Inflammatory Bowel Diseases

Idiopathic Inflammatory Bowel Diseases (IBD) are digestive diseases characterised by chronic recurrent inflammation of the gastrointestinal tract. There are two main forms of idiopathic inflammatory bowel diseases, Ulcerative Colitis and Crohn's disease, while in recent years another condition, microscopic colitis, has tended to be another type of inflammatory bowel disease. Although they appear to have a similar pathogenic mechanism and a similar mode of manifestation, Crohn's disease and ulcerative colitis are different diseases, with ulcerative colitis being a disease of the large intestine, whereas Crohn's disease can affect the entire digestive tract, with the small intestine being more frequently affected.

What are the causes of ulcerative colitis and Crohn's disease and how common are they?

​The exact pathogenic mechanism of IBD has not been precisely defined. The onset of IBD appears to be the result of an successive environmental stimuli (e.g. smoking, diet, infections, antibiotic use) in a genetically predisposed individual that results in abnormal activation of our immune system against the gastrointestinal tract. Although it is not a purely hereditary disease, it seems to tend to occur more frequently in people in the same family.

IBD affect 1-2% of the population with a higher incidence of the disease in countries in Northern Europe and America. However, the westernisation of lifestyle seems to be responsible for the increase in new diagnoses of IHNE in other countries including our country.  

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At what ages do IBD occur and what are the most common symptoms?

​IHNEs occur mainly in young people younger than 35 years of age but in recent years it has been increasingly diagnosed in people aged 60-65 years. They are chronic diseases and their clinical picture is characterised by continuous remissions and exacerbations.

The main symptom is the occurrence of frequent, watery stools with or without blood. Patients complain of abdominal pain, especially in Crohn's disease, while in ulcerative colitis the loss of blood with the stools, the urge to defecate and even frequent faecal incontinence are prominent. In more severe cases, more systemic symptoms such as fever, nausea and vomiting also occur.

 As a result of the systemic activation of the immune system, extra-intestinal manifestations occur, affecting other systems besides the digestive system, such as the joints (enteropathic arthritis), the eyes (epidural inflammation/iritis), the skin (erythema nodosa/gangrenous pyoderma) and other digestive organs such as the liver, the peri-anal ring and the oropharynx.

The impact of AFS is often evident in the daily lives of AFS patients, affecting both their physical and mental health. Their overall health status is determined not only by clinical assessment, disease severity and disease activity but also by factors such as psychological state, professional, social and love life, as well as potential complications and adverse effects of treatment.

Diagnosis and monitoring of IBD

​Colonoscopy is the most specific test for the diagnosis and monitoring of IBD. Ulcerative colitis affects the large intestine and is characterized by the presence of inflammation and ulceration of the mucosa of the colon, while Crohn's disease is a transmucosal inflammation that can affect all parts of the digestive tract. Taking biopsies is essential and helps in the differential diagnosis of CFS.

Other tests used are blood and stool tests and especially stool calprotectin, which is an indirect indicator for monitoring inflammatory activity in the gut. In recent years an important role in the diagnostic monitoring of Crohn's disease has also been played by performing MRI of the small intestine and pelvis. Also in patients with Crohn's disease, the performance of an endoscopic small bowel capsule is an additional test that helps in the diagnosis and monitoring of the disease.

Treatment

Treatment of IBD depends on the extent and severity of the disease, as well as the response to previous treatments. The use of corticosteroids is still nowadays quite common and necessary in some cases to control relapses and flares. Surgical treatment is often necessary to manage the complications of IBS and in the case of drug-resistant disease. The use of immunosuppressive therapy and in particular biological agents in recent years is probably the most effective therapeutic weapon for the treatment of relapses but more importantly for the maintenance of idiopathic inflammatory bowel diseases in long-term remission and prevention of long-term complications.