Bonds of Irritable Bowel Syndrome: A Psychological Approach to Regaining Control of Your Life. Oakland, CA: New Harbinger Publications, Inc. 2000. p.79-94.

Irritable bowel syndrome (IBS) consists of recurrent episodes of abdominal pain related to altered bowel habit, which may consist of predominantly constipation or diarrhea, or an alternation between the two. This chapter on dealing with difficult situations is from a book in which the author encourages an open discussion of the symptoms and feelings that accompany irritable bowel syndrome (IBS). Charts and worksheets help readers track the relationship between unpleasant symptoms and external triggers such as foods, stressful events, emotional states, and certain thoughts. Coping skills, such as relaxation exercises and assertiveness techniques, teach readers how to manage their stress more effectively and help them break free of the restrictions placed upon them by the disruptiveness of this digestive disorder. This chapter focuses on various situations that can be difficult to cope with for people with IBS and discusses strategies for successful management. Situations can include work, public speaking, conferences, deadlines, parties, holidays, family conflict, restaurants, travel, and situations that interact with each other. The author provides worksheets for readers to help identify situations that are triggers for symptoms in their own lives. Throughout the chapter, the author emphasizes the importance of educating oneself and taking an active role in one's own disease management.

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Diabetes and the Gastrointestinal Tract. Clinical Diabetes. 18(4): 148-151. Fall 2000.

This article focuses on gastrointestinal (GI) disorders among people who have diabetes. GI disorders are common among people affected by diabetes, with as many as 75 percent of patients visiting diabetes clinics reporting significant GI symptoms. The entire GI tract can be affected by diabetes. Acute and chronic hyperglycemia can lead to specific GI complications. Many GI problems associated with diabetes seem to be related to dysfunction of the neurons supplying the enteric nervous system. One common GI disorder experienced by people who have diabetes is gastroparesis. In this condition, emptying of food from the stomach is delayed. Ulcer disease is another common problem that affects both people who do and do not have diabetes. People who have diabetes may develop yeast infections in the GI tract, especially if they have had poor glycemic control. Limited information is available concerning the effects of diabetes on the large intestine. Enteric neuropathy may affect the nerves innervating the colon, leading to a decrease in colon motility and constipation. People with long term diabetes may experience frequent diarrhea. Diabetic diarrhea is a syndrome of unexplained persistent diarrhea in people with long term diabetes that may be the result of autonomic neuropathy leading to abnormal motility and secretion of fluid in the colon. Pancreatic exocrine dysfunction rarely leads to any clinical problems with digestion. Fatty infiltration of the liver is common among people who have type 2 diabetes. The article discusses these common GI disorders in terms of their diagnosis and treatment. Diagnosis is based on patient history, a physical examination, and appropriate diagnostic tests. Therapeutic options include pharmacological therapy, glycemic control, and dietary manipulation.

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Diabetes Neuropathy: What Can I Do About It?. American Family Physician. 62(9): 2141-2142. November 1, 2000.

This article uses a question and answer format to provide people who have diabetes with information on the causes, prevention, and outcomes of diabetic neuropathy. This condition is a type of nerve damage that occurs in people who have diabetes. Nerve damage occurs if blood glucose levels are not well controlled. Preventing nerve damage involves keeping blood glucose under control by eating healthy foods, exercising, and taking prescribed medications. Numbness in the feet and toes is a sign that a person may have diabetic neuropathy. Other symptoms include pain in the legs, a feeling of lightheadedness that results in a fall, diarrhea and constipation, and, in men, failure to get erections. If diabetic neuropathy has damaged the nerves in the legs and feet, a person may not be able to feel pain in those parts of the body, so an injury could remain untreated. People can prevent foot problems from diabetic neuropathy by examining their feet daily, looking inside their shoes for gravel and torn linings, having their doctor perform a foot examination at every office visit, buying shoes that fit properly, wearing white socks, and washing feet daily and drying them carefully.

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Diabetes and the Gastrointestinal Tract. Clinical Diabetes. 18(4): 148-151. Fall 2000.

This article considers the interplay between diabetes mellitus and the gastrointestinal (GI) tract. The authors note that GI disorders are common among all people and as many as 75 percent of patients visiting diabetes clinics will report significant GI symptoms. Common complaints in this population may include dysphagia (difficulty swallowing), early satiety (fullness after eating), reflux (return of gastric acid from the stomach up the esophagus, resulting in heartburn), constipation, abdominal pain, nausea, vomiting, and diarrhea. Many patients go undiagnosed and under-treated because the GI tract has not been traditionally associated with diabetes and its complications. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems. Patients with a history of retinopathy (eye disease), nephropathy (kidney disease), or neuropathy (nervous system disease) should be presumed to have GI abnormalities until proven otherwise. The authors review the problems that may be encountered in each part of the GI tract, including the esophagus and stomach (gastroparesis, ulcer disease, candida infections), the small intestine, the colon (including diabetes related diarrhea), the pancreas, and the liver. Symptoms can be complex and varied, because of the impact of diabetes on each part of the GI tract. The workup starts with a thorough patient history and appropriate laboratory, radiographic, and GI testing. In addition to drug therapy, glycemic control, and diet therapy play an important role in managing GI disorders in people with diabetes. Accompanying the article is a patient education sheet that includes an eight item questionnaire for screening patients for GI problems associated with their diabetes.

