Clinical Editor's comments (October 2017)
Dr Hayley Willacy recently read a paper looking at lifetime risks of cancer in children who are diagnosed as having inflammatory bowel disease in childhood [ 21 ] . This group has an increased risk of cancer, especially gastrointestinal cancers, both in childhood and later in life. The increase persists into adulthood, and has not fallen since the introduction of modern drug therapies for inflammatory bowel disease. However, the researchers stress that absolute risks are low - corresponding to one extra case of cancer for every 556 patients with inflammatory bowel disease followed for a year, compared with healthy individuals.
Therapy for Crohn's disease has been discussed in practice guidelines published in 2009 7 . These guidelines set up a definition for the severity of a Crohn's disease flare. Mild to moderate disease is indicated when patients can tolerate oral intake without dehydration, high fever, abdominal pain, abdominal mass, or obstruction. Moderate to severe disease describes the disorder in patients who have failed to respond to therapy for mild or moderate disease or those with fevers, weight loss, abdominal pain, anemia, or nausea and vomiting without frank obstruction. Severe to fulminate disease is found in patients with persisting symptoms despite the introduction of steroids on an outpatient basis or those presenting with high fever, persistent vomiting, obstruction, rebound tenderness, cachexia, or an abscess. In addition, it is important to distinguish between differing behaviors of disease: inflammatory, fistulizing, or fibrostenotic because different therapies are best suited for different disease behaviors regardless of disease severity.
Many diets have been proposed for the management of Crohn's disease, and many do improve symptoms, but none have been proven to cure the disease.  The specific carbohydrate diet usually requires adjustments by patients; if a patient finds that certain foods increase or decrease symptoms, they may adjust their diet accordingly. A food diary is recommended to see what positive or negative effects particular foods have. A low residue diet may be used to reduce the volume of stools excreted daily. People with lactose intolerance due to small bowel disease may benefit from avoiding lactose -containing foods. Patients who cannot eat may be given total parenteral nutrition (TPN), a source of vitamins and nutrients.