Integral Unit for Inflammatory Bowel Disease

What is the Inflammatory Bowel Disease?

It is a set of diseases which affect the digestive tract causing chronic inflammatory processes in any of its parts (from mouth to anus). Among these diseases we find Ulcerative Colitis and Crohn Disease.

Symptoms of Inflammatory Bowel Disease appear in outbreaks of the disease throughout the life of the patient in more or less extent periods of time depending on the severity and treatment followed.

At what age does this disease appear?

The Inflammatory Bowel Disease affects men and women indistinctly. It may appear at any time although it is more frequently diagnosed in patients between 20 and 40 years of age. Moreover, according to the latest data presented by the European Crohn’s and Colitis, Spain the incidence of this disease has increased 200% in under 18’s.

It is an inherited condition?

There are no studies concluding that the Inflammatory Bowel Disease has a hereditary component. Nevertheless between 15-20% of patients with this pathology have a direct relative suffering from it. The most frequent combination is mother-son followed by sibling-sibling.

Is it a serious disease?

Inflammatory Bowel Disease appears as more or less serious outbreaks. During these outbreaks sometimes the patient requires hospitalization to treat the symptoms.

As it is a chronic disease it is necessary to undergo close and thorough monitoring of the medication prescribed by digestive specialists. The suspension of treatment (medication, diet, routines) may cause serious complications which may lead to surgery (obstructions, perforations, etc.).

Integral Unit of Inflammatory Bowel Disease

Chronic diseases require monitoring and maximum specialization to improve the quality of life of people suffering from them. In CMED, Dr Guerra Flecha and Dr Luca de Tena, offer broad professional experience of over 30 years in the diagnosis and treatment of the Inflammatory Bowel Disease.

In the Integral Unit of Inflammatory Bowel Disease of CMED patients obtain:

• An early and differential diagnosis to know the type of inflammatory bowel disease they suffer.
• Shorter waiting times for the results of the diagnostic tests because they are developed in our premises: blood tests, ultrasound, colonoscopy, CT.
• Personalized treatment and a Program for Medication Adhesion which eases the follow up of a course of chronic medical treatment (whole life).
• Specific nutritional guidelines for each type of inflammatory disease.
• Immediate capacity to decide on surgical intervention having available a team of surgeons specialized in the digestive system.

Pathologies included in the Inflammatory Bowel Disease

Crohn Disease

Its main feature is the chronic swelling of any of the parts of the digestive tract from mouth to anus. In general most affected areas are the end of the small intestine (ileum) and the beginning of the large intestine (caecum) although both large intestine (colitis) and small intestine (enteritis) may be affected.

This swelling is the one causing the symptoms of the Crohn Disease which normally alternate outbreaks of the disease with remission stages (without symptoms although pathology is still present).

During outbreaks, most frequent symptoms are diarrhea (with occasional bleeding), abdominal pain, weight loss, fatigue and fever. The duration of outbreaks is normally of 2-4 weeks. In occasions, the anal area can be affected with the onset of abscesses (a collection of pus causing pain) and fistulae (pus excretion through orifices around the anus). When disease is not controlled there may be cases of bowel perforation and abscesses in abdomen when surgery is strictly necessary.

Ulcerative colitis

A disease characterized by the swelling of large intestine walls (formed by the colon and rectus) which leads to small ulcers (open wounds) causing pain associated to this pathology. Ulcerative colitis may affect a part of your large intestine more or less extent (proctitis, proctosigmoiditis, distal colitis, ulcerative colitis) or to the whole colon (pancolitis).

As in Crohn disease, symptoms appear in outbreaks which alternate with inactivity stages. The seriousness and type of symptoms depend on the damage of the large intestine.

Most common ones are diarrhea (stools with blood, mucus or pus), abdominal pain, continuous need to pass stools (tenesmus) urge to pass stools and occasionally, nausea and vomits.

Undetermined colitis

It is a disease presenting symptoms both of Crohn Disease and ulcerative colitis. It may be considered half way through both of them so treatment has to be even more personalized and specific. As it progresses, it may turn into an ulcerative colitis or Crohn Disease.

Collagenous colitis

The main feature of collagenous colitis is the swelling of colon causing chronic and watery diarrhea which does not normally cause bleeding. Unlike previous pathologies, it is normally diagnosed in patients between 60 and 80 years of age.

