There have been several questions from our users about digestive disorders. With the help of Professor Silvio Danese, Head of the Centre for Chronic Inflammatory Bowel Diseases at Humanitas, we try to clarify Crohn’s disease, but also some aspects related to irritable bowel syndrome.
How to recognize Crohn’s disease? What are the possible symptoms?
Crohn’s disease can be located throughout the digestive tract, from the mouth to the anus, so symptoms may vary depending on where the disease is located.
The most frequent localization is at the level of the ileum and colon and therefore the most typical symptoms are abdominal pain, diarrhea and sometimes fever. When the disease affects the upper tract of the intestine you may also have nausea and vomiting. Finally, in patients with perianal disease, the symptoms are usually pain in the anal region and sometimes swelling and secretions in this area.
I always have bellyache and yellow, unformed stools; I have a rheumatic disease. Can it be Crohn’s disease?
It may be useful to better investigate the problem through blood, feces, and bowel ultrasound examinations in order to understand whether more invasive examinations, such as colonoscopy, are needed for a diagnosis of Crohn’s disease.
I read the testimony of an American girl who managed to improve her situation with Crohn’s disease thanks to a genetic test that gave her more details about her body. Is this really possible and useful for a better management of Crohn’s disease?
We do not know the exact causes of the disease and there is no specific genetic test for its diagnosis or treatment. Considering that Crohn’s disease is multifactorial, we know that genetic factors are certainly involved and that perhaps in the future genetic analysis will help us in the management of the disease, but at the moment genetic tests are not routinely used by us.
How best to manage Crohn’s disease? Are there effective therapies?
There are numerous drugs available to treat this disease. Thanks to continuous research, over the years we have increased and continue to increase our possibilities. Unfortunately, not all patients respond in the same way to the proposed therapies, so there is not the right drug for everyone.
The most widely used drugs are cortisone, immunosuppressants and biologicals, in particular infliximab, adalimumab and vedolizumab. In addition, another biological drug with another mechanism of action, ustekinumab, will soon be on the market.
Can irritable bowel syndrome and food intolerances lead to more important diseases in the long run? What are the possible signs and risk factors?
Irritable colon syndrome or lactose intolerance does not herald more serious problems and does not degenerate into more important diseases. A separate issue is instead intolerance to gluten: celiac disease. In fact, if celiac patients do not follow the gluten-free diet, they may increase the risk of developing more important diseases, such as lymphoma or dermatological problems.
For years I have suffered from irritable bowel syndrome; I am also lactose intolerant and have gluten sensitivity. I try to follow a diet poor in fiber, legumes, fats, gluten and rice. I suffer from swelling and severe pain as if the intestine were inflamed. Which foods are causing inflammation and which diet should I follow for the irritable bowel?
Irritable bowel syndrome is not an inflammation. The symptoms are not related to the presence of inflammatory lesions at the colon level, as happens in ulcerative colitis for example, but to altered intestinal motility and a change in intestinal bacterial flora. The therapies can be multiple and the most recommended diet is that with a low content of FODMAPS (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols).