Inflammatory Bowel Disease
Patients with mild symptomatic Inflammatory bowel disease usually are able to take food orally. The diet should be nutritious. Traditionally, fiber has been restricted during periods of active symptoms.
Examination for ova and parasites may establish the diagnosis of amebiasis, although the sensitivity of stool examination for amebae is lower than 40%. The serum indirect hemagglutination and gel diffusion precipitant tests are more than 90% sensitive for amebic infection. It is particularly important to obtain several stool samples for examination of ova and parasites before barium contrast studies are performed, because the presence of barium in the gastrointestinal tract can obscure ova and parasites for a week or more.
Most women do not want to ingest any medications or products such as alcohol or tobacco when conceiving. With quiescent inflammatory bowel disease, many patients consider discontinuation of maintenance treatments.
The proper surgical management of perianal Crohn’s disease is controversial. Ever since fistulas were first recognized as a manifestation of Crohn’s disease by Penner and Crohn, the specter of incontinence from aggressive perianal surgery has haunted its operative management. Given the often extensive presentation of Crohn’s disease, the decision of when to operate must be a collaborative effort among the patient, gastroenterologist, and surgeon.
There are two forms of idiopathic inflammatory bowel disease: ulcerative colitis, a mucosal inflammatory condition confined to the rectum and colon, and Crohn’s disease, a transmural inflammation of gastrointestinal mucosa that may occur in any part of the gastrointestinal tract. The etiologies of both conditions are unknown, but they may have a common pathogenetic mechanism.
The surgical treatment of perianal fistulas in Crohn’s disease is based on the fistula type (low or high) and, more importantly, the presence of active proctitis. For those with low fistula in ano, fistulotomy still has a role.
Ulcerative colitis and Crohn’s disease, collectively referred to as inflammatory bowel disease, are diagnosed most commonly in patients in their childbearing years. The incidence of Crohn’s disease in young adults is increasing, whereas the incidence of Ulcerative colitis affecting patients in their reproductive years has remained stable. The etiology of IBDs is unknown, but clearly genetic factors and tobacco use have been implicated.
The first line of drug therapy for the patient with mild to moderate colitis is oral sulfasalazine or an oral mesalamine derivative, or topical mesalamine or steroids for distal disease.
Because Crohn’s disease cannot be cured by surgery, the guiding surgical principle is to do as little as possible while relieving symptoms as completely as possible. Risks of iatrogenic injury combined with disappointing surgical results prompt a conservative approach in nearly all patients. We agree completely with Alexander-Williams’ observation that “fecal incontinence is the result of aggressive surgeons and not progressive disease.