REGIONAL ENTERITIS

(This is part of Inflammatory Bowel Disease (IBD) along with Ulcerative Colitis and Whipples)

• Chron’s, or Iliocolitis are the aka’s

• Regional Enteritis starts at the distal ileum

• 40% involve cecum at the beginning; however it can be anywhere from mouth to anus.

• This is not the same as ulcerative colitis even though they are related

• Know Dif bet. UC, RE, and Whipples

• It is a full thickness IBD

• It involves very big holes

• Leads to perforations

• Can have long periods of remission

• Skip lesions seen on endoscopic exam and contrast.

• In remissive tissue lesions fill in with adhesion (scar tissue) that shrinks down over time

• Can decrease peristaltic wave through that region

• Can get low grade obstruction from narrowed lumen

• Can happen at any age though 2^nd and 3^rd decade is most common

• RE has no gender bias

• More Caucasians of Jewish descent get RE (chron’s)

• Chron’s is 2-3x more common in blood relatives.

• Diarrhea followed by constipation is a major sign of RE

• The lesion is dominated by immune globulins

• Milk and dairy are trigger foods, however they don’t cause the disease

• The cause seems to be genetic predisposition with viral trigger

• Once the skip lesions reach the capillary bed you will begin to see blood in the stool of RE patients (hemocult = positive)

• RE can cause anemia but so can menstruation so RE in women can be missed especially since it is prime in the 2^nd and 3^rd decade.

• If the SI isn’t absorbing appropriately RE people will see weight loss

• THE stool of RE patients will have stuff in it that should have been absorbed

• Retrograde endoscopy is the best way to diagnose it (contrast shows decrease peristaltic wave

• If it goes through one loop, it can go into another causing a fistula

• Additionally, it can also break through to surrounding organs (i.e. bladder) and urine will smell like caca (that means poop)

• TREATMENT of REGIONAL ENTERITES a.k.a. chron’s/iliocolitis

  • the most successful drugs claim 40% success rate, barely beating placebo

  • we (chiropractors) can help 40-50% without the side effects of drugs so we are better tx.

  • Cutting out/ avoiding trigger foods (i.e. dairy) is a good form of treatment

  • During inflammation consume highly absorbable foods

  • Avoid raw vegetables and fruits b/c the bulk of it will not get absorbed and will speed through the SI and not get absorbed.

  • Corticosteroids – are advised if the flare up is very bad

Category: Gastroenterology Notes