Iron and IBD

Low iron or a lack of it commonly causes iron deficiency anaemia. This type of anaemia leads to a reduction in the production of red blood cells and this can mean a reduced amount of oxygen being carried around the body in your blood. Iron deficiency is a common complication for people who suffer from inflammatory bowel disease but it is very easily treated.

The most common symptoms of iron deficiency are:

·         Tiredness

·         Lack of energy

·         Heart palpitations

·         Pale complexion

Less common symptoms include:

·         Headaches

·         Tinnitus

·         Altered taste

·         Itchiness

·         Sore or abnormally smooth tongue

·         Hair loss

·         Desire to eat non-food items like coal

·         Difficulty swallowing

·         Ulcers in the corner of your mouth

·         Spoon shaped nails

If the iron deficiency is left untreated it can lead to:

·         Increased risk of infections

·         Heart and lung problems

·         Restless leg syndrome

Iron deficiency can be diagnosed through a blood test by your doctor.

People who suffer from IBD who lose blood and also iron through bleeding in their stools from their intestines are usually at a higher risk of developing iron deficiency. This can happen in both people who suffer from both Crohn’s disease and Ulcerative Colitis. People with Crohn’s disease in their small intestine in the duodenum are at further risk as this is where the iron is absorbed. If this is where you have your Crohn’s disease you might have an issue absorbing the iron. Some people with IBD and on a restricted diet due to the foods they can eat will not be getting enough iron through their diet. 

Most people with iron deficiency will be able to take and iron supplement orally from the doctor on a daily basis. Others will need to be given iron intravenously. This will help to boost the iron levels in your body. 

Most people find they have side effects from taking iron supplements such as cramping and constipation. 

You can also help boost your iron intake through your diet by eating foods like:

·         Dark green leafy vegetables like kale or spinach

·         Brown rice

·         Pulses and beans

·         Nuts and seeds

·         Meat, fish and tofu

·         Eggs

·         Dried fruit

·         Also some cereals and bread are also fortified with iron.

If you cannot eat all these just eat what you can tolerate to help boost your iron. I know I have dips every so often that I need to get an infusion every so often and it means 2 trips to the hospitals day case unit for a few hours. I do try to eat what I can to prevent me from having to get an infusion by eating the foods I can tolerate like beef, fish, eggs and cereals.

What is Crohn's Disease?

Crohn’s disease is a chronic illness which causes severe inflammation of the digestive tract.  It is known for abdominal pain, diarrhoea and affecting the persons quality of life.  It is characterised by alternating between flare ups and remissions.  It was named after the person who first described the disease back in 1932, Dr Burrill B Crohn.

Crohn’s disease is included within a larger group of illnesses known as inflammatory bowel diseases (IBD).  It can appear anywhere along the gastrointestinal tract from the lips to the anus.  However, it is mainly found in the distal small bowel and colon.  Due to it developing anywhere within the intestinal tract it can make diagnose and treatment slightly difficult.

Over time, ulcerations can develop and extend through the layers of the intestinal tract. This can cause severe complications such as:

·         Strictures (intestinal narrowing)

·         Fistulas (abnormal tunnelling)

·         Anal fissures (painful tears in the skin around the anal area)

·         Ulcers of the gastrointestinal tract

·         Malabsorption

What Causes Crohn’s Disease?

The cause of Crohn’s disease is unknown. It’s an autoimmune disorder. That means that a combination of genetics and environment cause your immune system to attack your own intestinal cells.  At the moment there is research into the different fungus and bacteria which live within our bodies in our digestive track to see if there are any differences in how they work within our body to a person who has not got Crohn’s disease.

• What about age?
Crohn’s disease most affects people between the ages of 15 and 35.  But with all the new technologies within the hospitals there are children as young as 6months old being diagnosed with Crohn’s disease and Ulcerative Colitis.

• Family History?
Those with a family history of Crohn’s disease unfortunately are at a higher risk of having the illness.  Unlike myself I happened to be the first of many generations who had been diagnosed with Crohn’s Disease.  With me having it, there is a chance of 10-15% of my children having but if they are not diagnosed with it they can be a carrier just like all the other genetic illnesses out there.

