INFLAMMATORY BOWEL DISEASE (IBD)

INFLAMMATORY BOWEL DISEASE (IBD)

IBD is a general term used to refer to chronic inflammatory condition of the intestine. It is applied to three conditions having similar symptoms but different underlying clinical problem. It includes:

  1. Ulcerative colitis

  2. Crohn’s disease

  3. Short bowel syndrome

ULCERATIVE COLITIS

It’s a diffuse inflammatory and ulcerative disease of unknown etiology involving the mucosa and sub-mucosa of the large intestine. It may occur at any age but predominates in young adults.

Symptoms

  1. Mild abdominal discomfort, leading to need to defecate several times a day.

  2. Diarrhea accompanied by rectal bleeding.

  3. Weight loss, dehydration, fever, anemia and general debility.

  4. If necrosis of the tissue is localized without any external symptoms, the case may be severe and remedy must be given immediately.

DIETARY MANAGEMENT

  • Proper dietary management is important for maintaining a good nutritional status. Long term management is required as the disease develops gradually and it takes a long time to cure this disorder.

  • It demands that the diet must be modified as per the individual’s needs. The entire meal is divided into five to six frequent feedings.

  • Nutritionally, the diet is made adequate by giving more proteins.

  • Tender meats, poultry, soft boiled eggs and fish cooked with very little spices for non-vegetarians is ideal.

  • Milk is restricted initially and intake increased as tolerance improves. Protein supplements can be used if necessary.

  • A very low residue diet is given initially; which may progress to a moderate fiber diet.

  • All raw vegetables and fruits and other similar foods which may irritate the bowel is avoided.

  • Vitamin and mineral supplementation is necessary especially iron and calcium, if milk is not tolerated.

General guidelines

  1. Restore weight status and maintain ideal body weight.

  2. A high protein diet is recommended. Proteins are necessary for tissue synthesis, tissue healing and to compensate for the increased losses in stools.

  3. Usual foods which contain fats are permitted but not fried foods, as they are not digested due to liver dysfunction. Thus fats rich in medium chain triglycerides should be consumed.

  4. Low residue diet is recommended to prevent severe bleeding during diarrhea. Sugars and starches can make the increased calorie intake.

  5. All kinds of irritant and spicy foods should be strictly avoided.

  6. Commercial multivitamin supplements can be administered orally.



SHORT BOWEL SYNDROME

It is a group of problems affecting people who have had half or more of their small intestines removed. The massive resection of the intestine decreases the transit time of the intestine.

Causes

  1. Anaemia

  2. Osteoporosis

  3. Stone formation

  4. Decreased susceptibility to infection

  5. Dehydration

Symptoms

  1. Anorexia

  2. Steatorrhoea

  3. Heart burn and cramping

  4. Bloating and abdominal pain

  5. Fatigue

  6. Weight loss

  7. Fluid retention

  8. Anaemia and osteomalacia

Dietary management

  • A high calorie and low residue diet that also supplies the vitamins, minerals and other nutrients is necessary. The food should be bland.

  • The food is divided into several small meals of protein and complex carbohydrates. A minimum of concentrated sweets, fruit juices should be included.

  • The vitamin and mineral supplements may be needed.

  • The diet is basically a soft diet; which can be digested without much work in the bowel. The complexity of the disease is increased over time.

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