Conditions and Treatment

Intestines - Small Intestines

Crohn’s Disease | Duodenal Ulcers
Lactose Intolerance | Ulcerative Colitis

The small intestine is a 20'-long segment of the bowel that begins at the stomach and joins the large intestine. The small intestine contracts to move food through your digestive system and extract nutrients for your body to use as fuel.

Crohn’s Disease
Crohn's disease is inflammation (swelling and irritation) of the digestive tract. Any part of the digestive tract, from the mouth to the anus, can be affected. Crohn's is often found in the intestines, especially the area where the small intestine and colon meet. All layers of the digestive tract may be inflamed, including the lining and inner and outer walls.

Crohn's disease is a type of IBD (inflammatory bowel disease). No one knows yet what causes IBD. But there are a number of treatment options. These can help people with Crohn's lead full, active lives.

The symptoms of Crohn's disease can include:

Abdominal pain and bloating after meals
Sores in the anal area
High fever and chills
Loss of appetite; possible weight loss
Bloody diarrhea
Nausea or vomiting

To diagnose Crohn's disease, your doctor will examine you and ask you questions. Give your doctor details about your symptoms and health history. Tell your doctor if anyone in your family has ever had IBD, because it may run in families.

You may have certain tests, including:

Barium enema, upper GI series, and small bowel series. These produce a series of x-rays that give your doctor a better look at your digestive tract.
Endoscopy to look directly into your rectum or colon. A sample of tissue (biopsy) is sometimes taken for later study. This test uses a thin, flexible tube to take video pictures of your digestive tract.
Blood or stool tests to help rule out other problems.
CT scan to look for problems in your digestive tract. This test uses x-rays and computers to create images of your digestive tract.

While Crohn's disease has no cure, the symptoms can be treated. Help manage your symptoms by following your doctor's advice and watching what you eat.

Certain medications can help control your symptoms. These may include:

A type of anti-inflammatory medication (called 5-ASA compounds) to help reduce intestinal swelling and discomfort.
Corticosteroids to help reduce inflammation
Antibiotics to fight bacteria that may lead to infection
Medications to control your body's immune system (the system that fights infection by causing inflammation)

Avoid any food that makes your symptoms worse. These foods vary from person to person. But high-fiber foods (such as fresh vegetables) and high-fat foods (such as dairy products and red meat) cause symptoms in many people. Keep track of foods that cause you problems.

Surgery can remove a severely affected part of the digestive tract. If this is an option for you, your doctor can give you more information.

Duodenal Ulcers
Duodenal ulcer is the most common type of peptic ulcer. The duodenum is the first part of the small intestine located just beyond the stomach. These crater like sores are due to breakdowns of the protective lining, and the secretion of acids and enzymes such as pepsin.

The most common symptom of duodenal peptic ulcer is a recurrent burning, gnawing pain in the upper abdomen - sometimes going through to the back. The pain often occurs an hour or so after eating and may be accompanied by bloating, nausea and vomiting. These symptoms may be temporarily relieved by eating, drinking milk or the use of antacid tablets or liquids. You may suffer few symptoms due to a so-called "silent" ulcer. In this case, the first sign may be blood in the stool due to bleeding in the ulcer.

Your physician may request an upper GI (gastrointestinal) series - barium x-frays of your esophagus, stomach and duodenum - to visualize the presence of an ulcer. If necessary, endoscopy may be performed, using a flexible viewing tube that is passed down your throat to directly observe and confirm the presence of an ulcer.

Specific treatment can relieve symptoms, promote healing, and maintain remission. Your physician may prescribe one or more types of medication. With proper treatment, ulcers heal within 4 to 8 weeks. If ulcers recur frequently, your doctor may recommend long-term drug treatment at reduced dosages (maintenance therapy).

Lactose Intolerance
Lactose is milk sugar. It is present in whole and skim milk and in all other dairy products. Like most sugars, lactose is broken down by enzymes in the intestinal track so it can be absorbed as an energy source. The enzyme that breaks down lactose is called lactase. When the intestine does not contain lactase, then lactose intolerance can develop. It is a troublesome and annoying problem, but it is never a serious one.

As would be expected, infants and small children have the enzyme lactase so they can digest mothers' milk. However, during childhood, lactase begins to disappear in many people. By adolescence, it is gone in about 75% of African-Americans, Jews, Native Americans, Mexicans, and in 90% of Asians. So the condition is very common.

When undigested lactose reaches the colon (large intestine), it is broken apart by bacteria. Lactic acid and other acidic chemicals result. It is these products that create the symptoms of lactose intolerance. These symptoms include nausea, abdominal cramps and rumbling, bloating, rectal gas (flatus), and diarrhea. They usually occur 30 minutes to two hours after ingesting lactose-containing foods. The severity of symptoms usually depends on the amount of lactose ingested and how much of the enzyme, lactase, remains in the intestinal tract.

First, the physician reviews the patient's medical history. Sometimes that is enough to determine the problem. However, to make a definitive diagnosis, one of several tests may be needed:

Lactose Tolerance Test - A test dose of lactose is ingested and blood sugar determinations are made over several hours. If lactase is present to break down the lactose load, then the blood sugar rises. If no lactase is present, the sugar level does not change.
Hydrogen Breath Test - When lactose is broken down by the colon's bacteria, hydrogen is released, which then passes out through the lungs. The amount of hydrogen released after a lactose meal can indicate a problem.
Stool Acidity Test - When lactose breaks down to lactic and other acids in the colon, the resulting acidity can be detected by a simple measurement of stool acidity.
The Home Do-It-Yourself Test - Since lactose intolerance is not a serious disorder, some people may want to test themselves at home. First, avoid milk and lactose-containing foods for several days. Then on a free morning, such as a Saturday, drink two large glasses of skim or low-fat milk (14-16 oz.). Finally, wait. If symptoms develop within four hours, the diagnosis of lactose intolerance is fairly certain.

