Inflammatory bowel disease is a chronic and incurable, immune-mediated disease for which there is currently no definitive cure. They are characterized by inflammation and ulceration of the digestive tract walls as well as the unpredictable and progressive course of the disease. Taking all these aspects into account, as well as the cost of treatment, the development of IBD entails an increasing socioeconomic burden. Over the past few decades, there has been a global increase in the incidence of inflammatory bowel disease, currently around 0.3% of the European population. You can get sick at any age, the peak incidence is 15-40 years of age.
The group of inflammatory bowel diseases includes:
ulcerative colitis (UC)
Crohn’s disease (Crohn’s disease)
Both disease entities differ in terms of the extent of the disease. UC occurs only in the large intestine and very often affects the rectum, while CD-C occurs in any part of the gastrointestinal tract. When it comes to the distribution of inflammation, in the case of UC, we talk about continuous areas of inflammation and they are limited to the mucosa and surface layers of the submucosa, while in CHL-C the foci of inflammation alternate with healthy ones and cover the entire thickness of the gastrointestinal tract wall.
Factors involved in the etiopathogenesis of UC:
Genetic: familial occurrence; susceptibility genes were established
Environmental: bacteria of the intestinal flora (bacterial flora in inflammatory bowel diseases differs quantitatively and qualitatively from that of healthy ones. High harmfulness of some strains of E. coli and Bacteroides vulgatus.
Symptoms of Inflammatory bowel disease :
Inflammatory bowel disease may be indicated by: chronic, recurrent diarrhea lasting several days / weeks, often with blood, recurrent abdominal pain, nausea, weight loss, loss of appetite, anemia, unexplained general symptoms of inflammatory disease (low fever and fever, increased CRP levels, leukocytosis, thrombocytosis, hypoproteinaemia). Of these symptoms, diarrhea and anemia are more typical of ulcerative colitis, and pain, weight loss, and inflammatory features are more typical of Crohn’s disease.
Parenteral symptoms occur in nearly half of patients with inflammatory bowel diseases. These include:
low-grade fever and fever,
peripheral arthritis, ankylosing spondylitis,
eye diseases – inflammation of the epidural, sclera or uvea.
Do you have worrying symptoms? Consult a doctor online without leaving home.
Treatment of Inflammatory bowel disease:
Treatment scheme for UC:
The choice of drugs depends on whether we are dealing with the active form of the disease or with an asymptomatic period (remission) and the extent of inflammatory changes. In patients whose inflammatory changes are limited to the rectum, rectal preparations in the form of suppositories, enemas, foams are used. Oral treatment is initiated when local administration is ineffective.
MESALASIN (drug of first choice) – Asamax, Salofalk, Pentasa,
The mechanism of action has not yet been fully elucidated. Based on in vitro studies, it is suggested that mesalazine has an inhibitory effect on lipoxygenase and therefore exhibits anti-inflammatory properties.
Side effects are mainly headache and dizziness, myocarditis, pericarditis, abdominal pain, diarrhea, flatulence, nausea and vomiting
Severe renal or hepatic impairment is contraindication.
It exhibits 3 mechanisms of action: anti-inflammatory effect caused by the locally produced mesalazine, immunosuppressive effect due to inhibition of lymphocyte and granulocyte metabolism and inhibition of various enzymatic systems by all three compounds (sulfasalazine, sulfapyridine, mesalazine), bacteriostatic sulfapyridine produced locally in the colon.
Section. Side effects: gastrointestinal disorders or headaches, may reduce sperm motility and affect fertility.
P / indications: Hypersensitivity to sulfonamides or salicylates, porphyria, obstruction of the urinary tract or intestines, children under 2 years of age
Severe cases of UC
GCS – glucocorticosteroids are effective in treating exacerbations of UC, when first-line drugs are ineffective.
hydrocortisone, budesonide, prednisone (Encorton), prednisolone (Encortolone), methylprodnisolone (Metypred)
Therapy with these preparations should not exceed 3-6 weeks, because the risk of side effects such as hypertension, impaired glucose tolerance, hypokalemia, weight gain, peptic ulcer disease, increased risk of fractures and osteoporosis increases.
azathioprine, mercaptopurine, cyclosporine
They are used to maintain remission in patients who do not respond to treatment with 5-aminosalicylic acid preparations.
The mechanism of action is based on the release of 6-mercaptopurine, which is a purine antimetabolite, preventing the proliferation of cells involved in determining and enhancing the immune response.
Side effects include: leukopenia, thrombocytopenia, nausea, vomiting, anorexia, cholestasis, and hepatic impairment.
Treatment regimen-Crohn’s disease
Crohn’s disease is incurable, therefore the therapeutic goal is to reduce intestinal inflammation and prevent complications. At the beginning, drugs are weaker, with a lower risk of side effects, i.e. glucocorticosteroids, sulfasalazine (effective in the mild form of CLC limited to the large intestine), and in the event of their ineffectiveness, stronger drugs (immunosuppressants). Mesalazine should not be used.
Diet in inflammatory bowel disease should be varied, easily digestible and well digestible. This can be achieved by boiling / steaming, rubbing, mixing, baking in foil.
Summing up, the diagnosis must be established on the basis of a thorough history and physical examination, after performing the necessary additional examinations. In the first place, the causes of the symptoms which are most common and dangerous for a given age should always be excluded. A sufficiently early diagnosis will significantly improve the patient’s comfort and slow down the disease process and improve their quality of life. Therefore, if you notice any disturbing symptoms, make an appointment.
Intern by Szczeklik
Mutschler pharmacology and toxicology