Factors That Determine Risk for Surgery in Pediatric Patients With Crohn’s Disease

Learn more about Crohn’s Disease and the risks involved with surgery in young patients. 


Our Gastroenterology department at Amarillo Diagnostic Clinic can help you get through the difficulties
of Crohn’s Disease. Watch this helpful video summarizing questions you may have about young people who suffer from Crohn’s.

Gastroenterology: ADC

Daniel A. Beggs, M.D.
R. Todd Ellington, Jr., M.D.
Thomas Johnson, M.D.
Jake Lennard, M.D.
James E. Lusby, M.D.

Factors That Determine Risk for Surgery in Pediatric Patients With Crohn’s Disease

Background & Aims

We examined the incidence of Crohn’s disease (CD)-related surgery in a multi-center, inception cohort of pediatric patients with CD. We also examined the effect of starting immunomodulator therapy within 30 days of diagnosis.

Methods

Data from 854 children with CD from the Pediatric Inflammatory Bowel Disease Collaborative Research Group who were diagnosed with CD between 2002 and 2008 were analyzed.

Results

Overall, 76 (9%) underwent a first CD-related surgery, 57 (7%) underwent a first bowel surgery (bowel resection, ostomy, strictureplasty, or appendectomy), and 19 (2%) underwent a first non-bowel surgery (abscess drainage or fistulotomy). The cumulative risks for bowel surgery, non-bowel surgery, and all CD-related surgeries were 3.4%, 1.4%, and 4.8%, respectively, at 1 year after diagnosis and 13.8%, 4.5%, and 17.7%, respectively, at 5 years after diagnosis. Older age at diagnosis, greater disease severity, and stricturing or penetrating disease increased the risk of bowel surgery. Disease between the transverse colon and rectum decreased the risk. Initiation of immunomodulator therapy within 30 days of diagnosis, sex, race, and family history of inflammatory bowel disease did not influence the risk of bowel surgery.

Conclusions

In an analysis of pediatric patients with CD, the 5-year cumulative risk of bowel surgery was lower than that reported in recent studies of adult and pediatric patients but similar to that of a recent retrospective pediatric study. Initiation of immunomodulator therapy at diagnosis did not alter the risk of surgery within 5 years of diagnosis.

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Stomach Aches and Pains: Do You Have Irritable Bowel Syndrome?

IBS affects at least 10–15 percent of adults and is a common issue around the world.

Irritable bowel syndrome (IBS) is a long-term and many times reoccurring disorder that affects the functioning of your stomach and intestines. It usually involves disturbances in the colon and small intestine which can involve symptoms of:

  • abdominal pain or discomfort,
  • bloating or a sense of gaseousness, and
  • a change in bowel habits (diarrhea and/or constipation).

IBS affects at least 10–15 percent of adults and is a common issue around the world. In fact, it is second only to the common cold as a cause of absenteeism from work.

The Most Common Symptoms of IBS

Common symptoms of irritable bowel syndrome are abdominal pain and discomfort which are often improved with a bowel movement. The causes for abdominal pain are usually associated with a change in bowel habits (diarrhea and/or constipation).

Symptoms can change over time, with periods when symptoms flare up as well as periods of remission when they diminish or disappear. The main bowel habit can vary over time, alternating between constipation and diarrhea.

Other symptoms of IBS include:

  • bloating (a sensation of fullness in the belly),
  • urgency (the need to use a restroom in a hurry),
  • mucus (white or yellow liquid) in the stool, and
  • the sensation of incompletely passing stools.

How is IBS Diagnosed?

The first steps are to confidently recognize the diagnosis of IBS and remove the suspicion of other diseases. In making a positive diagnosis, a physician will check for the most common symptoms of IBS. The next important step is to look for signs and symptoms that suggest a condition other than IBS, such as inflammatory bowel disease, colon cancer, or celiac disease. These signs and symptoms are referred to as “alarm signs” or “red flags.” They include:

  • anemia and other abnormal blood tests
  • blood in the stool
  • unexplained weight loss
  • fever
  • new onset of symptoms at the age of 50 or older
  • family history of inflammatory bowel disease, colon cancer, or celiac disease

These alarm signs usually do not occur because of IBS. They suggest other medical problems. When these symptoms occur, you should tell your doctor right away.

If your doctor suspects you have IBS, an evaluation will follow starting with a detailed history to identify the characteristic symptoms of IBS, and a physical examination. There is no test for IBS. Lab blood and stool tests, x-rays, and endoscopic procedures (e.g., colonoscopy) are used to rule out other diseases of the bowel, which can present with similar symptoms. These tests are common for people with IBS.

Click here to read more.

