Gastric Problems and Abdominal Aches and Pains

There are basically two kinds of human colons: happy colons and unhappy colons. When it's happy, all five feet of it, it is the terminal end of the digestive tract and functions to remove water and salts from the foods digested above it, and it is the structure which forms regular evacuations of stool. When it is unhappy, its manifestations can range from nuisance discomfort to life-threatening and dire illness

The colon begins in the right lower quadrant of the abdomen. Its initial segment is the cecum, which, by the way, is the location of the appendix. The small bowel joins the colon just above the cecal pouch.  The colon then ascends the abdomen to just under the liver and then travels transversely across the abdomen, and finally turns down to descend toward the rectum (hence, the terms:  ascending colon, transverse colon, and descending colon). It is lined with mucosal and epithelial cells which are specialized for its absorptive activities. This lining can be disrupted by infections, tumors, and chronic inflammatory conditions which will be discussed.

As mentioned the appendix is part of the colon. It is a closed tubular structure off the cecum. It can become blocked, inflamed, and infected leading to acute appendicitis. A similar condition can occur, usually involving the left-sided sigmoid colon. The mucosa lining can form pouches through the surrounding muscle called diverticuli. They are like miniature appendices, and can become similarly inflamed and infected, and even at times, they can rupture into the abdominal cavity. Up to fifty per cent of elderly individuals have diverticuli, and half of them will have diverticulitis over their lifetimes.

The most common unhappy colon condition is Irritable Bowel Syndrome. It causes cramps, flatulence, diarrhea and/or constipation, and increased mucus in the stool.  The good news, if there is any, is that it doesn't cause structural disease to the colon, and it doesn't lead to colon cancer. Symptoms can be worse with certain trigger foods like chocolate, caffeine or dairy products, and it is aggravated by stress. It occurs more often in women, and may be worse around the time for their menstrual periods. It's hard to say if the worse part of the condition occurs in the brain or in the colon itself: both are involved, and methods of treatment usually involve both.

Another type of unhappy colon occurs when there is an infection of the lining, so-called colitis or enteritis. The most common type is viral gastroenteritis which is usually a self-limited damaging infection to the mucosa that resolves in two to three days. Its principal symptoms might be diarrhea, low grade fever, and loss of appetite. Bacteria can infect the lining including certain varieties of Staphylococcus. One form of bacterial colitis that occurs is Clostridium difficile which happens after a person has taken certain antibiotics that destroy the normal bacteria of the colon, and there is overgrowth of the C. difficile.

There is a condition called ulcerative colitis which is classified as one of the inflammatory bowel diseases (IBD's). It occurs at continuous area of the colon, and it is usually manifest by abdominal pain and diarrhea. Blood in the stool is another frequent sign. Once a person has ulcerative colitis, and it may not be diagnosed for years, it is usually a life-long illness. The good news is that there are drugs like 5-ASA, sulfasalazine, and certain biological medications which can alleviate symptoms and induce long periods of remission. The bad news is that it does cause structural lesions in the colon, can be of such severity as to be life-threatening, and leads to an increased risk of colon cancer. In addition to the medications specific for ulcerative colitis, the day to day colon health practices, like the ones used in Irritable Bowel, are useful in limiting disease severity.

Another type of inflammatory bowel disease is Crohn's Disease. It is different from ulcerative colitis in that it can occur anywhere in the G.I. tract from the mouth to the anus. It causes patches of inflammation, some of which frequently occur in the colon. These patches can cause damage to the very deep layers of the intestine. Like ulcerative colitis, the symptoms can include abdominal pain, diarrhea, and blood in the stool. Often they can cause malnutrition and growth delays in children. Another difference is that the inflammation can occur in other parts of the body, including the eyes, (arthritic) joints, and skin. Cigarette smoking can cause the disease to be much worse, while in ulcerative colitis, nicotine patches may be one part of treatment. Crohn's Disease can lead to the necessary removal of the entire colon, or can present acutely with life-threatening severity. There is strong evidence that Crohn's Disease has a degree of heredity, and also that it is an auto-immune disease. The same medicines that are used for ulcerative colitis are used to try to induce remission. There is an increased risk of colon cancer in Crohn's Disease.

This leads to a final note on the colon disorders which is colon cancer. It is the third or fourth leading cancer in the United States. It usually begins from adenomatous polyps in the colon which can be visualized and removed during colonoscopy. This is why colonoscopy is recommended at age fifty and every five years thereafter.  It is also recommended that the stool be checked for occult blood once a year by submitting stool cards to the lab. If these recommendations were followed, it is estimated that eighty per cent of colon cancers could be prevented. Localized colon cancer is relatively successfully treated with surgery and chemotherapy, but if it metastasizes to distant organs, success of treatment is much less. Risk factors for colon cancer include colon polyps, previous history of colon cancer, excessive alcohol, increased intake of red meats, certain family histories of colon cancer, and history of inflammatory bowel disease. Cigarette smoking causes an increased need for surgery, and outcomes of treatment are significantly less successful. It's interesting, informing someone of how to prevent colon cancer are general health guidelines: don't be sedentary, exercise regularly, don't smoke, moderate use of alcohol, and eat a healthy diet. It's ironic how often these preventive practices come up when discussing ways to prevent illness in different parts of the body.

John Drew Laurusonis

Doctors Medical Center 

www.doctorsmedicalctr.com