Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

Crohn’s disease most often begins gradually and can become worse over time. You may have periods of remission that can last for weeks or years.

How common is Crohn’s disease?

Researchers estimate that more than half a million people in the United States have Crohn’s disease. Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world. Experts do not know the reason for this increase.

Who is more likely to develop Crohn’s disease?

Crohn’s disease can develop in people of any age and is more likely to develop in people

• between the ages of 20 and 29
• who have a family member, most often a sibling or parent, with IBD
• who smoke cigarettes

What are the complications of Crohn’s disease?

Complications of Crohn’s disease can include the following:

• Intestinal obstruction. Crohn’s disease can thicken the wall of your intestines. Over time, the thickened areas of your intestines can narrow, which can block your intestines. A partial or complete intestinal obstruction, also called a bowel blockage, can block the movement of food or stool through your intestines.
• Fistulas. In Crohn’s disease, inflammation can go through the wall of your intestines and create tunnels, or fistulas. Fistulas are abnormal passages between two organs, or between an organ and the outside of your body. Fistulas may become infected.
• Abscesses. Inflammation that goes through the wall of your intestines can also lead to abscesses. Abscesses are painful, swollen, pus-filled pockets of infection.
• Anal fissures. Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
• Ulcers. Inflammation anywhere along your digestive tract can lead to ulcers or open sores in your mouth, intestines, anus, or perineum.
• Malnutrition. Malnutrition develops when your body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
• Inflammation in other areas of your body. You may have inflammation in your joints, eyes, and skin.

What other health problems do people with Crohn’s disease have?

If you have Crohn’s disease in your large intestine, you may be more likely to develop colon cancer. If you receive ongoing treatment for Crohn’s disease and stay in remission, you may reduce your chances of developing colon cancer.³

Talk with your doctor about how often you should get screened for colon cancer. Screening is testing for diseases when you have no symptoms. Screening for colon cancer can include colonoscopy with biopsies. Although screening does not reduce your chances of developing colon cancer, it may help to find cancer at an early stage and improve the chance of curing the cancer

Symptoms & Causes

What are the symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are

• diarrhea
• cramping and pain in your abdomen
• weight loss

Other symptoms include

• anemia
• eye redness or pain
• feeling tired
• fever
• joint pain or soreness
• nausea or loss of appetite
• skin changes that involve red, tender bumps under the skin

Your symptoms may vary depending on the location and severity of your inflammation.

Some research suggests that stress, including the stress of living with Crohn’s disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.

What causes Crohn’s disease?

Doctors aren’t sure what causes Crohn’s disease. Experts think the following factors may play a role in causing Crohn’s disease.

Autoimmune reaction

One cause of Crohn’s disease may be an autoimmune reaction—when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn’s disease.

Genes

Crohn’s disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohn’s disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohn’s disease.

Other factors

Some studies suggest that other factors may increase your chance of developing Crohn’s disease:

• Smoking may double your chance of developing Crohn’s disease.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, antibiotics, and birth-control pills may slightly increase the chance of developing Crohn’s disease.
• A high-fat diet may also slightly increase your chance of getting Crohn’s disease.

Stress and eating certain foods do not cause Crohn’s disease.

Diagnosis

How do doctors diagnose Crohn’s disease?

Doctors typically use a combination of tests to diagnose Crohn’s disease. Your doctor will also ask you about your medical history—including medicines you are taking—and your family history and will perform a physical exam.

Physical exam

During a physical exam, a doctor most often

• checks for bloating in your abdomen
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged

Diagnostic tests

Your doctor may use the following tests to help diagnose Crohn’s disease:

• lab tests
• intestinal endoscopy
• upper gastrointestinal (GI) series
• computed tomography (CT) scan

Your doctor may also perform tests to rule out other diseases, such as ulcerative colitis, diverticular disease, or cancer, that cause symptoms similar to those of Crohn’s disease.