ADC Endoscopy Specialists Center provides quality care with comfort and convenience to their patients in Colonoscopies, Flexible Sigmoidoscopies, and Esophogogastroduodenoscopy(EGD). ADC Endoscopy Specialists Center is licensed by the Texas Department of State Health Services and certified for Medicare services.

Making the Most of Your Checkup

For some people, the doctor’s office is a stressful place. Sometimes patients are so stressed, they forget their physician’s instructions! The best way to prevent this from happening to you is to have a plan when you visit your doctor.

A productive checkup increases the potential for a more effective outcome. Before you visit your doctor, check out these seven simple tips:

Preparing for Your Doctor’s Visit

1. Your Symptoms

Your physician can help you most if he or she knows exactly how you are feeling. When you go to see the doctor for a specific reason, write down in advance how you feel. Your physician needs to know who, what, where, when, why and how much – just like a middle school word problem.

Take 15 minutes to write down:

  • What your symptoms feel or look like. Be specific with your descriptors. Here’s a quick list, but use your own words: achy, stabbing, dull, burning, tingly, stiff, sore.
  • Where your symptoms affect you. Do they start in one place or all over?
  • When your symptoms began.
  • Why your symptoms act up. What seems to trigger them.
  • Also write down what reduces or eases your symptoms. Don’t be afraid to include anything that helps. Alcohol, nicotine or other substances can help, and that information will help your doctor.
  • How often do you experience your symptoms and for how long. Are they annoying or crushing?

2. Your Homework

Believe it or not, it helps doctors when you have already looked up your symptoms and have done a bit of research about your condition. This isn’t like your uncle who gets on WebMD and then posts on Facebook that he now has the rarest form of cancer ever.

Researching in advance helps a physician because you can now better understand medical terms they might use. If your throat hurts, glance over the different parts of the throat so you can be specific about your pain and where in the throat you feel discomfort. That helps improve diagnoses than starting with, “It hurts when I swallow.”

Right Before You See the Doctor

3. What Do You Want?

Once you’ve prepared for the doctor, it’s important to prepare for yourself. Write down what you want to know, because – believe it or not – some people get stressed in the doctor’s office and forget what they want to ask. Your checkup is your time. Make sure you get the answers you want. And leave space so you can write down your doctor’s answers (see No. 6).

  • What is wrong with me? What is the name of my disease?
  • Do I need a diagnostic test? Which ones?
  • What are my treatment options? What drugs are you prescribing, and what do I need to know about them?
  • Can the doctor detail their prognosis: What can I expect to happen to me? How long can we expect this to last?
  • Should you reach out for help? Will you experience fatigue, depression or other negative feelings?

4. Where’s Your Medical Information?

  • Did you doctor order tests before your meeting? Make sure you’ve picked up your results in advance. (Nowadays, many imaging results can be sent digitally.)
  • Your doctor is going to ask you what medication you are already taking. Make a list of all your prescriptions and any over-the-counter medication you’ve been taking to alleviate your symptoms. Please add medicines like Tylenol or NyQuil, any natural supplements you’ve been using, or herbal remedies. If they’ve been working well, please let the doctor know that, too.
  • For most appointments, you should bring along a detailed medical history. If your symptoms are especially problematic, make sure to include the health history of your immediate blood relatives.

5. Who Should Your Doctor Contact?

  • Your intake form will ask for emergency contacts.
  • List other doctors who treat you and for what conditions. This should even include chiropractors and holistic healers.
  • Include your preferred pharmacy name, phone and address.

Listening

6. Document New Information

  • Nothing beats an old pen and paper when it comes to learning new information. Write down your doctor’s answers to your questions so you can fully understand them.
  • Take notes on other information the doctor gives you.
  • If a caregiver, spouse or friend joins you on your visit, ask them to take notes for you, so that you can focus on what the doctor is saying.

7. Next Steps

  • Talk to your insurance company about the doctor’s suggestions to make sure you can follow their orders in-network.
  • Ask for authorizations for specialists or other procedures.
  • Make sure you have the phone number of the doctor’s office to follow-up or to ask further questions. Ask for the best person to contact and the best times to call.

Being prepared for a doctor’s appointment will help ensure a more productive office visit. When you are ready to see the doctor, contact us here. We look forward to serving you and will do the very best we can to answer all of your health questions.

Do you have other tips you’d like to share with us? Comment below, please!

Diabetes is Not a Death Sentence

Together with ADC, people can live normal lives even with diabetes.

Over 400 million people worldwide have diabetes, and the disease causes over 1 million deaths every year. The disease also damages the body, amplifying other health concerns and is a secondary cause for even more deaths. It also causes blindness and amputations – it’s a very serious disease which, as of yet, has no cure.

But, there is some good news.

