The Inflammatory Bowel Diseases Crohn’s Disease Ulcerative Colitis Ulceration + granulomas usually in ileum and colon. At risk: Jewish descent; ages Causes? Unknown Treatments? Palliative; no cure yet.

Progressive loss of absorptive capacity due to: build-up of fibrous tissue narrowing 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 nearby organs or skin. stomach:intestineintestine:skin stomach:colon (high volume fistulas)

Sx:Weight Loss 2˚ to anorexia N/ 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 remove significant 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 MALABSORPTION MULTIPLE VITAMIN/MINERAL DEFICITS

Feeding Strategies Return of bowel sounds Start using enteral route as soon as possible to promote adaptation! 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 as salad dressing, ice creams, etc.) READ FOOD LABELS!! Substitutes:soy flour, corn, potato, rice, or low-gluten wheat starch

Presenting Sx:steatorrhea, wt loss, diarrhea PEM, anemia PEM Low serum albumin Edema Etiology:Gliadin causes massive flattening/atropy of 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)