Crohn's Disease & Ulcerative Colitis - Your Personal Health Series
by Fred Saibil MD FRCPC

This is a very useful book for people with IBD and their families. Published in 2003, it is a revised edition of the author's 1996 publication entitled Crohn's Disease & Ulcerative Colitis - Everything you need to know. The updated version is written in simple easy to read language and covers a lot of territory in just over 200 pages.

Topics such as diagnosis, drugs, surgery, and complications are dealt with in a non-threatening way and opinions are backed up with research and statistics where appropriate.

The first three chapters describe the normal gastro-intestinal system, the signs and symptoms of IBD, who gets it and possible causes. How IBD is diagnosed canvasses the various methods of imaging the digestive tract, but stops short of considering the blood tests that are used as a tool to aid diagnosis.

'Diet and IBD' includes information on common dietary restrictions such as lactose intolerance, fibre, meat, fat, spicy and fried foods. The role of clear fluids and special liquid diets is discussed at some length in relation to both UC and CD. Total Parenteral Nutrition (TPN) is briefly touched on. It concludes with advice not to unnecessarily restrict the diet as good nutrition is especially important for people with IBD.

The chapter on drugs is divided into sections - drugs that reduce inflammation, which includes the 5-ASA compounds, steroids, immunosuppressive drugs, the biologicals such as infliximab, and several which were still being tested and not yet available on the market, and drugs that reduce symptoms without affecting inflammation which includes antidiarrheals, bulk formers and bile-salt binders.

The information given on each drug includes how it works, how and when it might be used, and side-effects. The role of antibiotics and other therapies including prebiotics and probiotics, nicotine, and fish oil are also included.

Drugs for other problems such as haemorrhoids and anal fissures, iron deficiency, pain and arthritis are a helpful addition and there is also useful advice on complementary and alternative remedies.

Surgery is one of the important forms of treatment for IBD. Sometimes it's the best choice. Sometimes it's the only choice. These words are in the opening paragraph of Chapter 7 - 'Surgery for IBD' where the author takes a very compassionate look at surgical options for people with UC or CD, making it appropriate reading for teenagers, and with parental guidance, for upper primary school age children faced with the prospect of surgery for their IBD.

Surgery for ulcerative colitis is treated as a historical evolution, with the different operations described, along with information about when each would be appropriate, how it is performed, and problems associated with it. All these operations involve removal of the colon, with or without an ileostomy. The longest discussion is reserved for the current 'favourite' - the pelvic pouch with ileo-anal anastomosis. The operation is described in three stages, with a lengthy assessment of potential side-effects and complications.

Surgery for Crohn's disease is undertaken for any of three main reasons - chronic or frequently recurring obstructions, abscesses with or without fistulas, and the failure of medical therapy to control the disease adequately. Dr Saibil advises that this last reason should be discussed between the gastroenterologist, the surgeon and the patient as 'the criteria may be different for different people'.

The discussion on surgery for CD is divided into areas of intestinal tract involved. Strictureplasty and resection are discussed in detail, along with the considerations for such surgery and the side-effects. The surgical choices are summarised in a useful table for easy reference. Other subjects discussed include recurrence of Crohn's after surgery, laparoscopic surgery, short bowel syndrome, and small bowel transplantation. There is also a section covering the surgical treatment for abscesses, fistulas, and adhesions.

There is a brief but helpful chapter on children with IBD. Issues discussed include diagnosis, growth, drug therapy, nutrition, surgery, and the psychological effects of having IBD.

Complications of IBD can occur within the intestine or in other parts of the body. Some of the most common complications are described along with the treatments that may be required. The topic of cancer and IBD considers who is at risk and discusses the role of surveillance.

The final chapter 'Living with IBD' covers sex, fertility and pregnancy, life expectancy and quality of life, financial and social effects of having this chronic disease, relationships within families and with employers, insurance and travel. These last two topics include some particularly useful tips.

The conclusion to the book is very upbeat, focussing on continuing research into drugs, and improvements in diagnostic tools and surgical procedures. There follows a table of drugs commonly used by IBD patients, a glossary of terms, a list of further resources, and the detailed index.

This book could be recommended reading for IBD patients and may be particularly appropriate for younger people, as it is simply and clearly written in a non-threatening way.

Published by Key Porter Books Limited, Canada (www.keyporter.com)