Dr. Iglesias is a renowned expert in Digestive Diseases. He is an expert in digestive endoscopy, as well as in inflammatory bowel diseases and functional digestive disorders. He currently practices as a doctor at the Instituto Gallego Gastroenterología.
What is inflammatory bowel disease and what pathologies does it encompass?
Inflammatory bowel disease is a condition, generally chronic, of the digestive system. Depending on the type we are referring to, it can affect anything from the mouth itself to even the exit of the anus. There are others that only affect a section of the digestive tract, and would be less serious. As I have said, it is a chronic disease, which generally presents with outbreaks and there are three main types. There is Crohn’s disease type inflammatory bowel disease which, as I said before, affects from the mouth to the anus, it can affect from the mouth to the anus. It is a slightly more serious condition than the next one that we are going to talk about, because it affects deep in the wall of the digestive tract and not superficially like the next one, the second one that I am talking about. It is ulcerative colitis. In this case, as its name indicates, it affects the colon. Only the affected organ is the colon. It is a limited section, as everybody knows very well.
In this case, the condition is slightly milder because it does not affect the wall of the digestive tract in depth, it is superficial, only the mucosa, although this does not mean that it does not have its complications and its severity in certain cases. And there is a third entity within chronic inflammatory bowel disease, which is indeterminate, which is one that meets criteria for Crohn’s disease and criteria for inflammatory bowel disease, such as ulcerative colitis. It mixes criteria of both, so we cannot define whether it is one or the other. It generally affects the colon, because if it comes out of the colon it would have to be Crohn’s disease, so the differential diagnosis is generally with ulcerative colitis. In addition to this we have some other entity that can simulate an inflammatory disease and that, before giving it a chronic surname, we must be very sure, because as the name says, it is for life.
The great importance of a correct diagnosis
These diseases that can simulate chronic inflammatory bowel disease, can be of infectious origin, of pharmacological origin, or even associated with other diseases, generally rheumatologic, so the diagnostic process must be important, to be able to cross them out of the disease to which we are referring. The treatment of which is very similar although at the moment that we put the surname we have to elucidate which treatment we are going to apply, both for Crohn’s disease and for ulcerative colitis. Regarding the treatment we have to say that in the last years it has advanced a lot, so the quality of life of the patients has improved infinitely. From a first moment, when practically everyone had to be admitted to the hospital in order to receive the treatment, the care derived from the poor quality of life caused by the disease, nowadays, thanks to the discovery of immunosuppressive drugs and monoclonal antibodies, we can manage patients on an outpatient basis, and with the discovery of day hospitals, where the application of the treatment and the basic care are carried out in these places, hospital admission has dropped dramatically, and practically everything is managed on an outpatient basis.
These are the severe forms, some side effects of the drugs, which I am mentioning and which require hospitalization to adjust the dosage or to correct the side effect per se. In any case, medicine is evolving a lot, it is making great progress in these matters and drugs are coming out which, with them, we are improving the side effects of the first ones, we are managing to increase the interval between the outbreaks of the disease and therefore improving the quality of life of the patients. It is a disease that we will try to make chronic, from the point of view that it requires treatment and does not require anything more than that, without having to make a quantitative leap, a surgical treatment, in order to achieve a better quality of life and for the patients to cope better with the disease.
At what age does this disease usually present itself?
Chronic inflammatory bowel disease usually presents in two age peaks. A young age around 20 and 40 years and there is a second age peak from the age of 60 years. Most frequently, generally, at 20 years of age or a little bit around 20 years of age, which is when our immune system is more active and that is when all those autoimmune diseases, such as chronic inflammatory bowel disease, really make their debut.
Is inflammatory bowel disease a hereditary pathology?
We can say that chronic inflammatory bowel disease is not per se an affectation, a hereditary condition, but the fact of having first-degree relatives affected, we have a greater predisposition to suffer from it. There are many associated factors, genetically, it is probably predetermined, but we need more factors to be able to develop it. Therefore, the fact of having parents with chronic inflammatory bowel disease does not mean that we are going to have chronic inflammatory bowel disease in our children, but the risk is greater than in the general population. We are studying this to try to determine what environmental factors can influence these genetic factors in order to develop the disease. An example, to compare it with chronic inflammatory bowel disease, is celiac disease, where we need a genetic predisposition and there is an environmental factor, such as gluten, which is going to develop it. This genetic factor and an environmental factor are necessary in chronic inflammatory bowel disease, although it is known that there is a higher risk if we have a first-degree family history in the development of the disease.
How is it diagnosed?
Chronic inflammatory bowel disease is diagnosed from the clinical point of view; a clinical suspicion is necessary when patients come to the office. Generally as we know, in a range of age, around 20 or 40 years, with a characteristic clinic of abdominal pain accompanied with some alteration, either of the ingestion or of the deposition, of the way of doing of belly, in that case the clinical suspicion leads us to do a diagnostic test as it is the low digestive endoscopy, or colonoscopy, where we can find the affectation of the mucosa of the colon, in case it is an inflammatory disease type ulcerative colitis, or affectation of the small intestine in its terminal phase and/or part of the colon in the Crohn’s disease. In addition to these endoscopic tests we have other non-invasive tests, such as magnetic resonance imaging for small bowel study, which is called enteroresonance or even indirectly, we can do a stool analysis, which makes us suspect that there may be an inflammation of the colon and that leads us to perform the above tests.