Table Of Content76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page i
100 Questions & Answers
About Crohn’s Disease
and Ulcerative Colitis:
A Lahey Clinic Guide
Second Edition
Andrew S. Warner, MD
Chairman of the
Department of Gastroenterology
Lahey Clinic
Burlington, MA
Amy E. Barto, MD
Department of Gastroenterology
Lahey Clinic
Burlington, MA
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page ii
World Headquarters
Jones and Bartlett Jones and Bartlett Jones and Bartlett
Publishers Publishers Canada Publishers International
40 Tall Pine Drive 6339 Ormindale Way Barb House, Barb Mews
Sudbury, MA 01776 Mississauga, Ontario L5V 1J2 London W6 7PA
978-443-5000 Canada United Kingdom
[email protected]
www.jbpub.com
Jones and Bartlett’s books and products are available through most bookstores and online
booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000,
or visit our website, www.jbpub.com.
Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corpo-
rations, professional associations, and other qualified organizations. For details and specific dis-
count information, contact the special sales department at Jones and Bartlett via the above contact
information or send an email to [email protected]
Copyright © 2010 by Jones and Bartlett Publishers, LLC
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized
in any form, electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without written permission from the copyright owner.
The authors, editor, and publisher have made every effort to provide accurate information. However,
they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of
this book and take no responsibility for the use of the products and procedures described. Treatments
and side effects described in this book may not be applicable to all people; likewise, some people may
require a dose or experience a side effect that is not described herein. Drugs and medical devices are
discussed that may have limited availability controlled by the Food and Drug Administration (FDA)
for use only in a research study or clinical trial. Research, clinical practice, and government regulations
often change the accepted standard in this field. When consideration is being given to use of any drug
in the clinical setting, the health care provider or reader is responsible for determining FDA status of
the drug, reading the package insert, and reviewing prescribing information for the most up-to-date
recommendations on dose, precautions, and contraindications, and determining the appropriate usage
for the product. This is especially important in the case of drugs that are new or seldom used.
Production Credits
Executive Publisher: Christopher Davis
Editorial Assistant: Sara Cameron
Associate Production Editor: Leah Corrigan
Senior Marketing Manager: Barb Bartoszek
Manufacturing and Inventory Supervisor: Amy Bacus
Composition: Glyph International
Cover Design: Colleen Lamy
Cover Images: © Photos.com, ©Jessica Bilen/ShutterStock, Inc., © Biljana Kumer/ShutterStock, Inc.
Printing and Binding: Malloy, Inc.
Cover Printing: Malloy, Inc.
Library of Congress Cataloging-in-Publication Data
Warner, Andrew S.
100 questions & answers about Crohn’s disease and ulcerative colitis : a
Lahey Clinic guide / Andrew S. Warner, Amy E. Barto. -- 2nd ed.
p. cm.
Includes index.
ISBN 978-0-7637-7638-1 (alk. paper)
1. Crohn’s disease--Miscellanea. 2. Crohn’s disease--Popular works. 3.
Ulcerative colitis--Miscellanea. 4. Ulcerative colitis--Popular works. I.
Title. II. Title: 100 questions and answers about Crohn's disease and
ulcerative colitis. III. Title: One hundred questions and answers about
Crohn’s disease and ulcerative colitis.
RC862.E52W37 2010
616.3'44--dc22
2009031500
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page iii
Dedication
This book is dedicated to our patients.
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page iv
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page v
Contents
Preface ix
Part 1:The Basics 1
Questions 1–7introduce Crohn’s disease and ulcerative colitis:
• What are Crohn’s disease and ulcerative colitis?
• How do you know if you have Crohn’s disease or ulcerative colitis?
• How common are Crohn’s disease and ulcerative colitis? I seem to know
more and more people with it.
Part 2:Diagnosis 17
Questions 8–17discuss how Crohn’s disease and ulcerative colitis are
diagnosed, as well as the prognosis and other related diseases, such as:
• How are Crohn’s disease and ulcerative colitis diagnosed?
• Can I ever be cured of IBD, or will I have it for my entire life?
• Are Crohn’s disease and ulcerative colitis ever confused with
other disorders?
Part 3:Medications 43
Questions 18–30explain different types of medications used to treat
Crohn’s disease and ulcerative colitis, including:
• What is the role of topical therapy in treating proctitis, and is topical therapy
used for treating anything else?
• What are biologics and who should get them? I’ve heard of infliximab
(Remicade). Are there newer biologics available for the treatment
of Crohn’s and ulcerative colitis?
• Does having Crohn’s disease or ulcerative colitis mean I will be
on medication for my entire life?
Part 4:Cancer and Dysplasia 77
Questions 31–37discuss the relationship of cancer and dysplasia to
Crohn’s disease and ulcerative colitis, such as:
• Am I more likely to get colon cancer if I have ulcerative colitis?
• What is dysplasia and how is it related to cancer?
• Can I do anything to prevent getting colon cancer?