What tests do doctors use to diagnose Crohn’s disease?

Your doctor may perform the following tests to help diagnose Crohn’s disease.

Lab tests

Lab tests to help diagnose Crohn’s disease include:

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for changes in

• red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
• white blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.

Intestinal endoscopy

Intestinal endoscopies are the most accurate methods for diagnosing Crohn’s disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include the following:

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum to look for signs of Crohn’s disease.

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.

During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and colon and into the lower part of your ileum. If your doctor suspects that you have Crohn’s disease, the colonoscopy will include biopsies of your ileum, colon, and rectum. You won’t feel the biopsies.

Upper GI endoscopy and enteroscopy. In an upper GI endoscopy, your doctor uses an endoscope to see inside your upper digestive tract, also called your upper GI tract.

A trained specialist performs the procedure at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI endoscopy. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.

During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.

During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope using one of the following procedures:

• push enteroscopy, which uses a long endoscope to examine the upper portion of your small intestine
• single- or double-balloon enteroscopy, which uses small balloons to help move the endoscope into your small intestine
• spiral enteroscopy, which uses a tube attached to an endoscope that acts as a corkscrew to move the instrument into your small intestine

Capsule endoscopy. In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your digestive tract. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for a capsule endoscopy. You don’t need anesthesia for this procedure.

The test begins in a doctor’s office, where you swallow the capsule. You can leave the doctor’s office during the test. As the capsule passes through your digestive tract, the camera will record and transmit images to a small receiver device that you wear. When the recording is done, your doctor downloads and reviews the images. The camera capsule leaves your body during a bowel movement, and you can safely flush it down the toilet.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract.

An x-ray technician and a radiologist perform this test at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI series. You don’t need anesthesia for this procedure.

For the procedure, you’ll be asked to stand or sit in front of an x-ray machine and drink barium. The barium will make your upper GI tract more visible on an x-ray. You will then lie on the x-ray table, and the radiologist will watch the barium move through your upper GI tract on the x-ray and fluoroscopy.

CT scan

A CT scan uses a combination of x-rays and computer technology to create images of your digestive tract.

For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can diagnose both Crohn’s disease and the complications of the disease.

Treatment

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

• balsalazide
• mesalamine
• olsalazine
• sulfasalazine

Some of the common side effects of aminosalicylates include

• diarrhea
• headaches
• heartburn
• nausea and vomiting
• pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

• budesonide
• hydrocortisone
• methylprednisolone
• prednisone

Side effects of corticosteroids include

• acne
• bone mass loss
• high blood glucose
• high blood pressure
• a higher chance of developing infections
• mood swings
• weight gain

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

• 6-mercaptopurine, or 6-MP
• azathioprine
• cyclosporine
• methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

• a low white blood cell count, which can lead to a higher chance of infection
• feeling tired
• nausea and vomiting
• pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

• anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab , and infliximab
• anti-integrin therapies, such as natalizumab and vedolizumab
• anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

• acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
• antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
• loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

• ask you to drink a liquid that contains nutrients
• give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
• give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.⁸ Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

• fistulas
• bleeding that is life threatening
• intestinal obstructions
• side effects from medicines when they threaten your health
• symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

• laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

• laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

• Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
• Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
• Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
• Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
• Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
• Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
• Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines

Eating, Diet, & Nutrition

How can my diet help the symptoms of Crohn’s disease?

Changing your diet can help reduce symptoms. Your doctor may recommend that you make changes to your diet such as

• avoiding carbonated, or “fizzy,” drinks
• avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• drinking more liquids
• eating smaller meals more often
• keeping a food diary to help identify foods that cause problems

Depending on your symptoms or medicines, your doctor may recommend a specific diet, such as a diet that is

• high calorie
• lactose free
• low fat
• low fiber
• low salt

Talk with your doctor about specific dietary recommendations and changes.

