IBD - Chronic inflammatory bowel disease

Content

Introduction

Introduction

Chronic inflammatory bowel disease (IBD) is the ulcerative colitis and Crohn's disease (Video). Where it is not possible to distinguish between one and the other we speak of unclassified colitis. These are diseases characterized by chronic, i.e. persistent, inflammation of the intestinal wall, resulting in diarrhea, pain, weakness and weight loss. The main differences are:

  • Ulcerative colitis (CU), only concerns that part of the intestine called colon. It is characterized by inflammation that starts from the rectum and can extend over time to affect more or less large portions of the colon. It causes the development of superficial ulcers associated with chronic inflammation of the affected intestinal tract
  • Crohn's disease (MC), can affect any area of ​​the gastrointestinal tract, from the mouth to the anus. Usually, it involves the colon and the last part of the small intestine, called ileus, or only the colon in any part of it (colitis). About one third of patients also have perianal manifestations (fistulas and abscesses). The disease is characterized by the presence of inflamed and ulcerated intestinal tracts, often alternating with healthy ones. Unlike ulcerative colitis, in Crohn's disease inflammation affects the entire thickness of the intestinal wall with the formation of deep wounds (ulcers). This characteristic is associated with the possible appearance of intestinal narrowing (stenosis), abnormal openings between the bowel and surrounding organs (fistulas) or the development of intra-abdominal abscesses

In both diseases, inflammation can also be present in other parts of the body such as joints, skin, eye, etc.

Both, moreover, are characterized by the succession of periods in which the disturbances (symptoms) are present and others in which, instead, they are absent or are of slight entity (phases of remission). Over time, moreover, complications may occur consisting, in the case of Crohn's disease, by stenosis, fistulas, intra-abdominal abscesses; in the case of ulcerative colitis, from massive bleeding, colon dilation with retention of feces and toxic substances (toxic megacolon). The chronic intestinal inflammatory process can also expose you to an increased risk of colon and rectal cancer. Current treatment strategies, therefore, are aimed at avoiding, as far as possible, the onset of these diseases.

In Italy there is no official information on their spread but it is estimated that, globally, they affect over 200 thousand people. Crohn's disease is more common in Western countries and is rare, if not absent, in developing countries. It occurs mainly in young people aged 20-30, more rarely after the age of 65. The incidence of ulcerative colitis varies from one nation to another, although the highest rate is found in industrialized countries. It can occur at any age but usually occurs in young adults. For some years there have been more and more cases of both diseases in children and adolescents. When they affect children, poor intestinal absorption of nutrients (malabsorption) can severely affect the growth process.

These diseases should not be confused with the more common irritable bowel syndrome which presents ailments such as constipation, diarrhea, abdominal pain not associated with the presence of inflammation.

Symptoms

Symptoms

The disorders (symptoms) of chronic inflammatory bowel diseases can vary depending on their severity and the part of the intestine affected.

Those with ulcerative colitis and Crohn's disease include:

  • abdominal pain
  • chronic diarrhea, often nocturnal
  • presence of blood in the stool (more often present in ulcerative colitis)
  • weight loss
  • tiredness
  • fever
  • loss of appetite

The presence of diarrhea, pain and weight loss represents the most frequent association of disorders (symptoms). They are not always present all together and, at times, vomiting can also appear. There may be periods in which they are absent alternating with others in which they recur.

Causes

Causes

The causes of chronic bowel disease (IBD) are not yet clear.

The knowledge currently available leads to the hypothesis that chronic inflammation develops due to an improper stimulation of the immune system of a genetically predisposed person, by environmental factors (including diet) that act on the microbial flora normally present in the intestine (microbiota) . The presence of some microorganisms capable of causing the disease (pathogens) has also been hypothesized, but there is no definitive evidence.

The factors involved in the development of IBD are:

  • genetic factors, existence of a family predisposition to develop the disease
  • immunological factors, malfunction of the body's defense system (immune system) which reacts improperly to the microorganisms of the bacterial flora normally present in the intestine. This action is favored by a defect in the mucosa which allows them to enter the intestinal wall more deeply
  • environmental factors, the "Western" diet would seem to facilitate the onset of chronic inflammatory bowel diseases. Cigarette smoking favors, in patients with Crohn's disease, exacerbations of the disease and the reappearance of inflammation after surgery to remove the affected intestinal tract. Environmental factors would seem to influence the composition of the microbiota causing an alteration of the relationship between protective and harmful microorganisms, with a relative reduction of protective bacterial species.
Diagnosis

Diagnosis

The rapid identification of the disease from the moment of its onset (early diagnosis) allows the most appropriate treatment to be started immediately, thus avoiding the development of complications that could become irreversible (Video).

For this reason, it is advisable to consult your doctor immediately if you notice a lasting change in bowel habits over time or if certain disorders (symptoms) appear which include:

  • abdominal pain
  • blood in the stool
  • lasting diarrhea (at least 4 weeks)
  • nocturnal diarrhea
  • fever repeated for no apparent cause

There is no single test to identify chronic inflammatory bowel diseases. Their assessment (diagnosis) is based on the combination of information from the medical examination, from endoscopic investigations, from histological and radiological examinations completed by a "careful evaluation of the history of the person's health over time.

The path to ascertaining the disease involves carrying out blood tests, faeces and instrumental investigations.

