gastrointestinal tract. Physicians accordingly use addi-
tional tests such as:
Barium enema before x rays. In this test, also called a
‘‘lower gastrointestinal (GI) series’’, an enema tube is
inserted into the patient’s rectum and a barium sol-
ution is allowed to flow in to improve the contrast of
the x rays.
Colonoscopy. Test that allows the physician to look
inside the colon using a colonoscope, a long, flexible
tube that has a miniaturized color-TV camera at one
end. It is inserted through the rectum into the colon,
and provides a view of the lining of the lower diges-
tive tract on a television monitor.
Complete blood count (CBC) test. This test measures
the number of red and white blood cells, the amount
of hemoglobin in the blood, the fraction of the blood
composed of red blood cells (hematocrit), and the
size of the red blood cells.
C-reactive protein (CRP). CRP is a test that meas-
ures the amount of a protein in the blood that signals
acute inflammation.
Endoscopic ultrasound (EUS). Technique that uses
sound waves to create a picture of the inside of the
body. It uses a special endoscope that has an ultra-
sound device at the tip. It is placed in the gastro-
intestinal tract, close to the area of interest.
Esophagogastroduodenoscopy (EGD). EGD is a
technique used to look inside the esophagus, stom-
ach, and duodenum. It uses an endoscope to inves-
tigate swallowing difficulties, nausea, vomiting,
reflux, bleeding, indigestion, abdominal pain, or
chest pain.
Flexible sigmoidoscopy. Technique that allows to
look at the inside of the large intestine from the
rectum through the last part of the colon, called the
sigmoid colon.
Sedimentation rate (ESR). This test draws blood
from a vein, usually from the inside of the elbow or
the back of the hand. It measures the distance that
red blood cells settle in unclotted blood toward the
bottom of a specially marked test tube.
Stool guaiac. This test finds hidden (occult) blood in
the stool.
Treatment
The primary goal of treatment is to control
inflammation and reduce the symptoms of pain, diar-
rhea, and bleeding when present. Many types of med-
icine can reduce inflammation, including anti-
inflammatory drugs such as sulfasalazine (Azulfidine),
corticosteroids such as prednisone, and immune sys-
tem suppressors such as azathioprine (Imuran) and
mercaptopurine (Purinethol). An antibiotic, such as
metronidazole (Flagyl), may also be helpful for
destroying germs in the intestines, especially for
Crohn’s disease. Anti-diarrheal medication, laxatives,
and pain relievers may also be prescribed. If symptoms
are severe, such as diarrhea, fever or vomiting, hospi-
talization may be required to administer intravenous
fluids and medicines.
In the case of severe ulcerative colitis that can not
be helped by medications, a type of surgery called
bowel resection may be performed to remove a dam-
aged part of the intestine or to drain an abscess. If a
part of the bowel is removed, a procedure is done to
connect the remaining two ends of the bowel (anasto-
mosis). In very severe cases, removal of the entire large
intestine (colectomy) is required. Bowel resections
may also be performed for Crohn’s disease patients.Nutrition/Dietetic concernsAn exact IBD diet does not actually exist, since no
specific diet has been shown to improve or worsen
bowel inflammation. However, eating a diet sufficient
in energy and balanced inmacronutrientsand essen-
tial micronutrients is important to avoid malnutrition
and weight loss. Foods that worsen diarrhea should
also be avoided. People who have blockage of the
intestines may need to avoid raw fruits and vegetables.
Those who have difficulty digesting lactose (lactose
intolerance) also need to avoid milk products. The
following guidelines, upon approval by the treating
physician or a registered dietician, can help prevent
malnutrition and extreme weight loss:
Drinking plenty of fluids (8–10 servings daily) helps
to keep body hydrated and prevent constipation.
A daily multivitamin and mineral supplement may
be indicated to replace lost nutrients.
Eating a high fiber diet can help when IBD is under
control. High fiber foods include grains (whole grain
breads, buns, bagels, muffins, bran cereals, Corn
bran, shredded whole wheat, 100% bran and fiber
cereal, cooked cereal such as oat bran, whole-wheat
pastas, whole grains such as barley, popcorn, corn
and brown rice), fruits (dried fruits such as apricots,
dates, prunes and raisins, berries such as blackber-
ries, blueberries, raspberries and strawberries,
oranges, apple with skin, avocado, kiwi, mango and
pear), vegetables (broccoli, spinach, green peas and
other dark green leafy vegetables, dried peas and
beans such as kidney beans, lima beans, black-eyed
beans, chick peas and lentils), and nuts and seeds
(almonds, whole flaxseed and soynuts).Inflammatory bowel disease