Your doctor may recommend nutritional supplements and vitamins if you do not absorb enough nutrients. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you 

The post Crohn’s Disease. Symptoms, Diagnosis, and Treatment appeared first on Medika Life.

Are people with Barrett’s esophagus more likely to develop cancer?

People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinoma.

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year. Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue. Doctors call this condition dysplasia and classify the dysplasia as low grade or high grade.

You may have Barrett’s esophagus for many years before cancer develops.

How common is Barrett’s esophagus?

Experts are not sure how common Barrett’s esophagus is. Researchers estimate that it affects 1.6 to 6.8 percent of people.

Who is more likely to develop Barrett’s esophagus?

Men develop Barrett’s esophagus twice as often as women, and Caucasian men develop this condition more often than men of other races. The average age at diagnosis is 55. Barrett’s esophagus is uncommon in children

What are the symptoms of Barrett’s esophagus?

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD), which does cause symptoms.

What causes Barrett’s esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

What factors increase a person’s chances of developing Barrett’s esophagus?

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a more serious, chronic form of gastroesophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Between 10 and 15 percent of people with GERD develop Barrett’s esophagus.

Obesity—specifically high levels of belly fat—and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

What factors decrease a person’s chances of developing Barrett’s esophagus?

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. While the bacteria damage your stomach and the tissue in your duodenum, some researchers believe the bacteria make your stomach contents less damaging to your esophagus if you have GERD.

Researchers have found that other factors may decrease the chance of developing Barrett’s esophagus, including

• frequent use of aspirin or other nonsteroidal anti-inflammatory drugs
• a diet high in fruits, vegetables, and certain vitamins

Diagnosis

How do doctors diagnose Barrett’s esophagus?

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Doctors may diagnose Barrett’s esophagus while performing tests to find the cause of a patient’s gastroesophageal reflux disease (GERD) symptoms.

Medical history

Your doctor will ask you to provide your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Upper GI endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care provider uses an endoscope to see inside your upper GI tract, most often while you receive light sedation. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. The procedure may show changes in the lining of your esophagus.

The doctor performs a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab to determine whether Barrett’s esophagus cells are present. A pathologist who has expertise in diagnosing Barrett’s esophagus may need to confirm the results.

Barrett’s esophagus can be difficult to diagnose because this condition does not affect all the tissue in your esophagus. The doctor takes biopsy samples from at least eight different areas of the lining of your esophagus.

Who should be screened for Barrett’s esophagus?

Your doctor may recommend screening for Barrett’s esophagus if you are a man with chronic—lasting more than 5 years—and/or frequent—happening weekly or more—symptoms of GERD and two or more risk factors for Barrett’s esophagus. These risk factors include

• being age 50 and older
• being Caucasian
• having high levels of belly fat
• being a smoker or having smoked in the past
• having a family history of Barrett’s esophagus or esophageal adenocarcinoma

Treatment

How do doctors treat Barrett’s esophagus?

Your doctor will talk about the best treatment options for you based on your overall health, whether you have dysplasia, and its severity. Treatment options include medicines for GERD, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.

Periodic surveillance endoscopy

Your doctor may use upper gastrointestinal endoscopy with a biopsy periodically to watch for signs of cancer development. Doctors call this approach surveillance.

Experts aren’t sure how often doctors should perform surveillance endoscopies. Talk with your doctor about what level of surveillance is best for you. Your doctor may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia.

Medicines

If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with acid-suppressing medicines called proton pump inhibitors (PPIs). These medicines can prevent further damage to your esophagus and, in some cases, heal existing damage.

PPIs include

• omeprazole (Prilosec, Zegerid)
• lansoprazole (Prevacid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)
• esomeprazole (Nexium)
• dexlansoprazole (Dexilant)

All of these medicines are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Your doctor may consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines. However, research has not shown that medicines or surgery for GERD and Barrett’s esophagus lower your chances of developing dysplasia or esophageal adenocarcinoma.

