What are inflammatory bowel diseases?
Inflammatory Bowel Diseases (IBD) are conditions characterized by being secondary to disorders of the immune system, which develop a direct inflammatory reaction against the intestine. IBD has a chronic/recurrent course and presents with periods of exacerbation alternating with remission phases. They are defined as “chronic” because they do not heal permanently, even after medical treatment or surgery. IBD includes two main diseases: Crohn’s disease and Ulcerative Colitis, along with other forms called “Indeterminate Colitis” as they cannot be classified with certainty. IBD is estimated to affect about 250,000 people in Italy and tends to occur predominantly in young people (15/30 years) and the elderly (65 years), but there are also rare cases in children and adolescents.
Crohn’s disease: characteristics of the condition
Crohn’s disease primarily affects the last part of the small intestine and the colon, but it can involve the entire gastrointestinal tract (from the mouth to the anus). The disease presents as a chronic or recurrent immunological reaction of the intestine against certain antigens. It is mainly characterized by the presence of intestinal ulcers with a segmental distribution that can lead to complications such as stenosis (narrowing and intestinal blockages), abscesses (infected pus collections), and/or fistulas (perforations that can connect parts of the intestine with other organs or the external environment). If not adequately treated over time, it can degenerate and lead to the development of serious complications usually requiring surgical intervention.
Symptoms and causes of Crohn’s disease
Crohn’s disease manifests with diverse symptoms that vary depending on the affected gastrointestinal tract. The most common symptoms are abdominal pain, chronic diarrhea, persistent low-grade fever, and weight loss. Additionally, associated disorders such as hemorrhoids, anal fissures, mouth ulcers (canker sores), erythema, joint pain, episcleritis, and others can occur.
But what are the causes that lead to the development of this condition? The causes of Crohn’s disease (as well as all Inflammatory Bowel Diseases) are still largely unknown. Current knowledge suggests that chronic inflammation develops as an abnormal immune reaction in the intestine against antigens to which the individual is exposed. Multiple factors are involved in its development:
- genetic factors (family predisposition to developing the disease);
- environmental factors (such as diet and cigarette smoking);
- immunological factors (dysfunction of the immune system, which reacts improperly to the microorganisms of the intestinal bacterial flora).
Diagnosis and therapies: the role of proctology
The diagnosis of Crohn’s disease is rarely simple and quick. It often requires various instrumental and laboratory tests, which must be interpreted in light of the clinical picture. There are no individual symptoms or tests (as with many other diseases) that can provide a definitive diagnosis. Among the tests required by specialists are:
- Blood tests (particularly ESR and C-reactive protein to evaluate the body’s inflammatory status);
- Stool examination (to exclude infectious causes of abdominal pain and diarrhea);
- Echography of the intestinal loops (to evaluate the inflammation of the intestinal walls);
- Radiological investigations such as CT and abdominal MRI;
- Gastroscopy (allows visualization of the esophagus, stomach, and the first part of the small intestine or duodenum);
In particular, colonoscopy is performed by the proctologist, a surgeon who specializes in the prevention, diagnosis, and treatment of all disorders and conditions related to the colon and rectum. Colonoscopy is a crucial examination for identifying Crohn’s disease as it allows the physician to directly assess the state of the intestinal mucosa. Furthermore, the possibility of taking small tissue samples (biopsy) allows for detailed laboratory analysis.
Medical therapies and quality of life
Currently, there are no definitive cures for this condition. The available therapies for treating Crohn’s disease aim to reduce intestinal inflammation and induce symptom remission to stabilize the patient’s condition. Among the most commonly used classes of medications are immunosuppressants to reduce the activity of the immune system. There are also intestinal antibiotics, monoclonal antibodies, experimental drugs, and surgery as treatment options. Thanks to new medications, the need for surgery has significantly decreased; however, it remains a fundamental approach in the presence of severe and irreversible complications.
Drugs on the market and new scientific studies aim to have a comprehensive effect on the person’s quality of life, as Crohn’s disease has a considerable impact, making it a disabling condition. The pain, treatments, and flare-ups significantly affect social life, interpersonal relationships, and the patient’s work life. Understanding the disease allows for early symptom recognition, accurate diagnosis, and finding the most suitable supportive therapy to live a fulfilling and productive life.
The contents of this page are for informational use only and in no case should they replace the opinion, diagnosis or treatment prescribed by your doctor. The response to the same treatment can vary from one patient to another. Always consult with your doctor on any information relating to diagnosis and treatment and scrupulously follow his instructions.