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What Are Chronic Inflammatory Intestinal Diseases (IBD)?

Inflammatory bowel diseases (IBD) are a group of diseases characterised by inflammation and damage to the digestive tract

These diseases can have different manifestations in different people and also over time.

They are characterised by periods of disease exacerbation and periods of latency or remission.

During the active phases of the disease, the patient with IBD has frequent discharges of diarrhoea, including bloody diarrhoea, abdominal pain, weight loss and fever.

Symptoms diminish during the remission phases, which in many cases can last a long time.

Inflammatory bowel diseases (IBD) include:

  • Crohn’s Disease;
  • Ulcerative Colitis;
  • Indeterminate Colitis;
  • microscopic Colitis (Lymphocytic Colitis, Collagenous Colitis, Eosinophilic Colitis).

IBDs are diseases with a chronic/recurrent course, presenting with periods of flare-ups alternating with phases of remission.

Their cause is unknown, but the alteration of the immune system and multifactorial aetiology (causes) are believed to play a decisive role according to the most current scientific evidence.

The age at which these diseases most frequently occur is between 20 and 40, but onset can occur at any age.

They affect males and females equally.

Clinical features of the main IBDs, Inflammatory bowel disease

OICs have several clinical manifestations, but the most frequent are Crohn’s Disease and Ulcerative Colitis.

Crohn’s disease: symptoms and treatment

Crohn’s disease can affect the entire gastrointestinal tract. Depending on location, symptoms may vary, but generally include:

  • chronic abdominal pain
  • diarrhoea (with or without blood);
  • fever (<38°C, especially in the afternoon or evening);
  • significant weight loss;
  • anaemia.

It is estimated that approximately 3 out of 10 patients may have no symptoms.

If not detected early or if not adequately treated, Crohn’s disease can cause:

  • stenosis;
  • fistulas (including perianal fistulas);
  • abscesses.

These complications almost always require surgery.

Ulcerative colitis: symptoms and treatment

Ulcerative colitis can also affect the entire colon.

Depending on location, symptoms may vary, but generally include:

  • blood in the stool;
  • diarrhoea;
  • fever (<38°C, especially in the afternoon or evening);
  • abdominal pain;
  • anaemia.

In 10-30% of patients, an ineffective response to therapy may occur, thus necessitating surgery to remove the colon.

Persistently active ulcerative colitis is one of the causes that may increase the risk of colon cancer.

Diagnosis of IBD

The most appropriate method to arrive at the diagnosis of a Chronic Inflammatory Intestinal Disease is to perform a colonoscopy with biopsies.

In Crohn’s disease, the diagnosis is completed by:

  • an MRI of the abdomen;
  • an ultrasound scan of the intestinal loops;
  • in cases involving the small intestine, an enteroscopy with video capsule may be useful.

It is essential to know that the earlier the diagnosis, the more the risk of complications is reduced, thus increasing the possibility of responding fully to treatment.

Monitoring of Inflammatory bowel disease

Monitoring the course of the disease, even when it is in remission, is essential in the treatment of IBD.

The standard monitoring strategy involves performing at regular intervals

  • blood tests;
  • faecal calprotectin assay;
  • ultrasound of the intestinal loops.

When necessary to check the response to therapy or to confirm a flare-up, it is also useful to repeat a colonoscopy with biopsies.

Prevention of colon cancer

As a secondary prevention of colon cancer risk, it is very useful to regularly perform a chromoendoscopy, i.e. an endoscopy with dye that can highlight any areas of dysplasia and/or neoplasia.

Therapies available today

There are several therapies available today:

  • Mesalazine;
  • Budesonide;
  • Systemic cortisone;
  • Azathioprine/mercaptopurine;
  • Monoclonal antibodies against TNF (infliximab, adalimumab, golimumab);
  • Anti-integrin monoclonal antibodies (vedolizumab);
  • Monoclonal antibodies against IL12/23 (ustekinumab);
  • Micromolecules (tofacitinib);
  • Surgery.

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