Endoscopic ablative therapies

Endoscopic ablative therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells.

A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive local anesthesia and a sedative. The most common procedures are the following:

• Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus. A doctor injects porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.

Complications of photodynamic therapy may include

• sensitivity of your skin and eyes to light for about 6 weeks after the procedure
• burns, swelling, pain, and scarring in nearby healthy tissue
• coughing, trouble swallowing, stomach pain, painful breathing, and shortness of breath.

• Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.

Complications of radiation ablation may include

• chest pain
• cuts in the lining of your esophagus
• strictures

Clinical trials have shown that complications are less common with radiofrequency ablation compared with photodynamic therapy.

Endoscopic mucosal resection

In endoscopic mucosal resection, your doctor lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive local anesthesia to numb your throat and a sedative to help you relax and stay comfortable.

Before performing an endoscopic mucosal resection for cancer, your doctor will do an endoscopic ultrasound.

Complications can include bleeding or tearing of your esophagus. Doctors sometimes combine endoscopic mucosal resection with photodynamic therapy.

Surgery

Surgery called esophagectomy is an alternative to endoscopic therapies. Many doctors prefer endoscopic therapies because these procedures have fewer complications.

Esophagectomy is the surgical removal of the affected sections of your esophagus. After removing sections of your esophagus, a surgeon rebuilds your esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover.

Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.

Eating, Diet, & Nutrition

How can your diet help prevent Barrett’s esophagus?

Researchers have not found that diet and nutrition play an important role in causing or preventing Barrett’s esophagus.​

If you have gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), you can prevent or relieve your symptoms by changing your diet. Dietary changes that can help reduce your symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

Avoid eating or drinking the fol​lowing items that may make GER or GERD worse:

• ​chocolate
• coffee
• peppermint
• greasy or spicy foods​
• tomatoes and tomato products
• alcoholic drinks

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you

The post Barrett’s Esophagus. Symtoms, Diagnosis and Treatment appeared first on Medika Life.

• Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.
• Health history affects the risk of developing colon cancer.
• Signs of colon cancer include blood in the stool or a change in bowel habits.
• Tests that examine the colon and rectum are used to detect (find) and diagnose colon cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.

The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are about 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Health history affects the risk of developing colon cancer

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for colorectal cancer.

Risk factors for colorectal cancer include the following:

• Having a family history of colon or rectal cancer in a first-degree relative (parent, sibling, or child).
• Having a personal history of cancer of the colon, rectum, or ovary.
• Having a personal history of high-risk adenomas (colorectal polyps that are 1 centimeter or larger in size or that have cells that look abnormal under a microscope).
• Having inherited changes in certain genes that increase the risk of familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer).
• Having a personal history of chronic ulcerative colitis or Crohn disease for 8 years or more.
• Having three or more alcoholic drinks per day.
• Smoking cigarettes.
• Being black.
• Being obese.

Older age is a main risk factor for most cancers. The chance of getting cancer increases as you get older.

Signs of colon cancer include blood in the stool or a change in bowel habits.

These and other signs and symptoms may be caused by colon cancer or by other conditions. Check with your doctor if you have any of the following:

• A change in bowel habits.
• Blood (either bright red or very dark) in the stool.
• Diarrhea, constipation, or feeling that the bowel does not empty all the way.
• Stools that are narrower than usual.
• Frequent gas pains, bloating, fullness, or cramps.
• Weight loss for no known reason.
• Feeling very tired.
• Vomiting.

