Inflammatory bowel diseases

Inflammatory bowel disease is a heterogeneous group of diseases defined by inflammation, persistence or recurrence in the gastrointestinal tract but different as an extension of lesions, symptoms, prognosis and treatment. The most well-known diseases in this group are ulcerohemorrhagic rectocolitis and Crohn's disease. Given that both prognosis and evolution and treatment are completely different, precise diagnosis is important; . Contents Factors triggering inflammatory bowel disease Establishing a diagnosis Treatment Consequences and risks Up Factors that trigger intestinal inflammatory diseases These diseases are triggered by an abnormal reactivity of the immune system, producing inflammation in the intestine; . The intervention of genetic factors is evident in intestinal inflammatory diseases. There is a clear trend of family aggregation, both in ulcer hemorrhagic rectocolitis and Crohn's disease; .

1 in 5 people with Crohn's disease have at least one family member affected. Also 10-20% of patients with ulcer hemorrhagic rectocolitis have at least one other family member with the same disease. Ethnicity also plays a role - Eastern European Jews have a significantly higher risk of developing intestinal inflammatory diseases than other ethnic groups in the same geographical region. And socioeconomic factors play a role, this pathology is more common in industrialized countries and in urban areas. Smoking has different influences in the two diseases, decreases the risk of hospitalization in ulcerohemorrhagic rectocolitis, while in Crohn's disease the impact is negative, increasing the risk of surgery and recurrence after surgical resection.

Also, ulcerohemorrhagic rectocolitis occurs more frequently in non-smokers or former smokers, while Crohn's disease occurs in smokers. The use of antibiotics, especially in childhood, during the development of the immune system is associated with an increased risk of inflammatory bowel disease. In Crohn's disease, inflammation can affect any segment of the gastrointestinal tract from the mouth to the anus; . The preferential location of the lesions is in the distal small intestine and the first part of the colon; . Another third has limited damage to the small intestine, the others having colon lesions or less often affecting the esophagus, stomach and duodenum.

Characteristic manifestations are chronic diarrhea and abdominal pain; . Extension of inflammation in the entire thickness of the intestinal wall can lead to the affiliation of the affected segment to other organs by producing fistulas (abnormal communication tracts) between the small intestine or thick intestine and other intestinal or vaginal loops, urinary bladder or skin. Another consequence of extensive inflammation in the intestinal wall is narrowing of the intestine; . Perianal cracks like fissures or fistulas are commonly found in people with Crohn's disease. Unlike Crohn's disease, in ulcer hemorrhagic rectocolitis inflammation is restricted to the large intestine, starting from the last segment, the rectum, and with variable extension to the colon, but with continuous impairment.

Inflammation is always more severe in the distal portion of the colon. Only the inner part of the intestinal wall (mucosa) is involved in the inflammatory process. Characteristic symptoms are blood stools and transit disorders - either diarrhea or constipation; . In severe forms, patients may have anemia and fever. up Diagnosis Diagnosis is based on the clinical picture following an endoscopic evaluation with biopsy and histopathological examination.

Endoscopy identifies inflammation of the intestinal mucosa, the presence of superficial or deep ulcers, and based on the distribution of lesions and details of the histopathological examination, it is attempted to categorize as Crohn's disease or ulcerohemorrhagic rectocolitis. It is necessary to exclude other causes for endoscopically observed lesions - infectious bacterial, parasitic, ischemic causes, irradiation - by stool samples, clinical context and histopathological changes. top Treatment The treatment is different depending on the diagnosis (Crohn's disease / rectocolitis), the severity of the activity, the digestive segments affected and the lesion extension. In ulcerative haemorrhagic rectocolitis, the first line of treatment is mesalazine, an intestinal anti-inflammatory that can be administered both systemically, both in the form of oral and topical tablets, acting on the last segment of the large intestine as suppositories or enemas. In severe or unresponsive forms, however, it is necessary to use immunomodulatory preparations to influence the abnormal response of the immune system (glucocorticoids, thiopurin agents, biological therapy); .

In severe forms that do not respond to treatment or complications (uncontrolled bleeding, toxic megacolon, perforation, cancer), complete resection of the large intestine (colectomy). In Crohn's disease the role of mesalazine is limited, usually necessary in light forms and immunomodulatory drugs. Surgery of intestinal resection can not cure these patients, this disease can occur in any intestinal segment, and extensive resections of the small intestine, frequently affected, can compromise the state of nutrition. However, up to three quarters of patients require surgery 20 years after diagnosis. The basic principle in chiruggy performed in Crohn's disease is the preservation of intestinal length and function.

Indications for surgery are represented by the presence of fistulas, fibrous intestinal stenoses, intraabdominal abscesses, intestinal tumors. Consequences and risks Individuals with inflammatory bowel disease may also exhibit extraintestinal manifestations as an expression of alterations in the immune response: ocular (uveitis, episcleritis); . Approximately 25% of newly diagnosed cases of Crohn's disease are in people under 20 years of age, with extensive consequences on physical and psychosocial development. The frequency peak for this disease is between 15 and 30 years of age, basically reproductive age; . A second peak of incidence is in the elderly, in the 7th decade, with this category of patients also having to take into account the other diseases associated with the choice of medication.

The progression of the disease is variable, with sickness alternating with remission periods. Over a four-year period, a quarter of patients remain in remission, a quarter have active chronic disease and half have a fluctuating evolution with periods of activity and periods of inactivity. Most patients continue to live an active life but up to 10% get disabilities due to the need for intestinal resection, malnutrition, associated extraintestinal diseases. And in ulcerohemorrhagic rectocolitis the peak of incidence is at young and active ages, in the 2-3 decades of life; . 80% of patients have a disease progression with periods of activity alternating with remission periods.

Up to 10% of patients have a first severe attack requiring colectomy. The risk of colectomy is higher in the first year after diagnosis and in people with extensive impairment. Most people with rectal disease maintain their activity and have a normal social function. The quality of life can be altered during the breaks, and sometimes in the remission period there may be fear of relapse and consecutive changes in lifestyle. Factors influencing the occurrence of activity breaks are multiple: psychosocial stress, use of non-steroidal anti-inflammatory drugs and antibiotics, viral and bacterial infections.

There is an association between these inflammatory bowel diseases and the risk of colorectal cancer. In Crohn's disease, this risk exists for patients with colon disease; . Given this risk, endoscopic surveillance at 1-2 years is required with multiple biopsy sampling in affected segments, usually after a longer period of disease activity, depending on lesion extension. Patients with Crohn's disease with small bowel disease also have a higher risk of developing tumors at this level. .