For the purpose of this review, Crohn's disease involving any part of the intestine and chronic ulcerative colitis will be the topics discussed. While these diagnoses are only part of the group of disease states included under the heading of IBD, they do include the largest proportion of inflammatory diseases of the small intestine and colon.
Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus. It is a transmural disease that involves the terminal ileum and colon in 35-45% of cases, the terminal ileum only in 25-35%, the colon only in 15-25% and the proximal small bowel or diffuse distribution throughout the small bowel in the remaining 5-10%. Skip lesions with interspersed normal mucosa are the typical form of Crohn's disease. Treatment prior to the past decade was primarily based on corticosteroids and surgical resection, though the more recent therapies using immunomodulating drugs have focused on sparing intestine lost to resection as well as decreasing complications of steroid therapy. The incidence of Crohn's disease is increasing worldwide .
Ulcerative colitis, by contrast, involves only the colon, sometimes with associated "backwash ileitis" affecting the most distal several centimeters of the terminal ileum. It is characterized by continuous inflammatory changes of the colon from the rectum to its proximal extent of disease. It typically involves only the mucosal and submu-cosal layers of the intestine. There is pancolitis in about 20% of cases. The implications for nutritional status in IBD, not surprisingly, vary based on the anatomic and pathophysiological differences between Crohn's disease and ulcerative colitis.
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WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.