Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), represent a growing challenge to gastrointestinal health in countries around the world. These diseases, characterized by inflammation of the gastrointestinal system, are emerging as one of the most common gastrointestinal conditions with an equal distribution in both men and women, and with a constantly growing incidence.
In Italy, the situation is no different: it is estimated that patients suffering from chronic intestinal inflammatory diseases are around 250,000, of which 60% with ulcerative colitis and 40% with Crohn’s disease; although they are more common in young adults, they do not spare either children or the elderly, with an incidence of 6-8 new cases per 100,000 inhabitants. We talk about chronic intestinal inflammatory diseases with Dr. Valeriano Castagna, gastroenterologist at Humanitas Gavazzeni, specialist in this area of gastroenterology.
Doctor Castagna, what are the main causes and/or risk factors?
«Although the exact causes of IBD are not yet fully understood, it is hypothesized that a combination of genetic predisposition, environmental factors such as diet, smoking, stress, dysbiosis of the intestinal microbiota and altered immune response, may play an important role in the development of these illnesses”.
How do they manifest themselves and what are the problems for those who are subject to them?
«Crohn’s disease and ulcerative colitis manifest themselves in different ways. CD typically involves the terminal ileum, cecum, perianal area and colon but can affect any region of the intestine discontinuously. UC, ulcerative colitis, involves the rectum and can affect part of the colon or the entire bowel continuously; the most serious form, called extensive colitis or pancolitis, manifests itself with the symptoms of left-sided colitis, fatigue and fever. Patients with CD present with symptoms such as abdominal pain, fever and clinical signs of intestinal obstruction or diarrhea with the passage of blood or mucus. In addition to gastrointestinal symptoms, 25-40% of IBD patients may have extraintestinal manifestations that primarily affect joints, skin, liver and eyes.”
How do we get to diagnose these diseases?
«The most effective method is colonoscopy, with biopsies of the affected areas, which allows an accurate distinction between UC and CD. Ultrasound and radiological imaging are also essential for an early diagnosis: the study of intestinal loops, CT and MRI have an important role in early diagnosis by providing evidence of intestinal alterations in patients with suspected IBD, in particular CD.”
What are the treatments?
«Drug therapy varies based on the severity of the disease. However, the risk of surgery remains high, with a significant proportion of patients potentially requiring bowel resection or restorative procolectomy. Nutritional management plays an increasingly important role in treatment, as many patients have nutritional deficits that require special attention. In conclusion, IBD represents a significant challenge for patients and physicians, requiring a multidisciplinary approach to effectively manage symptoms and improve the quality of life of affected patients.”