Tests that examine the colon and rectum are used to detect (find) and diagnose colon cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual.
• Fecal occult blood test (FOBT): A test to check stool (solid waste) for blood that can only be seen with a microscope. A small sample of stool is placed on a special card or in a special container and returned to the doctor or laboratory for testing. Blood in the stool may be a sign of polyps, cancer, or other conditions.There are two types of FOBTs:
  • Guaiac FOBT: The sample of stool on the special card is tested with a chemical. If there is blood in the stool, the special card changes color. A guaiac fecal occult blood test (FOBT) checks for occult (hidden) blood in the stool. Small samples of stool are placed on a special card and returned to a doctor or laboratory for testing.
  • Immunochemical FOBT: A liquid is added to the stool sample. This mixture is injected into a machine that contains antibodies that can detect blood in the stool. If there is blood in the stool, a line appears in a window in the machine. This test is also called fecal immunochemical test or FIT.A fecal immunochemical test (FIT) checks for occult (hidden) blood in the stool. A small sample of stool is placed in a special collection tube or on special cards and returned to a doctor or laboratory for testing.
• Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.
• Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps (small areas of bulging tissue), other abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.
• Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.
• Virtual colonoscopy: A procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (whether the cancer is in the inner lining of the colon only or has spread through the colon wall, or has spread to lymph nodes or other places in the body).
• Whether the cancer has blocked or made a hole in the colon.
• Whether there are any cancer cells left after surgery.
• Whether the cancer has recurred.
• The patient’s general health.

The prognosis also depends on the blood levels of carcinoembryonic antigen (CEA) before treatment begins. CEA is a substance in the blood that may be increased when cancer is present.

Stages of Colon Cancer

• After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The following stages are used for colon cancer:
  • Stage 0 (Carcinoma in Situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV

After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.

The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, pelvis, or chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the colon. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Surgery: A procedure to remove the tumor and see how far it has spread through the colon.
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells. This may be done during surgery or by endoscopic ultrasound-guided fine needle aspiration biopsy.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Carcinoembryonic antigen (CEA) assay:A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts,it can be a sign of colon cancer or other conditions.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels  to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if colon cancer spreads to the lung, the cancer cells in the lung are actually colon cancer cells. The disease is metastatic colon cancer, not lung cancer.

The following stages are used for colon cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the mucosa (innermost layer) of the colon wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I colon cancer, cancer has formed in the mucosa (innermost layer) of the colon wall and has spread to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the colon wall.

Stage II

Stage II colon cancer is divided into stages IIA, IIB, and IIC.

• Stage IIA: Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall.
• Stage IIB: Cancer has spread through the serosa (outermost layer) of the colon wall to the tissue that lines the organs in the abdomen (visceral peritoneum).
• Stage IIC: Cancer has spread through the serosa (outermost layer) of the colon wall to nearby organs.

Stage III

Stage III colon cancer is divided into stages IIIA, IIIB, and IIIC.

In stage IIIA, cancer has spread:

• through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the colon wall. Cancer has spread to one to three nearby lymph nodes or cancer cells have formed in tissue near the lymph nodes; or
• through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue next to the mucosa). Cancer has spread to four to six nearby lymph nodes.

In stage IIIB, cancer has spread:

• through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to one to three nearby lymph nodes or cancer cells have formed in tissue near the lymph nodes; or
• to the muscle layer or to the serosa (outermost layer) of the colon wall. Cancer has spread to four to six nearby lymph nodes; or
• through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the colon wall. Cancer has spread to seven or more nearby lymph nodes.

In stage IIIC, cancer has spread:

• through the serosa (outermost layer) of the colon wall to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to four to six nearby lymph nodes; or
• through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to seven or more nearby lymph nodes; or
• through the serosa (outermost layer) of the colon wall to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissue near the lymph nodes.

Stage IV

Stage IV colon cancer is divided into stages IVA, IVB, and IVC.

• Stage IVA: Cancer has spread to one area or organ that is not near the colon, such as the liver, lung, ovary, or a distant lymph node.
• Stage IVB: Cancer has spread to more than one area or organ that is not near the colon, such as the liver, lung, ovary, or a distant lymph node.
• Stage IVC: Cancer has spread to the tissue that lines the wall of the abdomen and may have spread to other areas or organs.

