IBD: The Role of Surgery: Interview with Prof. Poggioli

Inflammatory Bowel Diseases (IBD) represent an increasingly significant clinical challenge. Globally, they affect nearly 7 million people; in Italy, around 250,000 (source: Osservatorio Malattie Rare, 2024).

These are complex conditions, often diagnosed at a young age between 15 and 30, that profoundly impact patients’ quality of life and require a personalized, multidisciplinary therapeutic approach. Among them, ulcerative colitis is one of the most widespread and well-known forms, but also one of the most feared due to its chronic and unpredictable course.

Fortunately, in recent decades the therapeutic landscape has changed dramatically: alongside advances in pharmacological treatments, surgery has undergone a true revolution, redefining its role in the care pathway.

We discuss this with Professor Gilberto Poggioli, specialist in General Surgery at UPMC Salvator Mundi International Hospital, with over 40 years of clinical, surgical, and academic experience.

Professor, Let’s Start with the General Framework: What Are IBD?

They are conditions characterized by persistent inflammation of the gastrointestinal tract with a chronic relapsing course, meaning they alternate between periods of remission and flare-ups.

The most common forms are ulcerative colitis (or ulcerative rectocolitis) and Crohn’s disease. These are accompanied by less frequent conditions such as microscopic colitis and indeterminate colitis. Symptoms can range from mild forms to more severe manifestations, including persistent diarrhea, abdominal pain, nausea, vomiting, the presence of blood in the stool, and a marked sense of fatigue.

What Is Ulcerative Colitis?

Unlike Crohn’s disease, ulcerative colitis is a form of IBD that affects exclusively the colon and rectum. The inflammation involves the intestinal mucosa, starting from the rectum and, in more severe cases, extending throughout the colon.

This condition results from a combination of factors, including genetic predisposition, alterations in immune response, and environmental factors (lifestyle, diet, smoking, intestinal microbiota). The immune system reacts abnormally against the intestinal mucosa, maintaining a chronic inflammatory state.

If left untreated, the inflammatory process can lead to progressive deterioration of the colon’s structure, causing permanent changes in intestinal cells and increasing the risk of precancerous and cancerous transformations.

What Are the Main Symptoms and Causes?

Typically, the first manifestation is the passage of bright red blood from the anus—an alarm signal that should prompt consultation with a specialist. Other common symptoms may include chronic diarrhea, often with blood and mucus, abdominal pain and cramps, urgency to defecate, fatigue, anemia, weight loss, and, in more severe cases, fever, tachycardia, and palpitations.

In many patients, the disease may also be associated with symptoms outside the intestine, affecting joints, skin, eyes, and liver, leading to joint inflammation, skin lesions, ocular disorders, and specific liver conditions.

As for the causes, they are not yet fully understood. The most widely accepted theory is that, in genetically predisposed individuals, environmental factors—including alterations in the intestinal microbiota—may trigger an abnormal immune response against the colon mucosa.

Professor, In Recent Decades IBD Surgery Has Changed Profoundly: Can We Speak of a “Revolution”?

In the last 50 years, IBD surgery has undergone a radical transformation, comparable in terms of clinical impact to that of transplantation. It is not only how surgery is performed that has changed, but above all when and why it is performed. In the past, surgery was reserved for cases with severe complications or complete failure of medical therapies. Today, this is no longer the case.

What Is the Contribution of New Surgical Techniques and Technologies?

The development of minimally invasive techniques has played a fundamental role. In particular, laparoscopy and robotic surgery allow for more precise, less traumatic interventions, with reduced post-operative pain, shorter hospital stays, and a faster return to daily life. Moreover, they enable better preservation of intestinal function and, in appropriate cases, also of sphincter function.

Have The Treatment Guidelines for IBD Also Changed Over the Years?

The clinical approach has evolved. Today, gastroenterologists and surgeons increasingly work in multidisciplinary teams, and surgery is no longer seen as a failure of medical therapy, but as an integrated therapeutic option, sometimes even an early one, when it can improve prognosis and quality of life.

In certain situations, timely surgical intervention can avoid years of ineffective pharmacological treatments, reduce long-term complications, and restore a substantially normal life to the patient.

Can We Speak of a Nearly “Primary” Role of Surgery?

In some cases, yes—especially in ulcerative colitis. When the disease is extensive, aggressive, or does not respond adequately to other treatments, surgery may represent the most appropriate choice. The goal is not only to treat the disease, but to treat the person, considering function, expectations, and quality of life.

A Message for Patients Living With IBD?

Today, IBD can be managed with many more options than in the past. Being informed and relying on specialized centers and multidisciplinary teams makes a real difference. Modern surgery should not be feared: in many cases, it is part of the solution, not the problem.

If you suspect you may suffer from Inflammatory Bowel Disease or have already been diagnosed and would like a second opinion, learn more about the Gastroenterology and General Surgery services at UPMC Salvator Mundi International Hospital and book an appointment today with one of our specialists.