Chronic Inflammatory Bowel Disease (IBD)

Chronic Inflammatory Bowel Disease (IBD)

Chronic inflammatory bowel diseases (IBD) affect approximately 250,000 people in Italy (7 million worldwide), with an estimated incidence of 5-10 new cases per 100,000 inhabitants. They include:

  • Crohn's disease.
  • Ulcerative colitis.
  • Indeterminate Colitis.
  • Microscopic Colitis (Lymphocytic Colitis, Collagenous Colitis, Eosinophilic Colitis).

They manifest themselves with episodes of aggravation alternating with periods of mitigation. Their aetiology is still obscure, however the most recent scientific evidence points to a decisive role of altered immune system and multifactorial elements.

Chronic inflammatory bowel disease may present periodic manifestations and evolve over time. Although modifying diet and lifestyle can help reduce the symptoms of the disease, people with IBD often have to manage them through drug therapies. The therapeutic approach is highly individualised and treatment varies according to the severity of the condition. In some cases, surgery may be necessary to remove severely compromised parts of the digestive tract.

Clinical Features of the Main MICI

About a quarter, and in some cases as many as 40-50%, of cases of chronic inflammatory bowel disease occur during childhood or adolescence. Of these, approximately 6% are diagnosed within the first two years of life.

The most common are Crohn's disease, which shows an increase in incidence between the ages of 6 and 12 years, and Ulcerative colitis, which maintains a constant frequency after the age of 3 years.

Crohn's disease: symptoms and treatment

Crohn's disease can affect any part of the gastrointestinal tract. Symptoms may vary depending on location, but usually include:

  • Persistent abdominal pain.
  • Diarrhoea, sometimes accompanied by blood.
  • Fever (usually below 38°C, especially in the afternoon or evening).
  • Significant weight loss.
  • Anaemia.

It is important to note that about three out of ten patients may be asymptomatic. If not diagnosed early or treated appropriately, Crohn's disease can lead to:

  • Stenosis.
  • Fistulas (including perianal fistulas).
  • Abscesses.

These complications often require surgery.

Ulcerative colitis: symptoms and treatment

Ulcerative colitis can also involve the entire colon. Symptoms may vary depending on the site of inflammation, but commonly include:

Presence of blood in the stool.

  • Diarrhoea.
  • Fever (usually below 38°C, especially in the afternoon or evening).
  • Abdominal pain.
  • Anaemia.

In about 10-30% of patients, treatment may not be effective, necessitating surgery to remove the colon. Persistently active ulcerative colitis is a risk factor for the development of colon cancer.

Risk Factors for Chronic Inflammatory Bowel Disease

The prevalence of chronic inflammatory bowel disease varies significantly depending on the country of origin and cultural habits, especially related to diet, indicating a significant role of environmental factors in the development of these diseases.

IBDs are complex conditions with multiple causes, including:

  • Abnormal immunological reaction of the gut towards intestinal bacteria.
  • Interaction between genetic and environmental factors.
  • Familial tendency, but not direct inheritance.
  • Mutations in more than 240 gene loci associated with the risk of developing IBD.
  • Cigarette smoking.
  • Psychological distress, such as anxiety and depression.
  • Abuse of antibiotics or NSAID drugs, such as aspirin or ibuprofen.
  • Infections in childhood.
  • Changes in the intestinal microbiota (the bacteria in the digestive tract).
  • The pre-existence of other autoimmune diseases, such as psoriasis or rheumatoid arthritis.

Diagnosis of Chronic Inflammatory Bowel Disease

After an accurate anamnesis, the specialist doctor may recommend a series of instrumental tests to diagnose intestinal inflammation. These include:

  • Endoscopy: e.g. colonoscopy, which allows direct examination of the inside of the colon and small intestine for signs of inflammation, ulcers or other abnormalities.
  • X-ray with contrast: especially useful for the diagnosis of Crohn's disease, this technique involves the use of a contrast medium to highlight any areas of inflammation or stenosis in the gastrointestinal tract.
  • Scintigraphy: an imaging technique that uses small amounts of radioactive material to detect inflammation or other abnormalities in the intestinal tract.
  • Nuclear magnetic resonance imaging (NMR): this imaging technique provides detailed images of the gastrointestinal tract without the use of ionising radiation, and is particularly useful for assessing the extent and severity of inflammation in patients with inflammatory bowel disease.

These instrumental examinations can be used individually or in combination, depending on the patient's specific diagnostic needs.

How to Prevent Chronic Inflammatory Bowel Disease

Just as the causes of IBDs are not known for sure, there is no guaranteed way to prevent them. However, certain tricks can help reduce risk factors, especially if there is a family history of these or other autoimmune diseases:

  • Reduce exposure to environmental toxins such as cigarette smoke, pesticides or other harmful chemicals.
  • Take antibiotics or painkillers only if recommended by your doctor.
  • Adopting a healthy diet, reducing stress and getting enough sleep help protect the immune system.
  • Favour fibre-rich foods such as fruit, vegetables, legumes and whole grains, which help healthy gut bacteria. Fermented foods such as yoghurt, kefir or naturally fermented vegetables are also good for the gut.
  • Evaluate with your doctor whether to take a probiotic supplement.

Chronic inflammatory bowel disease is a serious medical condition that can have a major impact on your life. Learn more about UPMC's gastroenterology services and how we can help you identify possible risk factors and reduce them in our dedicated web section.