• History of Autoimmune Disorders?
If other autoimmune disorders are present within the family or within yourself (such as rheumatoid arthritis and fibromyalgia) you have a higher risk for developing Crohn’s disease.

• Race/Ethnicity?
Although people of all races have the disease, Crohn’s is found more often among people from Eastern Europe and American Jews of European descent.

Symptoms

What Are the Symptoms of Crohn’s Disease?

Symptoms of Crohn’s vary depending on the severity of the disease and the location of the inflammation. The most common symptoms, however, are severe abdominal pain, bloating and cramping during a severe episode. Other symptoms can include weight loss, diarrhoea that may or may not contain blood or mucus, fever, and fatigue.

Because it involves the immune system, symptoms of Crohn’s disease can also be found outside of the gastrointestinal tract. The disease can also include arthritis, skin rashes such as; erythema nodosum, sores inside of the mouth such as; mouth ulcers or canker sores, osteoporosis, and kidney or gallstones.

How Is Crohn’s Disease Diagnosed?

Crohn’s disease is difficult to diagnose because the symptoms can mimic many other diseases, such as a parasitic infection, diverticulitis, a common disease found in the large intestine, Coeliac disease and colon cancer. Another reason that Crohn’s is difficult to diagnose is that there is no specific blood test to identify the disease.

A doctor will consider a variety of factors in diagnosing Crohn’s disease. These include:

· History and Physical Exam

Your doctor will begin with a detailed history of your symptoms and any ask about a family history of autoimmune disorders.

· Abdominal X-ray

This is done to check for any intestinal narrowing or obstruction, which can be a medical emergency.

· Ultrasound

An ultrasound will rule out diseases of other abdominal organs such as the liver, gall bladder, or pancreas.

· CT Scan or MRI

These imaging methods are used to determine any complications of the disease such as fistulas or abscesses.

· Colonoscopy

This is the gold standard for diagnosis of Crohn’s disease. A colonoscopy enables a doctor to see the inside of the intestinal wall and remove a tissue sample for further examination.

How Is Crohn’s Disease Treated?

Due to no known cure as yet for Crohn’s disease doctors can only try to prevent complications and control inflammation. Since the disease alternates between periods of remission and flare-ups, treatment focuses on helping you avoid any flare ups. Treatment varies based on the site and severity of disease as well.

Some treatment options include:

Medications

Many different medications are used to manage Crohn’s disease. They may be used alone, or in combinations.

· Corticosteroids can be used to control inflammation and quiet the immune system. Because of the side effects of chronic use, steroids are often prescribed for a short-term during a flare-up.

· Aminosalicylates are anti-inflammatory drugs that treat mild to moderate symptoms and help keep you in remission.

· Immunosuppressive agents are prescribed to help you maintain remission by calming an over-active immune system.

· Antibiotics are prescribed to prevent and treat infection or decrease the overgrowth of bacteria in the gastrointestinal tract.

· Biologic agents are similar to drugs used in chemotherapy and are given for more severe cases. These medications may be given orally, intravenously, or by self-injection.

Surgery

Depending on the location and severity of the condition, it may be necessary to remove a diseased portion of the intestine. Unfortunately, this doesn’t cure the disease. Crohn’s is a chronic illness that often will reoccur later in life. There are also times when it is necessary to remove an ulceration or blockage in the digestive tract.

Surgery is done cautiously and every attempt is made to preserve as much intestine length as possible to avoid further complications.

Nutrition

People with Crohn’s disease are often underweight because intestinal inflammation interferes with the absorption of food. Nutritional counselling and dietary supplements may be used to try and prevent malabsorption.

Stress Management

Stress can increase the frequency and severity of flare-ups. Stress management and emotional support are important to a successful treatment plan.

Can a Crohn’s Flare-up Be Prevented?

Crohn’s flare-ups cannot be prevented. Certain lifestyle changes, however, can decrease the severity of a flare-up:

· Dietary Changes

A low fibre diet can decrease bowel frequency and help reduce diarrhoea. Many Crohn’s patients find that diarrhoea and flatulence improves by limiting gas-producing foods such as beans, cabbage, broccoli, raw fruits, and juices. Limiting dairy has also been helpful in managing the condition. A dietitian may also recommend six small, frequent meals per day instead of three large ones.

