Will I Need To Be Hospitalized?
In the past, hospitalization for IBD patients was very common, especially at the time of first diagnosis. In recent years, disease flares have been managed on an outpatient basis, with hospitalization reserved primarily for very severe disease flares, for complications of the disease and for surgery. Many physicians now realize that, in most cases, hospitalization is not needed in order to provide effective medical therapy or to properly monitor a patient's response to therapy.
However, outpatient treatment requires more time and effort on the part of the physician and other members of the health-care team. Health-care professionals now spend more time educating patients and their families about what to expect from the therapy and what to look for in the way of side effects or potential complications. This requires close communication between the treatment team — the physician or nurse clinician — and the patient and family.
Will I Need To Have Surgery?
On average, 40% of ulcerative colitis patients and 80% of Crohn's disease patients will require surgery at some point in the course of their disease.
The likelihood of requiring surgery depends, to a large extent, on how well the disease responds to non-surgical treatments, such as nutritional support or medications. Surgery also depends on the severity, extent, and location of the disease. Patients and families should keep in mind that hospitalization and surgery are not the same as admitting defeat, and that many IBD sufferers go on to lead very fulfilling lives with many years free from recurrent disease following surgery.
In ulcerative colitis, surgery is said to 'cure' the disease, although it does leave the individual with a different internal and, occasionally, external anatomy. There are also some risks of complications of surgery. Unfortunately, in individuals with Crohn's disease, many operations carry a risk of possible recurrence of the disease in areas of the intestine that were not affected before surgery.
Will I Need A 'Bag' Outside My Body To Collect Stool?
Occasionally, the surgeon must bring part of the intestine out to the skin so that the waste material (stool) collects in a bag, which is known as a stoma. There are two main types of stomas that are performed in IBD patients: an ileostomy, which involves bringing the last part of the small intestine out to the skin; and a colostomy, which involves bringing the large intestine out to the skin. These two types of stomas are somewhat different in their appearance and function.
Many patients fear the possibility of surgery because they believe that this means that they will be left with a stoma for the rest of their lives. Fortunately, this situation is the exception rather than the rule. The stoma can be reversed by another operation several months after the first. Even when a permanent stoma is required, a person can lead a normal life with good health and an active lifestyle. This requires some adjustment and support, but it can almost always be achieved.
Can I Get Cancer From IBD?
The first thing to do is to determine your degree of risk. This should be done in consultation with your doctor. If it is determined that you are at increased risk, your doctor may recommend that you enter into a screening program. Even if screening is not recommended, regular follow-up with your doctor is important.
Some of the methods of screening used for non-IBD individuals, such as testing the stool for microscopic traces of blood, are not effective for screening IBD patients. Monitoring for symptoms of cancer is not effective because the symptoms of colorectal cancer may be very similar to those of IBD.
Screening in IBD patients involves carrying out a colonoscopy in order to take numerous random biopsy samples of the colonic lining. These biopsies are carefully examined by a pathologist for precancerous changes called dysplasia. If these changes are found, they indicate a higher possibility (10% to 20%) that the patient may already have cancer or, if cancer isn't already present, the patient has a substantial chance of developing cancer over the subsequent few years. When dysplasia is found and confirmed, surgery to remove the colon is usually recommended.
Other Crohn's Disease Articles...