Colonoscopy with ileoscopy retrograde it is an essential test to confirm the presence of both ulcerative colitis and Crohn's disease. It allows not only to highlight the lesions, but also to take small fragments of tissue (biopsies) on which to carry out the histological examination. In Crohn's disease, other instrumental tests such as computerized axial tomography (CT), nuclear magnetic resonance (MRI) and ultrasound can be used to complete the picture of the disease by defining the extent of the lesions, the possible presence of narrowings ( stenosis), fistulas and / or abscesses These examinations, in particular abdominal ultrasound, should be performed in hospitals with experience in the diagnosis and treatment of chronic inflammatory bowel diseases.

Therapy

Therapy

There is currently no cure for ulcerative colitis or Crohn's disease. The therapies serve to reduce inflammation, relieve ailments, prevent flare-ups of the disease and avoid complications.

Surgical therapy with the removal of the inflamed intestinal tract (Crohn's disease) or the entire colon (ulcerative colitis) usually results from the development of complications or failure to respond to treatment. Perianal manifestations (often associated with the disease) Crohn's) can be treated surgically when medical treatment is ineffective.

Medical therapy involves the use of drugs and nutritional aids. The drugs most used to treat ulcerative colitis or Crohn's disease are:

  • aminosalicylates, (drugs derived from acetylsalicylic acid) alone or in combination with corticosteroids, to reduce inflammation
  • corticosteroids
  • immunosuppressants, to reduce the activity of the immune system
  • antibiotics
  • "biological" drugs, represented by synthetic antibodies that block the pro-inflammatory molecules produced by the body (ps TNF-alpha) or prevent the passage of inflammatory cells (lymphocytes) into the intestinal mucosa. At the moment these drugs, for hospital use only, are used when other drugs are ineffective. Their administration is carried out after excluding the simultaneous presence of other diseases in which they are contraindicated. You can also use, under medical supervision, drugs to reduce disorders (for example, anti-diarrhea drugs or painkillers) or supplements to restore the right levels of nutrients and vitamins decreased as a result of malabsorption and / or reduction in nutrition

Surgical therapy it is used in cases where the drugs alone are not sufficient to relieve the ailments (symptoms) and / or in the presence of complications. It consists in eliminating the parts irreparably damaged by the inflammatory process. However, while in ulcerative colitis the removal of the entire colon protects against the return of the disease (relapse), in Crohn's disease the removal of the inflamed intestinal tract does not exclude the disease can return to other parts of the intestine.

Prevention

Prevention

The causes that cause chronic inflammatory bowel diseases (IBD) are not yet clear. Certainly an important role is played by genetic and immune factors but there are also other elements that can act on a person already predisposed such as, for example, the diet rich in refined sugars and low in fiber, sedentary lifestyle and cigarette smoking (Crohn's disease). However, their role has not yet been effectively demonstrated. At the moment, therefore, there is no effective prevention to avoid the appearance of chronic inflammatory diseases of the intestine.

Living with

Living with

Given the complexity of IBD, it is advisable to rely on specialized centers for the assessment (diagnosis) and treatment of these diseases. In these structures, careful surveillance of the disease is carried out through regular visits and checks. disorders (symptoms) caused by chronic inflammatory diseases of the intestine and lengthen the times of well-being.

Regarding the diet, there are no data to affirm that a particular food can be directly involved in the development of chronic inflammatory diseases of the intestine and there is no dietary approach that reduces the risk of their occurrence.

Some foods and drinks, however, are not recommended in the flare-up stages of the disease. In particular, during these times, you should avoid eating dairy products and foods rich in fiber. These foods should be gradually reintroduced during the phases of well-being characterized by the absence of disturbances (phase of remission of the disease), provided that there is no intolerance to dairy products or stenosis is present. In this case it is advisable to reduce the content of fiber in the diet.

It may be useful to keep a food diary to identify any food intolerances, since these situations vary from person to person and not common to all. In this case, the temporary removal of the food can reduce the severity of the ailments.

Frequently, chronic inflammatory bowel diseases are associated with malnutrition. It is partly related to the lack of appetite generated by the food-disturbance association (pain, diarrhea) and partly, in the case of Crohn's disease, to malabsorption. It is therefore necessary to prevent and correct any nutritional deficiencies that may arise. In this sense, it appears of fundamental importance to follow a diet rich in vitamins and trace elements, high in calories and rich in liquids to counteract the loss with diarrhea. It may also be necessary, always under the advice of your doctor, to take supplements.

Although chronic inflammatory diseases are not caused by stress, its management can be helpful in reducing ailments (symptoms) and their frequency.

Could help:

  • getting regular exercise
  • do relaxation exercises

Quitting smoking, in addition to being essential for health, is useful for relieving ailments and lengthening the times in which they are not present in people with Crohn's disease.

In-depth link

In-depth link

AMICI Onlus - National Association for Chronic Inflammatory Bowel Diseases

European Crohn's and Colitis Organization (ECCO) -European Federation of Crohn's and ulcerative Colitis Associations (EFCCA). Patients Guidelines on Crohn's Disease (CD)

European Crohn's and Colitis Organization (ECCO) -European Federation of Crohn's and ulcerative Colitis Associations (EFCCA). Patients Guidelines on Ulcerative Colitis (UC)

Editor'S Choice 2022

!-- GDPR -->