Professor Silvio Danese, Head of the Centre for Chronic Inflammatory Bowel Diseases at Humanitas and Professor at Humanitas Univerity, was the protagonist of a long interview in the studies of “My Doctor” on TV2000 to talk about inflammatory bowel diseases and especially about Crohn’s disease.
Inflammatory bowel diseases
“We distinguish Crohn’s disease and ulcerative rectocolitis; then there is a third pathology defined as indeterminate colitis and because of the overlaps between the two pathologies we are not always able to give a precise label, but this occurs only in 5-10% of cases.
Chronic intestinal diseases show a sharp increase, an increase that is estimated to be 20-30 times in the last 50 years. This phenomenon, however, is not only related to Crohn’s disease and ulcerative rectocolitis, but it is common to many autoimmune diseases, such as asthma, multiple sclerosis and juvenile diabetes. In the case of intestinal diseases, environmental factors could play a role: it is well known for example that the repeated use of antibiotics in childhood increases the risk of Crohn’s disease in adulthood because the intestinal flora undergoes dramatic changes at each cycle of antibiotic. Smoking is another risk factor, although its role is not yet clear; in Crohn’s disease it worsens the symptoms, in rectocolitis it improves them, but in any case it is recommended not to smoke.
As far as the incidence is concerned, there are two well recognized peaks: from 25 to 45 years old and a late one, between 65 and 75 years of age. The novelty is that there is a high incidence of these diseases even in children, with a very sharp increase. And even in this case, the phenomenon is common to other autoimmune diseases,” explained Prof. Danese.
Symptoms of Crohn’s Disease
“Our intestines often respond in the same way, so the symptoms are very blurred and are an example of an alteration of the regularity and presence of abdominal pain; then there may be more specific symptoms, such as fever, vomiting, lack of appetite, fatigue and slimming. In the presence of these symptoms it is very important to talk with your doctor or consult your specialist, also because going to the specialized centers means having early access to the best therapies and this can really change the evolution of the disease, said the specialist.
“A colonoscopy with biopsies is generally performed for diagnosis; radiology is also of great help, for example with the ultrasound of intestinal loops, magnetic resonance imaging and CT scans. Laboratory tests, such as blood tests, are often carried out, or inflammation parameters, such as the reactive C protein, can be evaluated; there are also very specific fecal tests that can measure intestinal inflammation. It should be noted, however, that unfortunately there is no one diagnostic test and the diagnosis proceeds like a puzzle, putting together piece by piece all the information in order to identify the disease as soon as possible. Patients with Crohn’s disease are often misdiagnosed with irritable bowel syndrome because Crohn’s symptoms are not always so striking. It is estimated that one in four patients has a diagnostic delay of more than 5 years and sometimes these patients arrive in first aid because of the complications of the disease that at this point no longer responds to drug therapy. Controlling the disease with innovative drugs is our goal,” said professor Danese.
Colonoscopy: what it is and how it works
Dr. Federica Furfaro, a specialist at the Centre for Chronic Inflammatory Bowel Diseases at Humanitas, spoke during the course of the service conducted at Humanitas and explained what colonoscopy is and how it works: “Colonoscopy is an endoscopic examination that uses a small tube with a camera to visualize the walls of the colon and the small intestine, in search of polyps, divertible or inflammation lesions. The examination lasts about 20 minutes and with respect to the pain that can be felt during its execution, the subjectivity of the patient comes into play; some patients do not perform any sedation, but it is still possible to undergo the examination in conditions of conscious or deep sedation, with the help of the anesthetist. After the examination you may feel a certain swelling due to the intake of air and water necessary to visualize the intestinal walls, but within a couple of hours the situation returns to normal.
Surgery, Pharmacological Care and Research
“In the past it was thought that Crohn’s disease should always have surgical treatment with the aim of removing the inflamed part of the intestine and thus solve the problem. In reality, this is no longer the case, also because the disease can reoccur after an operation and the patient cannot undergo so many surgical operations. Today surgery is minimally invasive; in some cases it can save the intestine and is a complementary practice to medical therapy.
As far as drug therapy is concerned, we have old generation drugs (such as cortisone drugs and immunosuppressants) and brand new drugs, so-called biological drugs. These are intelligent drugs that can switch off the switches of inflammation selectively; they are more effective and can change the history of the disease.
Research in this field is progressing and we are experimenting with drugs that can block multiple cytokines (i.e. inflammation molecules) at the same time, instead of blocking one switch at a time many mediators are shutting down, resulting in deeper and more effective control of inflammation. We are also using stem cells, which appear to be very effective for Crohn’s fistularizing disease. We then have the selective blockade of some white blood cells, those that attack the intestine in an autoimmune way. It is a moment of great optimism for the patients”, concluded professor Danese.
Watch the full interview with Professor Silvio Danese, click here.