The Inflammatory Bowel Diseases

Crohn’s Disease Ulcerative Colitis

Ulceration + granulomas usually in ileum and colon.

At risk: Jewish descent; ages 20-40

Causes? Unknown

Treatments? Palliative; no cure yet.

Progressive loss of absorptive capacity due to:

build-up of fibrous tissuenarrowing of intestinal lumen

Other common complications:

Fibrous tissue causes obstruction.Often obstruction leads to infection

(infection in peritoneal cavity= peritonitis)

Fistulas: the joining of inflammed tissue to nearbyorgans or skin.

stomach:intestine intestine:skinstomach:colon (high volume fistulas)

Sx: Weight Loss 2˚ to anorexiaN/ V / D abdominal pain

Nutritional Sequelae:

PEM Low serum albumin Immune fxn

Common deficiencies: Ca, Mg, Zn, B12, folate Vitamin C, folate

Supplements often required.

After acute attacks, bowel rest recommended

Feeding route (oral, tube, or parenteral) determined by status

Enteral often chosen (usually “hydrolyzed” formulas- “predigested” amino acids, monosaccharides, etc.)

Oral diets = high kcal, high protein (fat-restricted if malabsorbing fat;

Lactose intolerance often accompanies Crohn’s)

Short bowel syndrome (SBS)

Gut “short” to due surgeries to removesignificant portion of GI tract

Surgeries? IBD, Cancer, Repair fistulas/obstructions, diverticulitis

Sx? “Everything but the kitchen sink” rapid mobilization of

D, wt loss, wasting (muscle tissue for energy),malabsorption, anemia, hypoCa, Mg emias.

Nutritional effects? What part(s) resected?

Small Bowel Resection:

Adaptation and Feeding

On average ~50% of small bowel resection tolerable if ileum ,ileocecal valve and colon remains.

= TREMENDOUS ADAPTIVE ABSORPTION/DIGESTION CAPACITY

(EVEN THE COLON CAN TAKE OVER CERTAIN NONTYPICAL ABSORPTIVE FUNCTIONS)

ILEUM RESECTED? PRO/FAT/CHO MALABSORPTIONMULTIPLE VITAMIN/MINERAL DEFICITS

Feeding Strategies

Return of bowel sounds

Start using enteral route as soon as possible to promoteadaptation!

Use enteral formulas containing preferred GI fuels:

Glutamine, Short Chain Fatty Acids (fermentation products of WS fibers)

Type of regular diet? Fat-restricted (20% of kcal), high CHO (60% kcal), low oxalate

No colon? Likely require long-term parenteral nutrition

Celiac Sprue, Gluten-Sensitive Enteropathy, Celiac Disease

Genetically Determined Food Sensitivity Caused by a Protein Component of Gluten (Gliadin; found in wheat, oats, rye, barley; often in

processed foods containing thickeners such assalad dressing, ice creams, etc.)

READ FOOD LABELS!!

Substitutes:soy flour, corn, potato, rice, or low-glutenwheat starch

Presenting Sx: steatorrhea, wt loss, diarrheaPEM, anemia

PEM Low serum albumin Edema

Etiology: Gliadin causes massive flattening/atropyof intestinal villi

2˚ lactose intolerance may develop.

Two-three weeks gluten-free diet reverses sx

(Watch for breaded foods, Ovaltine, beer, root beer,Postum, soups in addition to bread/cracker/cereal products)