Other symptoms are pain and abdominal distension, stool incontinence and as a consequence dehydration and weight loss.

It is called collagenous colitis because upon intestinal biopsy collagenous levels present in the inner lining of colon are high.

Lymphocytic colitis

Lymphocytic colitis affects large intestine and shows the same symptoms as collagenous colitis. It is normally diagnosed in elderly patients, between 60 and 80 years of age.

It is called lymphocytic given the high increment of lymphocyte-type leukocytes in colon mucous. Both collagenous colitis and lymphocytic colitis present normal colonoscopies and it is with the biopsy that pathogenic abnormalities are detected.

Diagnosis

The accurate and early diagnosis is one of the main cornerstones to treat all pathologies included in the Inflammatory Bowel Disease. The first step is to develop a full and detailed clinical history showing family background, life routines (tobacco, alcohol, diet), prescribed drugs and symptoms experienced.

Afterwards, the team of gastroenterologists of CMED will prescribe the diagnostic tests most appropriate for each case. Those more common are the following:

• Blood and stools analysis: Allows the detection of abnormal values showing anemias, high level of sedimentation or high level of C-reactive protein and determines the presence of infections or parasites.
• Endoscopy: An essential test to know the damage of the colon and eases the taking of biopsies offering a concluding result for the diagnosis.
• Capsule endoscopy: Very useful to provide a comprehensive study of the small intestine and to know the area most affected by the disease.
• Ultrasound: It is necessary to determine in some cases the location of the inflammatory process and rule out other pathologies with similar symptoms.
• Radiological tests: Abdominal rays, CT and Magnetic Resonance are used to determine from bowel obstructions to determine the damage of different parts of the digestive systems.

Treatments

Inflammatory Bowel Disease is a very extent pathology which requires medical and pharmacological treatment according to the needs of each patient. Clinical history, tests results and symptoms are those serving as guide for specialists of the digestive system when prescribing treatment.

Medication in this type of diseases serves to treat outbreaks, prevent their onset and in general improve the quality of life of patients.

• Drugs: eThere is a broad range of drugs to treat these diseases. The specialist will be in charge of prescribing the most appropriate depending on the seriousness and progress of each patient. For the pharmacological therapies to be successful it is essential to monitor the treatment of the patient at home (adherence). Our specialist will offer a series of guidelines that will ease the intake of drugs.
• Probiotics: These are life micro-organisms (fungus, yeasts, etc.) that prescribed in the appropriate amount and form are beneficial for our digestive health. Probiotics act in our organism stabilizing the intestinal flora, increasing the resistance of pathogenic agents (causing diseases) and reinforcing our immunological system.
• Surgery: It is used in the event of serious complications or when pharmacological treatment does not result and affects very negatively the quality of life of the patient. Most frequent surgeries are due to bowel obstructions or perforations.

Importance of diet

Some of the consequences of the Inflammatory Bowel Disease are weight loss, anemia and malnutrition caused by the lower intake of food (in the event of abdominal pain), problems in the assimilation of nutrients and a greater caloric output as inflammation is a process that consumes much energy (calories). The new diet is aimed therefore at preventing and correcting these problems.

In general all patients have to follow a diet as varied as possible paying special attention to the appropriate intake of proteins, iron and calcium. There is no scientific evidence proving that food can trigger an outbreak so at first none of them have to be prohibited. Nevertheless, during the outbreak the patient has to be especially cautious with the intake of milk and fiber if they increase its symptoms (diarrhea, bowel obstruction) and limit their consumption.

Inflammatory Bowel Disease and pregnancy

Inflammatory Bowel Disease is normally diagnosed in young people and with child-bearing potential, so the possibility of having children and how to manage pregnancy are very important issues for patients. It is worth mentioning that the fertility rates of men and women with Inflammatory Bowel Disease are similar to the general population. However, surgery of the digestive system may affect fertility specially in women due to the adhesion formation of damages of the Fallopian tubes or ovaries.

It is essential to inform the specialist in the digestive system that you wish to have offspring to modify your treatment so that it does not affect the future baby. Conception is also very important. If possible, it is better to conceive during a disease remission period as this way the women has the same possibilities to suffer an outbreak than when she was not pregnant. However, if conception takes place during an outbreak there are many possibilities to maintain it during the whole pregnancy.

Regarding medication during pregnancy it has to be prescribed with the specialist to avoid risks of any type.