Ruth Serrano (Avila, 43 years old) does not remember the day she was diagnosed with inflammatory bowel disease (IBD) -she was just a few months old-, but she does have memories of what it has been like to grow up with this chronic pathology. Inflammation of the intestine at various points can even cause disabling symptoms, “that paralyze the life of those who suffer from it,” describes Serrano. “It implies having a lot of awareness and responsibility for your health. Imagine being a child or a teenager; it conditions your physical and social development, ”she points out.
Fortunately, in the last two decades there have been great advances in the fight against IBD, which encompasses two major pathologies: Crohn’s disease and ulcerative colitis. “The creation of specialized units to treat IBD and the development of new medications have allowed for greater control of the disease and improved our quality of life,” says Serrano, who today is the general director of the Confederation of Associations of Crohn’s Patients. and Ulcerative Colitis (ACCU).
A disease caused by a disturbance in the immune system
As Virginia Matallana, a doctor specializing in the digestive system and IBD at La Luz University Hospital (Madrid), explains, IBD is an immune-mediated disease, that is, caused by alterations in the immune system: “It usually occurs when we are younger because our system The immune system is more active, but it can also appear at older ages”, clarifies the doctor.
Some of the common symptoms for Crohn’s disease and ulcerative colitis are: diarrhea, bloody stools, tiredness, abdominal pain, loss of appetite, weight loss, and fever. In the case of Crohn’s disease, it will depend on the part affected, but it can also manifest extraintestinal with skin lesions and joint pain.
Orencio Bosch, head of the Comprehensive Care Unit for Patients with IBD at Fundacion Jimenez Diaz University Hospital (Madrid), points out: “Although it is a chronic disease, the appearance of symptoms can occur intermittently, depending on the phase in which for the patient to be found. The doctor explains that this disease occurs in two phases: one of outbreak periods, known as active, and another, where the symptoms are in remission, as inactive.
Physical and psychological reasons
In recent years, an increase in the incidence of IBD has been observed in Spain. Bosch argues that, although there are no clear and unique causes for the appearance of this chronic intestinal disease, there are several factors that do predispose to suffering from it, such as genetics or those related to our lifestyle. “As a society, we have undergone some changes as a result of westernization, in our diet –with a higher intake of fats and processed foods– or in our rhythm of life. Stress is another possible trigger for IBD ”, he gives an example.
Matallana highlights the psychological factor: “The brain and the digestive system are connected, as is the case with other parts of the body. There is a two-way communication that makes what happens in the brain affect the intestine and vice versa. It has been observed that anxiety, for example, is a risk factor for the development of the disease”.
Advances in the diagnosis and treatment of IBD
Behind the increase in cases there is also an improvement in health care and, consequently, in diagnosis: “There is greater knowledge about the disease. Specialized units have been created that allow Primary Care to refer patients to a specialist at the slightest suspicion, where we can perform the relevant diagnostic tests”, explains the specialist from the University Hospital of La Luz.
Examinations such as endoscopy and colonoscopy, blood tests and stool tests are the medical tools that will allow physicians to diagnose this pathology and immediately start treatment. “They also allow us to know what phase the patient is in so that we can apply one treatment or another,” adds Matallana.
The specialist highlights the importance of diet in this type of pathology, “to which years ago no special attention was paid.” And she specifies: “In moments of remission, a varied diet should be followed, like the one we should all have. In the active phase, it is advisable to “avoid foods that are more difficult to digest or that worsen symptoms, such as those rich in fiber, pastries or bakery products that contain seeds or nuts.”
Bosch adds that, in addition to the phase of the disease, other factors influence the prescription of treatment: “The age of the patient, the location of the disease, the degree of inflammation and how it compromises his life.”
Research has allowed great advances in medical treatment to fight infections, reduce the degree of intestinal inflammation and maintain the disease in remission by controlling the immune system. This has allowed surgery, another course of action against IBD, to be avoided in many cases, as explained by Damian Garcia, head of the General and Digestive Surgery Service of the Fundacion Jimenez Diaz University Hospital (Madrid). Only in cases of extreme complication for the patient is it decided to opt for the operating room: “Like stenosis (intestinal narrowing), perianal fistulas and rectovaginal fistulas”, the surgeon gives an example.
Garcia leads the Cell Therapy Unit of the Madrid hospital, responsible for the discovery of the first cell therapy for Crohn’s disease in the world, and which has been applied in Spain and other countries since 2019: “It is about applying stem cells to fistulas for them to close. We avoid aggressive surgery, because this process is minimally invasive, and we substantially improve the quality of life of patients ”, he affirms.
Improving the lives of patients beyond the consultation
Ruth Serrano has experienced first-hand the medical advances of recent decades, which have allowed IBD to no longer be a paralyzing disease, “but limiting in some cases. But the objective is that we do not have to give up essential aspects of our lives, such as getting a job or studying, because we suffer from a chronic illness”, claims the director of ACCU.
According to data from this entity and from the Platform for Patient Organizations (POP), 90% of students with IBD show lack of attendance, 55% see their daily productivity affected and only 30% of people with chronic diseases achieve complete their university studies.
ACCU organized this month a university meeting with medical, student and other agent representation to address the educational inclusion of IBD patients and other chronically ill patients. Serrano laments the loss of talent for not taking into account the personal circumstances of chronic patients who are taking non-compulsory studies. “They don’t have a sick leave like they do in a job, but the disease also prevents you from attending class or exams,” denounces the director of ACCU. From the Confederation they ask for more social awareness about IBD “in order to improve the quality of life of patients beyond the consultation.”
Source: EL PAIS