Inflammatory bowel disease (IBD) is a chronic nonspecific inflammatory disease of the intestine, including ulcerative colitis (UC) and Crohn’s disease (CD). UC lesions involve only the colon (large intestine), while CD lesions can involve all parts of the gastrointestinal tract, with the terminal ileum and its adjacent colon predominant. Nowadays, the incidence of IBD is increasing, and an article on the key points of clinical knowledge of IBD was published in JAMA on May 21, which briefly described the knowledge about the main clinical manifestations, diagnosis and treatment of IBD, bringing medical inculcation and popularization to more IBD patients, and a systematic sorting out for clinicians.
Schematic diagram of IBD: above left is ulcerative colitis (UC), which starts from the distal colon – rectum and progresses retrograde to the proximal end, involving the whole colon, with a continuous distribution; above right is Crohn’s disease (CD), a chronic granulomatous inflammatory disease, with lesions mainly in the terminal ileum and its adjacent colon, which can involve all parts of the gastrointestinal tract It is mostly segmental and asymmetrical in distribution. The following figure shows that, from the depth of involvement of the colon wall, UC usually involves only the inner layer of the intestinal wall, while CD can involve all layers of the intestinal wall.
The etiology of IBD in susceptible populations is not yet clear, but it is believed that four main factors may play a role: genetic inheritance, environmental factors, intestinal flora and abnormal immune response in the intestine. The age of the population diagnosed with IBD is mainly between 15-30 years old.
2. Main symptoms Clinically, the symptoms of IBD patients vary in severity, mainly manifesting as diarrhea, abdominal pain, bloody stools, fever, malaise and weight loss. As a result of systemic inflammatory involvement outside the gastrointestinal tract, IBD patients may present with arthralgia or arthritis, visual or eye disorders, skin rashes, and liver disease.
Symptoms usually show a smooth development of chronicity, but can also suddenly worsen and become violent, and if left untreated, can lead to serious infection, bleeding or intestinal perforation, or even life-threatening.
3, diagnostic points The patient’s medical history, imaging examinations including CT, X-ray, and gastrointestinal endoscopy should be combined to evaluate the patient comprehensively.
It should be emphasized that stool and blood tests should be used to exclude diarrhea caused by common infections.
In contrast, abnormalities seen in routine blood tests include: anemia, elevated inflammatory markers, electrolyte disturbances (due to diarrhea), decreased albumin (due to inflammation and impaired nutrient absorption) and vitamin deficiencies (common in patients with CD due to impaired nutrient absorption).
Endoscopy is an essential diagnostic tool, including gastroscopy and colonoscopy, depending on the likely site of the patient’s lesion. The diagnosis is often confirmed by taking a tissue biopsy of the suspected site for pathological examination.
4.Treatment plan For patients with IBD, graded treatment is adopted, that is, the treatment plan is determined according to the severity of the patient. For mild patients, anti-inflammatory treatment, oral or enema or suppositories can be used. In more severe cases, immunomodulators or immunosuppressants should be applied, which can be given orally, subcutaneously or by intravenous infusion. In severe fulminant cases, hormones must be applied to suppress the disease. (It is important to consider that the higher the drug level, the higher the cost and the greater the relative side effects).
If conservative medical treatment does not work, surgical treatment may be considered.
In addition, it is important to note that patients with IBD who have lesions involving the colon are at a much higher risk of developing colon cancer, and therefore, long-term colonoscopic surveillance is necessary for these patients.