Therapy depends on how many symptoms the patient can or will tolerate. If the condition is mild, then avoiding milk and large amounts of milk products may be enough. For those who are very sensitive to small amounts of lactose, there are two options. First, all foods should be carefully checked for lactose. Grocery items such as bread, baked goods, cereals, instant potatoes, soups, margarine, lunch meat, salad dressings, pancakes, biscuits, cookies, and candy can contain hidden lactose. Even prescription and over-the-counter drugs may contain lactose. The patient must become a label reader looking for and avoiding "milk" and "lactose".

The second option is buying milk to which lactase, the enzyme, has been added or adding lactase drops or tablets to milk. A pharmacist or food store manager can provide advice and there are over-the-counter lactase tablets that can be taken with meals to replace the enzyme the body no longer has. Finally, there are now a variety of lactose-free products available in the specialty section of food stores.

Ulcerative Colitis
Ulcerative colitis is a chronic, recurring disease of the large bowel. The large bowel (colon) is the 5 to 6 foot segment of intestine that begins in the right-lower abdomen, extends upward and then across to the left side, and downward to the rectum. It dehydrates the liquid stool that enters it and stores the formed stool until a bowel movement occurs.

When ulcerative colitis affects the colon, inflammation and ulcers, or sores, form in the lining of the colon. The disease may involve the entire colon (pan colitis), only the rectum (ulcerative proctitis) or, more commonly, some area between the two.

The cause of ulcerative colitis is unknown. Some experts believe there may a defect in the immune system in which the body's antibodies actually injure the colon. Others speculate that an unidentified microorganism or germ is responsible for the disease. It is probable that a combination of factors, including heredity, may be involved in the cause. The disorder can occur in both sexes, all races and all age groups. It is a disease that usually begins in young people.

The disorder typically begins gradually, with crampy abdominal pain and diarrhea that is sometimes bloody. In more severe cases, diarrhea is very severe and frequent. Loss of appetite and weight loss occur. The patient may become weak and very sick. When the disease is localized to the rectum, the symptoms are rectal urgency and passage of small amounts of bloody stool. Usually the symptoms tend to come and go, and there may be long periods without any symptoms at all. Usually, however, they recur.

Diagnosis of ulcerative colitis can be suspected from the symptoms. Certain blood and stool tests are performed to rule out an infection that can mimic the disorder. A visual examination of the lining of the rectum and lower colon (sigmoidoscopy) or the entire colon (colonoscopy) is always required. This exam typically reveals a characteristic pattern. Small, painless biopsies are taken which show certain features of ulcerative colitis. A barium enema x-ray of the colon is also needed at some point during the course of the disease.

Most patients with this disease respond well to treatment and go about their lives with few interruptions. However, some attacks may be quite severe, requiring a period of bowel rest, hospitalization and intravenous treatment. In rare cases, emergency surgery is required. The disease can affect nutrition causing poor growth during childhood and adolescence. Liver, skin, eye or joint (arthritis) problems occasionally occur, even before the bowel symptoms develop. Other problems can include narrowing and partial blocking of the bile ducts which carry bile from the liver to the intestine. Fortunately, there is much that can be done about all of these complications.

In long-standing ulcerative colitis, the major concern is colon cancer. The risk of developing colon cancer increases significantly when the disorder begins in childhood, has been present for 8 to 10 years, or when there is a family history of colon cancer. In these situations, it is particularly important to perform regular and thorough surveillance of the colon, even when there are no symptoms. Analysis of colon biopsies performed during colonoscopy can often predict if colon cancer will occur. In these cases, preventive surgery is recommended.

There are several types of medical treatments available:

Cortisone, Steroids, Prednisone - These powerful drugs usually provide highly effective results. A high dose is often used initially to bring the disorder under control. Then the drug is tapered to low, maintenance doses, even to a dose every other day. These medications are given by pill, enema or intravenously during an acute attack. In time, the physician will usually try to discontinue these drugs because of potential long-term, adverse side effects.
Other Anti-inflammatory Drugs - There are increasing numbers of these drugs available. They can be given by pill or enema. The generic and trade names of some of these drugs are sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Asacol, Pentasa, and Rowasa).
Immune System Suppressors - An overactive immune system is probably important in causing ulcerative colitis. Certain drugs such as azathioprine (Imuran), 6-MP (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex) suppress the immune system and at times are effective.

There are no foods known to injure the bowel. However, during an acute phase of the disease, bulky foods, milk, and milk products can increase diarrhea and cramping. Generally, the patient is advised to eat a healthy, well-balanced diet with adequate protein and calories. A multiple vitamin is often recommended. Iron may be prescribed if anemia is present.

Stress and anxiety may aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic disease can produce a serious emotional reaction in the patient. This can usually be handled through discussion with the physician. There are excellent support groups available in most communities. The Ileitis and Colitis Foundation is one of them.

For patients with longstanding disease that is difficult or impossible to control with medicine, surgery is a welcomed option. In these rare cases, the patient's lifestyle and general health have been significantly affected. Surgical removal of the colon cures the disease and returns good health and a normal lifestyle to the patient. In the past a bag, or ileostomy, was required for this surgery. Advances in surgery now can avoid this problem. The colon is removed and a pouch or reservoir is created from the small intestine. Three to six liquid bowel movements occur daily. Most patients are extremely pleased with this new surgery.