When managed properly, people with diabetes can lead long and productive lives. The Endocrinology Department at ADC deals daily with people managing the disease. Today, let’s learn more about the disease and what is necessary to manage it.

How Diabetes Affects the Body


After eating, carbohydrates in food are broken down into sugars to be carried throughout the body via the bloodstream. The body uses those sugars as energy for regular, daily function. The condition of diabetes disrupts this cycle – creating severe, damaging imbalances in blood sugar levels. There are two ways this imbalance occurs.

In Type I Diabetes, the body’s immune system damages the pancreatic cells responsible for producing insulin. The body’s naturally-produced insulin can no longer aid in breaking down blood sugars. With the body is incapable of producing enough of its own insulin, Type I Diabetes is treated with injections of an insulin replacement.

The second type, Type II Diabetes, is a more common form and is also a progressive form of the disease. This form of diabetes causes insulin resistance over time. The body still produces insulin, but has difficulty utilizing it effectively. There are various medications in pill form to treat Type II Diabetes. As a result of the nature of Type II diabetes, however, the pancreas often wears out due to late detection of the disease or from years of medication. At that point, insulin replacement by injection is – again – necessary.

When caught early, diabetes can easily be treated. The longer someone lives undiagnosed, the worse their health outcome is likely to be. Patients should visit their doctor every three to six months so that the efficacy of their treatment can be re-evaluated.

Good glucose control is essential to prevent the onset of diabetic complications that can can lead to blindness, heart attack or stroke, dialysis, and amputation. But with proper self-care and medical expertise people with diabetes can avoid these complications.

4 Ways To Effectively Manage Diabetes Symptoms

1. Exercise


If diagnosed, one of the best things a person can do for themselves is to exercise on a regular basis. Guidelines recommend a daily exercise regimen for at least 45 minutes that is initiated slowly and built up gradually to avoid injury and to build stamina. Clearance from a physician is imperative for any patient before starting an exercise regimen.

Every person that is overweight significantly increases their chances of contracting diabetes. The Amarillo Diagnostic Clinic has a patient education specialist to assist you in the care and management of diabetes through diet and exercise.

2. Check Your Blood Sugar

People living with this disease check their blood sugar levels regularly with a home glucose monitor. A physician or diabetic educator will prescribe a routine and frequency that best suits a patient’s needs. Most recommend checks before breakfast and before supper.

Not only is checking levels necessary for day-to-day health but recording those numbers daily is another necessary step. At doctor visits, a physician will need those readings to understand the full scope of how the patient is managing their disease.

3. Periodic Checks


Glycohemoglobin: This is a test developed for information about average blood sugar level over the course of two or three months. These checks may occur two to four times a year – varying between patients. The American Diabetes Association recommends that the patient’s diabetic regimen achieves a glycohemoglobin level of less than 7%. Any contributing risk factor for vascular disease should be aggressively assessed and treated.

Cholesterol, triglycerides, low HDL, high blood pressure, and smoking would all be considered factors of risk.

Some medications used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by a physician should be taken only as directed. Before adding or deleting any medication – including over the counter medications. Patients should consult their doctor about any changes to their prescriptions.

Microalbumin: This urine test is performed yearly to evaluate the likelihood of diabetic kidney involvement.

Ophthalmologist: A visit should be scheduled annually as well. The doctor can evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.

Finally, patients should have an annual comprehensive medical exam – including a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

4. Sick Days

Living with this disease means that some days are simply going to be worse than others. We refer to them at ADC as “sick days” and they require special consideration. Anything a body perceives as stress has the ability increase blood sugar levels. This stress can be physical or emotional in nature. If a person with diabetes is ill their blood glucose will likely rise – even if they cannot eat.

Sick Day Best Practices for Diabetics

  • Stick to meal plans if able to eat.
  • Continue diabetes medication unless a physician says otherwise.
  • Check with a doctor before taking any new medication.
  • Drink at least one large glass of liquid each hour. If eating, these liquids should be sugar-free.
  • Take a blood sugar test every 4 hours.
  • It is recommended to have someone check on the ill person every few hours, in case the illness progresses.

If in doubt, consult a physician. Early and effective management of these sick days will reduce chances of falling into a diabetic coma.

It Will Be Okay


Taking steps to prevent and control diabetes doesn’t mean life is over. It means eating a tasty, balanced diet, exercising and taking the necessary steps to stay healthy. With these tips, anyone can still take pleasure in life – with diabetes – without feeling deprived.

The Endocrinologists at Amarillo Diagnostic Clinic are thoroughly trained in the management of hormonal and metabolic disorders. Patient education services are available for patients in the care and management of these disorders. We also provide dietary counsel for lowering cholesterol and triglyceride levels.

We are here to help, please contact us if you have any questions or to schedule an appointment.