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Diabetes Travel Guide. Alexandria, VA: American Diabetes Association. 2000. 172 p.

This book organizes the process of traveling for people who have diabetes. Chapter one focuses on preparing for a trip. Topics include researching one's destination; seeing one's health care provider prior to departure, carrying a letter from one's doctor; locating medical facilities at one's destination; taking one's medications along; and obtaining health insurance, passports, and visas. Chapter two explains how to pack clothing, diabetes supplies, snacks, and items for an emergency and offers tips for preventing foot infections and other complications from happening. Chapter three provides detailed guidelines for packing and using insulin, syringes, a blood glucose meter, test strips, ketone strips, and a glucagon kit. Other topics include adjusting insulin and an insulin pump for various time zone changes. Chapter four provides tips for packing and taking oral medications, handling time zone changes, dealing with meals and physical activity, and creating a diabetes survival kit. Chapter five provides guidelines for traveling by auto, airplane, or boat. Chapter six addresses the issue of eating well and exercising while away from home. Topics include dealing with time zone changes, deciding where and when to eat, following a meal plan, eating fast foods, and adjusting insulin or diabetes pill doses according to physical activity level. Chapter seven uses a question and answer format to provide tips for coping with illness while traveling. Topics include receiving immunizations prior to traveling if necessary; checking blood glucose and ketones during an illness; dealing with vomiting, diarrhea, colds, jet lag, and urinary tract or vaginal infections; avoiding constipation; preventing insulin pump site infections; and preparing for health care prior to traveling. Chapter eight explains how to plan for situations that may occur during overseas travel, outdoor trips, and scuba diving. 22 appendices. 6 tables.

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Diagnosing Inflammatory Bowel Disease. In: Zonderman, J. and Vender, R.S. Understanding Crohn Disease and Ulcerative Colitis. Jackson, MS: University Press of Mississippi. 2000. p. 3-22.

Crohn's disease and ulcerative colitis, together known as inflammatory bowel disease (IBD), are chronic illnesses of unknown origin. This chapter on diagnosing IBD is from a book that provides timely information about how to obtain and maintain the highest quality of life possible while living with IBD. The authors offer a patient's perspective on coping with IBD. They caution that the diagnosis of IBD may be made quickly or may take a relatively long time, depending on the symptoms people have when they first visit a doctor because of distress. IBD is most commonly diagnosed in two age groups: young adulthood (ages 15 to 30 years), and middle age (ages 50 to 65 years). Prompt diagnosis and treatment of IBD is important; these are chronic, lifelong conditions that demand medical vigilance. In addition, those in their fifties are entering the age at which colorectal cancer becomes more prevalent; it is important that individuals be evaluated by a physician who can distinguish colitis from cancer. The chapter discusses the three classic symptoms that a doctor considers when assessing whether an individual has IBD: persistent or recurrent diarrhea (with or without rectal bleeding), pain, and fever. The authors review the laboratory tests and other diagnostic procedures that may be used, including sigmoidoscopy, colonoscopy, barium enema, and upper gastrointestinal (GI) x ray. The authors also describe the nine varieties (subtypes) of IBD: ulcerative proctitis, proctosigmoiditis, left sided colitis, pancolitis, gastroduodenal Crohn disease, jejunoileitis, ileitis, ileocolitis, and granulomatous colitis. 5 figures.

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Diagnosis of Inflammatory Bowel Disease: An Update. In: Williams, C.N., et al., eds. Trends in Inflammatory Bowel Disease Therapy 1999. Boston, MA: Kluwer Academic Publishers. 2000. p. 73-86.

This chapter on the diagnosis of inflammatory bowel disease (IBD) is from a monograph that reprints the presentations given at the Trends in Inflammatory Bowel Disease Therapy Symposium, held in Vancouver, British Columbia, Canada, in August 1999. The general objective of the conference was to provide an update in the etiology, pathogenesis, and treatment of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). In this chapter, the author notes that although the causes of IBD are still unknown, evidence is accumulating for the idea that both UC and CD are syndromes with multiple causes. Diagnosis of IBD has relied largely on patient history and physical examination, radiographic and endoscopic findings, and standard laboratory parameters. In general, UC is characterized by diffuse and relatively superficial mucosal inflammation with bloody diarrhea as it predominant symptom. CD involves focal and transmural inflammatory changes, often causing systemic manifestations in addition to pain, tenderness, and diarrhea. Antibody to Saccharomyces cerevisiae (ASCA) has been demonstrated in up to 79 percent of CD patients. Antineutrophil cytoplasmic antibodies (ANCA), autoantibodies directed against intracellular components of neutrophils, are present in the blood of 60 to 80 percent of patients with UC. ANCA antibodies have also been detected in a clinically distinct subpopulation of patients with CD. Analysis of these markers provides evidence of clinical, genetic and immunological heterogeneity, and implies distinct types of mucosal inflammation. As more is understood about the development of IBD, it seems likely that therapy can be refined to interfere at specific points in the disease process, depending on the specific dysregulation identified. Diagnosis and therapy can thus merge. The author notes that there is still some reluctance to use these diagnostic tests, even though there is mounting evidence for their utility. The author calls for additional research usingthese serum immune markers in large groups of new patients with UC and CD. 62 references.

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