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BACKGROUND


to connect. This may happen in patients with disease of both the rectum and the colon. After the surgeon removes the colon, the small bowel is brought to the skin, so that waste products may be emptied into a pouch attached to the abdomen. The result is an ileostomy or a colostomy. The overall goal of surgery in CD is to conserve bowel, where possible, and return the individual to the best possible quality of life.


Complications


The most common complication of CD is blockage of the intestine due to swelling and the formation of scar tissue. This usually results from repeated bouts of inflammation and ulceration. The result is the thickening of the bowel wall and a significantly narrowed intestinal passage. Symptoms include “crampy” pain around the mid-abdomen frequently associated with vomiting. The abdomen may also become bloated and distended. Medications may relieve the obstruction by reducing the local area of inflammation, but surgery may be required if the obstruction is severe and does not respond to medical treatment. Surgery may also be required if the blockage recurs frequently.


Another complication is ulcers within the intestinal tract that sometimes turn into fistulas. These affect about 30% of people with CD and often become infected. If the fistula is small, medical treatment may heal it. Large or multiple fistulas, on the other hand, may require surgery, particularly if they are accompanied by fever or abdominal pain or severe diarrhea. Occasionally a fistula forms an abscess, or collection of pus, near the intestine. This is a pocket of infection that requires drainage either through a catheter inserted by a radiologist or a special drain that is surgically inserted. The areas around the anus and rectum are often involved. In addition to fistulas, cracks or fissures may also develop in the lining of the mucus membrane of the anus.


Another complication commonly encountered in people with CD is related to malnutrition or the presence of nutritional deficiencies. These are deficiencies of proteins, calories, and vitamins. They generally do not develop unless the disease is extensive and of long duration, resulting in inadequate dietary intake and poor absorption of nutrients. Medical treatment and/or nutritional supplements are usually effective in the replacement of nutrients.


Low risk of cancer of the colon and small bowel is also a potential complication of longstanding CD.


ULCERATIVE COLITIS


UC is a chronic (ongoing) disease of the colon. The disease is marked by inflammation and ulceration of the colon mucosa, or innermost lining. Tiny open sores, or ulcers, form on the surface of the lining, where they bleed and produce pus and mucus. Because the inflammation makes the colon empty frequently, symptoms typically include diarrhea (most often bloody) and often “crampy” abdominal pain. There is also a sense of “dry heaves of the rectum” after bowel movements along with urgency. Some patients will have false urges and pass only tiny amounts of blood and mucus.


The symptoms of UC, as well as possible complications vary depending on the extent of inflammation in the rectum and the colon. The rectum is mostly involved, but can extend up to and including the entire colon.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 21


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