Ulcerative colitis and Crohn’s disease are on the rise. Some markers can prevent diagnosis, even by years. The role of nutrition and lifestyles and innovative therapies
There are those who confuse them with irritable bowel syndrome, but they chronic inflammatory bowel disease, or IBDare much more serious and can significantly compromise the quality of life of those affected, with symptoms such as diarrhea that does not go away, persistent pain, intestinal bleeding, loss of appetite and weight.
In Italy the number of sick people could double
They are a problem that even those directly involved talk little about, also due to the inconvenience they cause and the shame that many feel when having to face them, and yet ulcerative colitis and Crohn’s disease are continually increasing: the latest data speak of five million patients in the world, with an increase in the number of cases of 50 percent in the last 30 years.
In Italy there are at least 250 thousand sick peoplebut it is estimated that by 2030 the spread could double up reaching 1 percent of the population: a trend that is occurring in all Western countries and which is hypothesized to depend largely on environmental factors such as changes in diet and greater consumption of industrial foods
. Furthermore, no one can say they are safe, because although these are diseases with a peak onset between 20 and 30 years of age, in recent times this too is changing and there are more and more cases even among children (which account for approximately 1 in 4 diagnoses) or with a late onset, in middle age or even later.
There is good news: there are more and more possibilities for therapy and today we can also aim to heal the mucous membranes, that is, to bring the hyper-inflamed tissue of the intestine back to normal. And it is increasingly clear that nutrition can be fundamental for the management of these diseases and also for preventing them. Ulcerative colitis and Crohn’s disease are different, but they both set the intestine on fire: the precise causes are not well known, but it seems that alongside one genetic predisposition various environmental factors play a role, including diet, smoking, stress, use of certain drugs. The most accredited hypothesis is that these elements contribute to causing a malfunction of the immune systemwith the initiation of an abnormal response that leads to chronic inflammation responsible for the alteration of the intestine and therefore the symptoms of IBD.
A few weeks ago it was discovered that some anomalies could be detected several years before the appearance of the clinical signs of the two diseases, allowing the diagnosis to be significantly anticipated: a study by Francis Crick Institute of London on 20 thousand patients and around 4.6 million healthy people has shown that in the blood of those who get sick some mineral salts and markers of inflammationincluding calprotectin, they change up to eight years earlier before the onset of Crohn’s disease symptoms and up to three years earlier in the case of ulcerative colitis. The authors hope that this is the first step to understand whether it is possible to identify people at risk to slow down the inflammatory process, with lifestyle changes or other methods: for the moment no one knows whether quitting smoking or changing diet can modify the fate of patients, but it is certain that early diagnosis is fundamental, because it can limit the impact of IBD on people’s lives not only from a physical point of view, but also emotionally and economically, says Massimo Fantini, director of the Complex Gastroenterology Structure of the University Hospital of Cagliari. Many diagnoses, however, arrive after going to the emergency room with acute symptoms, which frighten patients and family members. It still sometimes happens that from the appearance of the first symptoms one ends up waiting up to five years to give a name to one’s illness, but in most cases the diagnostic delay is less than six months; why it is so essential to know how to recognize the alarm bells which they should take to the gastroenterologist in order to intervene promptly, control inflammation and reduce the impact on quality of life.
A sword of Damocles
Both IBDs are in fact characterized by periods of remission and relapses due to the flare-up of inflammation, in which symptoms such as the urge to go to the bathroom, diarrhea or pain come on suddenly and unpredictably. Patients live with a sword of Damocles over their heads, worrying about when they will have the next recurrence and often changing their work and habits to manage possible emergencies: 2 out of 3, for example, admit to checking where the bathrooms are when they have to attend an event . As underlined by Salvo Leone, general director of AMICI ETS National Association for Chronic Inflammatory Bowel Diseases, we must focus on timely diagnoses and increasingly appropriate and personalized treatment paths, which take into account the chronic condition, guaranteeing support, including psychological support, to patients “invisible” people who have the right to the best possible quality of life. Because it is not a utopia, on the contrary: as Alessandro Armuzzi, head of the MICI Unit of theIRCCS Humanitas Research Hospital of Milan, in the last 10 years there has been a revolution in the management of these diseases and today, thanks to scientific research, the objectives are the clinical remissionthe “healing” of the intestinal mucosa and the absence of disabilities, to improve the quality of life without having to resort to surgery (which may become necessary if the inflammation attacks sections of the intestine in a profound manner and cannot be managed in any other way , ed).
Achieving this with the therapies available today, which include steroids, immunosuppressants but also and above all immunomodulating biological drugs, is possible but still does not happen always and everywhere, on the contrary: the IBD-Podcast study, presented in recent days and conducted in 103 centers in 10 countries , showed that in Italy 54 percent of patients with Crohn’s disease and 49 percent of those with ulcerative colitis are not optimally controlled. The failure to control in the case of ulcerative colitis it sometimes depends on excessive use of corticosteroids, in Crohn’s disease on active perianal disease; in both cases, those who do not heal the mucosa often have manifestations of the disease outside the intestine (such as inflammation of the joints, skin or eyes). In practice all this translates into an uphill life, in which one is more often tired and tired or struggling with intestinal urgency; those who have no control over their illness admit to having negative repercussions on their emotional well-being and relationships, while working life for many becomes difficult, with an increase in sick days and a loss of productivity reported by around one in four patients.
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February 11, 2024 (modified February 11, 2024 | 07:46)
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