· Stress

Limiting stress and learning to manage it with exercise and relaxation techniques can help decrease symptoms.

· Smoking

Recent studies have shown that even light or occasional smoking can increase the intensity of flare-ups.

· Compliance

Patients who have Crohn’s must take their medications exactly as prescribed and follow their treatment plan in order to prevent complications and hospitalisations.

Crohn’s disease can be a lifelong challenge. Following your doctor’s advice and sticking with your diet and treatment plan can greatly improve your quality of life.

Crohn's Disease and Intestinal Blockages

The most common complication of small bowel Crohn's disease is bowel obstruction due to swelling. However, in a patient with small bowel Crohn's, the wall becomes swollen due to chronic inflammation. Not only does it swell outward, it swells inward too. 

Other Types of Blockages

Strictures

The chronic intestinal inflammation that characterises Crohn's disease may also lead to the development of scar tissue in the intestinal tract. 

As the cycle of inflammation and scarring continue, a segment of the tract may be become narrowed in what is known as a stricture (sometimes called stenosis). If a stricture narrows far enough, it may eventually obstruct the intestinal tract. 

Alternately, if a person with an intestinal stricture eats something that is difficult to digest—for instance, raw vegetables, corn, popcorn, or nuts—the food itself may lead to a bowel obstruction. Acute inflammation on top of a stricture may cause the intestine to become blocked as well. 

Because Crohn's disease affects the entire thickness of the bowel wall, strictures are much more common than they are in ulcerative colitis, which typically affects only the inner lining. With strictures, bowel obstructions may be either acute (temporary) or chronic (permanent). 

Adhesions

Adhesions are bands of scar tissue that develop normally after a patient has surgery on the gastrointestinal (GI) tract. 

Adhesions will run from the point of the surgery to other parts of the intestine, other organs, or to the lining of the abdominal cavity (also known as the peritoneum). 

For most people, adhesions are painless and don't cause any problems at all. However, for some patients, the adhesion may cause the intestine to become "fixed." If a fixed intestine becomes twisted, it will cause an obstruction. 

Most bowel obstructions caused by adhesions will get better without surgery, although, rarely, surgery will be required to cut the adhesions and untwist the bowel. New adhesions will form but will likely not cause problems. 

Symptoms

The symptoms of a chronic blockage will be a "crampy" abdominal pain, bloating, and nausea, which occur shortly after a meal. The elapsed time between the meal and the symptoms will determine the site of the blockage. 

If it’ is less than one hour, the small intestine is usually the culprit. Longer than one an hour suggests the blockage is in the colon. If the symptoms happen all or most of the time after eating, it’ is likely the patient is dealing with strictures as well as swelling. 

In addition to the other symptoms, vomiting, increased diarrhoea, or alternately, constipation, may sometimes occur as well. 

Treatments

A person with acute small bowel obstruction will usually get better within 48 hours of beginning a clear fluid diet or taking prednisolone (a powerful anti-inflammatory). In more serious cases, steroids and a sterilized liquid (enteral) diet will usually help to reduce the swelling. 

However, when the blockage is predominantly due to strictures, drugs, are usually of limited effectiveness. In those more serious cases, the first option for many patients is an endoscopy. In an endoscopy, a doctor passes an inflatable balloon through an endoscope, thus dilating the area of scarring. Success rates are as high as 75 percent with the endoscopy procedure. An endoscopy may relieve symptoms for weeks, months, or even years for some people. However, if the area isn't accessible with an endoscope, surgery will be necessary.

Surgery

The two types of surgery performed on patients with small bowel Crohn's are resection, which involves removing the scarred area of the intestine, and strictureplasty, which is like plastic surgery on the intestine.

The two types of Crohn's patients who are candidates for strictureplasty include those who have had a previous resection, or for those for whom the disease is very severe. Many of those who receive a strictureplasty are able to stop taking medications that help heal the disease and maintain the remission of their Crohn's. 

Strictures that are opened with strictureplasty usually remain open as well, and patients will generally only require surgery again if new strictures form elsewhere in the small intestine or bowel. In addition, most people will begin to eat normally (prior to their blockage) and even gain weight after the operation.