From the Guidelines
Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract, presenting with clinical features such as abdominal pain, diarrhea, rectal bleeding, weight loss, and anemia, with extraintestinal manifestations including arthritis, skin disorders, and uveitis 1.
Clinical Features of IBD
The clinical features of IBD can vary between its two main forms, Crohn's disease (CD) and ulcerative colitis (UC).
- CD is characterized by transmural inflammation that can occur in any part of the gastrointestinal tract, leading to complications such as abscesses and fistulas 1.
- UC, on the other hand, demonstrates mucosal inflammation, typically starting in the rectum and progressing proximally in a continuous manner, with rare ileal involvement 1.
Diagnosis and Management
Diagnosis of IBD is made by assessing symptoms, biochemical markers, and colonoscopy combined with radiology and histology 1.
- Management of IBD aims to achieve induction of remission, followed by maintenance therapy to prevent recurrent disease flares, with treatment regimens tailored to the type, distribution, and severity of the disease, as well as patient preferences 1.
Treatment Options
Treatment options for IBD include immunosuppressive therapies such as azathioprine, 6-mercaptopurine, methotrexate, and 6-thioguanine, with biologics such as anti-TNF agents, vedolizumab, and ustekinumab used in cases of insufficient response or intolerance 1.
Quality of Life and Socioeconomic Impact
IBD is a chronic and potentially disabling condition, frequently leading to hospitalizations, lower quality of life, and inability to work, with a substantial socioeconomic impact 1.
- Despite the current therapeutic arsenal, surgery is still frequently required, although the number of cases performed seems to have decreased in recent years, likely due to the introduction of anti-TNF therapy and improved multidisciplinary IBD management 1.
From the Research
Clinical Features of Inflammatory Bowel Disease
The clinical features of inflammatory bowel disease (IBD) include:
- Severe diarrhea, pain, fatigue, and weight loss 2
- Abdominal symptoms, such as abdominal pain, bloody stools, and vomiting 3
- Defects in intestinal epithelial barrier function 3
- Relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon in ulcerative colitis (UC) 2
- Transmural inflammation and skip lesions in the entire gastrointestinal tract from mouth to perianal area in Crohn's disease (CD) 2
- Fibrosis, strictures, microperforations, or fistulae due to transmural inflammation in CD 2
- Chronic abdominal pain, which can persist despite optimal management of intestinal inflammation 4
- Visceral hypersensitivity, alteration of the brain-gut axis, and multiple factors contributing to pain persistence 4
Types of Inflammatory Bowel Disease
The two major forms of IBD are:
- Ulcerative colitis (UC), characterized by inflammation limited to the mucosal layer of the colon 2
- Crohn's disease (CD), characterized by transmural inflammation and skip lesions in the entire gastrointestinal tract 2
Symptoms and Complications
Patients with IBD may experience:
- Abdominal symptoms, such as diarrhea, abdominal pain, bloody stools, and vomiting 3
- Weight loss and fatigue 2
- Defects in intestinal epithelial barrier function 3
- Chronic abdominal pain, which can negatively affect quality of life 4
- Life-threatening complications, such as fibrosis, strictures, microperforations, or fistulae 2