Inflammatory bowel disease (IBD)

12.10.2020
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Inflammatory bowel disease (IBD)

You are very important for us, therefore MediHelp International provides you the access to critical information for your wellbeing offered by prof. Irinel Popescu, a leader in surgical oncology and liver-related medical procedures.


Inflammatory bowel diseases (IBD) comprises a group of chronic diseases characterized by recurrent immune and inflammatory damage to the digestive tract. The most common problems included in this category are ulcerative colitis and Crohn's disease, which mostly affects the young, the socio-professionally active population. IBD have an impact on patients' personal lives, affecting both their professional life and ability to work, and social relationships, leading to chronic disabilities and high costs of health systems.

IBD can occur at any time during life; most cases begin in young people, aged between 15 and 30 years. Their prevalence and incidence are increasing worldwide, especially in Western countries, and are linked to socio-economic progress. Currently, over 3 million people in Europe suffer from inflammatory bowel disease, and in Romania, there are about 10,000 patients diagnosed with Crohn's disease or ulcerative colitis, of which over 3,000 are enrolled in the National Registers.

The cause of IBD is not yet known, but it is known that both genetic predisposition, the immune system, and environmental factors, diet, or stress have a significant role in the development of this disease.

IBD is characterized by chronic diarrhea, bloody stools, mucus, and pus (between 3-4 and over 20 / day), occurring both day and night, abdominal pain, fever, loss of appetite, weight loss. Anyone who develops these symptoms for more than 4 weeks should see a doctor immediately.

CROHN'S DISEASE (BC) can affect any digestive segment from the esophagus to the anus, but especially the distal portion of the small intestine (terminal ileitis) and colon. Patients may experience systemic symptoms (anorexia, fever, weight loss, asthenia), digestive (abdominal pain, chronic diarrhea with/without mucus or blood, lasting more than 4 weeks), perianal (abscesses, fistulas, cracks), extra digestive: articular, cutaneous, ocular. The main risk factors: smoking, family history of IBD, appendicectomy, recent infectious gastroenteritis (less than one year), use of non-steroidal anti-inflammatory drugs (NSAIDs).

The diagnosis consists in the careful evaluation of the doctor experienced in colorectal surgery or gastroenterologist with the history of the disease and the patient's personal history, diet, medication, particularities of intestinal transit. These will be followed by a digital rectal examination (examination in which the doctor will carefully insert into the patient's anus a lubricated gloved finger to assess any atypical anal or rectal lesions, sphincter tone, et cetera), a blood tests (in case of a possible infection), and stool analysis ( to identify blood loss, inflammation, or infection). A colonoscopy will follow - examination of the colon with a flexible telescope and taking a biopsy (a small portion of the colonic wall) to accurately diagnose and rule out possible colon cancer, abdominal MRI.

The treatment in BC requires a multidisciplinary team consisting of a gastroenterologist, radiologist, pathologist, surgeon, nutritionist, rheumatologist, psychologist, dermatologist, and an ophthalmologist.

Medical treatment includes diet, hygiene and dietary measures, and drug treatment (steroids, azathioprine, anti-TNF alpha agents).

Regarding the surgical treatment, segmental resection is preferred, limited to the affected regions, being minimally invasive surgery. The surgery aims to solve complications such as intestinal obstruction, fistulas, abdominal abscesses, or bleeding or is performed in order to remove an affected part of the intestine and thus to relieve severe symptoms that do not respond to drug treatment. It should be clear that the removal of the affected bowel area improves the symptoms but does not cure the patient, the disease usually recurring in the bowel areas close to the excised one.

Sometimes it is necessary to complete the surgery by performing an artificial opening (stoma) of the small intestine (ileostoma) or large intestine (colostoma) in the abdominal wall. It is often a temporary condition, although in some situations the stoma may be a permanent solution. If a stoma is needed, this will be presented in detail by the surgeon who will perform the surgery, and the team of nurses who take care of the stoma will provide the patient with all the support.

ULCEROHEMORAGIC RECTOCOLITIS - characterized by a non-granulomatous inflammation in the colon, which begins in the rectum and extends variably to the proximal, damaging continuously and concentrically the affected segments. Typically appear diarrhea with blood and/or mucus, rectorage, tenesmus, or urgency to defecate, colic pain in the left iliac fossa, which precedes defecation. General manifestations such as weight loss, fever/chills, anorexia, or abdominal pain syndrome suggest a severe outbreak of the disease.

The main risk factors: the urban environment, the high level of hygienic norms, a diet low in dietary fiber, with an exaggerated content of refined hydrocarbons, animal fats, margarine, cornflakes, fast food, consumption of nonsteroidal anti-inflammatory drugs. Smoking and appendicectomy are a protective factor in Ulcerohemoragic Rectocolitis.

In cases of severe evolution of Ulcerohemoragic Rectocolitis, the complications of the disease can occur: a lower digestive hemorrhage - massive rectal bleeding, which requires emergency hospitalization; a perforation - rupture of the colon; toxic megacolon - one of the most life-threatening complications, is marked by rapid dilation of the colon, which becomes dysfunctional and causes critical toxicosis, imposes the need for urgent medical and intensive care and, in case of inefficiency, resort to surgery; colorectal cancer (3-5% of cases).

Biopsy colonoscopy is usually used to diagnose the disease. Other tests that can be used to confirm the diagnosis are blood tests and stool analysis.

There is no curative treatment. The purpose of the treatment is to control severe outbreaks, prevent outbreaks and complications, obtain and maintain clinical and endoscopic remission and ideally, histological.

Treatment includes general measures, dietary and medication administration, and surgical procedures.

Certain types of food can worsen the symptoms of diarrhea and bloat, especially during periods of active illness. Diet suggestions:

  • small amounts of food throughout the day;
  • hydration corresponding to at least 2.5L liquid/day; avoiding high fiber foods;
  • avoiding fatty or fried foods and sauces;
  • limiting dairy products if there is lactose intolerance;
  • avoiding alcohol and caffeine.

Drugs that can be used: sulfasalazine, mesalazine, corticosteroids, immunomodulators.

In severe acute colitis refractory to drug treatment or serious complications, such as perforations, massive bleeding, or toxic megacolon, total colectomy with temporary ileostomy is recommended. Depending on the clinical evolution and nutritional status, a low ileorectal or ileoanal anastomosis with ileal pouch will be performed or the definitive ileostoma will be maintained.

At distance from surgery, operated patients usually have a good nutritional status.

In Romania, there is the Center Dedicated to Patients with Inflammatory Bowel Diseases (CDPIBD), which is a non-governmental organization with a medical and social character, which aims to contribute to improving the standards of treatment for patients with inflammatory bowel disease (IBD) to which they can address. The center was officially established in 2017, at the initiative of the Fundeni Clinical Institute in Bucharest. (Http://bii.icfundeni.ro/ ).

Prof. Irinel Popescu is a prominent surgeon and a member of the Romanian Academy of Sciences. He is a leader in surgical oncology and liver-related medical procedures. For the last three decades, Prof Popescu has been the pioneer and motivator of liver transplants in Romania and the founder of a Romanian school for liver transplantation.
Prof. Popescu is a social contributor in raising the public awareness for organ donation, which Romania is still showing a very sluggish progress in.
He is a member of many local and international medical associations and a respectable writer and speaker in the most important medical and surgical conferences.
Prof. Popescu serves as the President of the Romanian Academy of Medical Sciences and as a Corresponding Member of the Romanian Academy.


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