Recurrent Colon Cancer

Recurrent colon cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the colon or in other parts of the body, such as the liver, lungs, or both.

Treatment Option Overview

• There are different types of treatment for patients with colon cancer.
• Seven types of standard treatment are used:
  • Surgery
  • Radiofrequency ablation
  • Cryosurgery
  • Chemotherapy
  • Radiation therapy
  • Targeted therapy
  • Immunotherapy
• New types of treatment are being tested in clinical trials.
• Treatment for colon cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for patients with colon cancer.

Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Seven types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery:

• Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube with a cutting tool through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging area of tissue), the operation is called a polypectomy.
• Resection of the colon with anastomosis: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.Resection of the colon with anastomosis. Part of the colon containing the cancer and nearby healthy tissue is removed, and then the cut ends of the colon are joined.
• Resection of the colon with colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.Colon cancer surgery with colostomy. Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiofrequency ablation

Radiofrequency ablation is the use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then deliver the drugs throughout the liver.

Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used as palliative therapy to relieve symptoms and improve quality of life.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Types of targeted therapies used in the treatment of colon cancer include the following:

• Monoclonal antibodies: Monoclonal antibodies are made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.There are different types of monoclonal antibody therapy:
  • Vascular endothelial growth factor (VEGF) inhibitor therapy: Cancer cells make a substance called VEGF, which causes new blood vessels to form (angiogenesis) and helps the cancer grow. VEGF inhibitors block VEGF and stop new blood vessels from forming. This may kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramucirumab are VEGF inhibitors and angiogenesis inhibitors.
  • Epidermal growth factor receptor (EGFR) inhibitor therapy: EGFRs are proteins found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to the EGFR on the surface of the cell and causes the cells to grow and divide. EGFR inhibitors block the receptor and stop the epidermal growth factor from attaching to the cancer cell. This stops the cancer cell from growing and dividing. Cetuximab and panitumumab are EGFR inhibitors.
• Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that tumors need to grow.
  • Ziv-aflibercept is a vascular endothelial growth factor trap that blocks an enzyme needed for the growth of new blood vessels in tumors.
  • Regorafenib is used to treat colorectal cancer that has spread to other parts of the body and has not gotten better with other treatment. It blocks the action of certain proteins, including vascular endothelial growth factor. This may help keep cancer cells from growing and may kill them. It may also prevent the growth of new blood vessels that tumors need to grow.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy:

• Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Pembrolizumab is a type of immune checkpoint inhibitor.

Treatment Options for Colon Cancer

Stage 0 (Carcinoma in Situ)

Treatment of stage 0 (carcinoma in situ) may include the following types of surgery:

• Local excision or simple polypectomy.
• Resection and anastomosis. This is done when the tumor is too large to remove by local excision.

Stage I Colon Cancer

Treatment of stage I colon cancer usually includes the following:

• Resection and anastomosis.

Stage II Colon Cancer

Treatment of stage II colon cancer may include the following:

• Resection and anastomosis.

Stage III Colon Cancer

Treatment of stage III colon cancer may include the following:

• Resection and anastomosis which may be followed by chemotherapy.
• Clinical trials of new chemotherapy regimens after surgery.

Stage IV and Recurrent Colon Cancer

Treatment of stage IV and recurrent colon cancer may include the following:

• Local excision for tumors that have recurred.
• Resection with or without anastomosis.
• Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread. Treatment of cancer that has spread to the liver may also include the following:
  • Chemotherapy given before surgery to shrink the tumor, after surgery, or both before and after.
  • Radiofrequency ablation or cryosurgery, for patients who cannot have surgery.
  • Chemoembolization of the hepatic artery.

• Radiation therapy or chemotherapy may be offered to some patients as palliative therapy to relieve symptoms and improve quality of life.
• Chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor.
• Immunotherapy.
• Clinical trials of chemotherapy and/or targeted therapy.

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