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page vi
100 Q&A ABOUT CROHN’S DISEASE AND ULCERATIVE COLITIS: A LAHEY CLINIC GUIDE
Part 5:Complications 87
Questions 38–47review numerous complications that are associated
with Crohn’s disease and ulcerative colitis, including:
• What is toxic megacolon?
• I heard that people with Crohn’s disease can get something called
a fistula. Can you tell me what this is?
• I have ulcerative colitis and often pass blood with my bowel movements.
Is this something I should worry about?
Part 6:Surgery 101
Questions 48–54explain different surgery options used to treat
this disease, such as:
• What types of operations are performed in Crohn’s disease?
• What is the role of surgery in ulcerative colitis?
• What are some of the other complications found after ileal pouch surgery?
Part 7:Diet and Nutrition 119
Questions 55–64include helpful tips on how to best maintain a healthy diet,
such as:
• How does having Crohn’s disease or ulcerative colitis affect my nutrition?
• Since I have to avoid fruits and vegetables due to my Crohn’s disease,
what can I do to lose weight?
• Is there a specific diet that I should follow if I have Crohn’s disease
or ulcerative colitis?
Part 8:Extraintestinal Manifestations 139
Questions 65–77discuss the affects Crohn’s disease and ulcerative colitis
can have on the rest of your body, including:
• How can IBD affect my skin?
• My joints are often stiff and sore. Is this related to my IBD?
• Am I more likely to get osteoporosis if I have IBD and is there any way
to prevent it?
Part 9:Sexuality,Reproductive Issues,and Pregnancy 163
Questions 78–92review issues surrounding sexuality, pregnancy,
and the disease, like:
• Is it safe to have a baby if I have IBD?
• Can IBD affect fertility in men?
• Should I continue to take my IBD medications during pregnancy
and are they safe to use during pregnancy?
vi
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page vii
100 Q&A ABOUT CROHNS DISEASE AND ULCERATIVE COLITIS: A LAHEY CLINIC GUIDE
Part 10:Lifestyle 183
Questions 93–97discuss the potential affects of Crohn’s disease and
ulcerative colitis on your lifestyle, such as:
• Does stress affect Crohn’s disease and ulcerative colitis? C
o
• Do I have to take any precautions if I want to exercise? n
t
• Can I drink alcohol if I have IBD? e
n
t
s
Part 11:IBD in Children and the Elderly 193
Questions 98–99 explain IBD in children and the elderly:
• Does IBD occur in children? How is it different than in adults?
• Can IBD occur in the elderly?
Part 12:The Future ofCrohn’s Disease and Ulcerative Colitis 197
Question 100discusses the future of treatment options and
diagnosis methods:
• What does the future hold for the diagnosis and treatment of
Crohn’s disease and ulcerative colitis?
Appendix 199
Glossary 201
Index 215
vii
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page viii
76381_FMxx_FINAL.QXP 8/31/09 7:19 PM Page ix
PParretf Oacnee
Crohn’s disease and ulcerative colitis are the two most common
forms of inflammatory bowel disease (IBD). Believed to be caused
by an autoimmune process, Crohn’s disease and ulcerative colitis
are characterized by chronic inflammation of the gastrointestinal
tract, and potentially of many different organ systems throughout
the body. Symptoms of inflammatory bowel disease range from
mild to severe, and up to three-quarters of patients with Crohn’s
disease and one-quarter of patients with ulcerative colitis eventually
need surgery. Fortunately, many effective treatments are currently
available,with new and potentially even more effective therapies on
the horizon.
After a successful first edition, 100 Questions & Answers About
Crohn’s Disease and Ulcerative Colitis: A Lahey Clinic Guide, Second
Edition has been completely revised to contain up-to-date infor-
mation on these two diseases. It is intended to be a patient-
oriented, practical guide about Crohn’s disease and ulcerative
colitis. The questions are taken directly from the thousands we
have been asked over the years by our patients with IBD. The
answers are a compilation of the latest scientific information
along with our own experience in treating inflammatory bowel
disease. In essence, this book re-creates a visit to the doctor’s
office. It contains all the questions you wished you had asked and
many that you never even thought to ask. In addition to our
thoughts as physicians, two of our patients (one with Crohn’s dis-
ease and one with ulcerative colitis) have also offered helpful
hints and invaluable insights about living with IBD from the
patient’s perspective.
100 Questions & Answers About Crohn’s Disease and Ulcerative
Colitis:A Lahey Clinic Guide,Second Edition covers a wide range of
issues. We explore how inflammatory bowel disease is diagnosed
and treated, complications of the disease including dysplasia and
Description:Whether You’Re A Newly Diagnosed Patient, Or A Friend Or Relative Of Someone Suffering With Crohns Disease Or Ulcerative Colitis, This Book Offers Help. Completely Revised And Updated, 100 Questions & Answers About Crohns Disease And Ulcerative Colitis: A Lahey Clinic Guide, Second Edition Provide
