Commentary by: Professor Silvio Danese, Gastroenterologist, and Director of the Center for Inflammatory Bowel Disease at Humanitas Hospital


Irritable bowel syndrome or Crohn’s disease?

In order to diagnose this bowel disease early on, it is important to recognize its symptoms, which are often associated with simple colitis.

“The spreading of Crohn’s disease and ulcerative colitis is increasing. Today, more than 200,000 Italians, between the ages of 20-40, but also around 70 years old, suffer from these conditions. Over the past three decades, diagnosis has tripled and the reason is not entirely clear: the environment has undoubtedly played a decisive role. One of the most common and reliable theories – explains the professor – is the so-called “hygiene theory”, according to which our immune system is too clean and not trained to recognize the external agents.”

Another theory refers instead relates to stress: “The gut flora often is altered by environmental factors that are not yet identified and due to the widespread use of antibiotics in children. Stress also plays a key role in the exacerbation of these two diseases. Today, we are studying new non-drug treatments for vagus nerve stimulation with a kind of intestinal pacemaker.”

“Apart from Crohn’s disease and ulcerative colitis, there is also a third type of inflammatory bowel disease that is commonly known as “indeterminate colitis” and covers “the 5-10% of patients in which a precise diagnosis cannot be made” adds Professor Danese.

How are Crohn’s disease and ulcerative colitis diagnosed?

“The symptoms are often similar. The most common ones include diarrhea with or without recurrent bleeding, weight loss, and abdominal pain. In order to guide primary care and refer patients to preventive controls (especially for Crohn’s disease), we have developed an awareness campaign of “7 red flags”. If a person shows up with any of these symptoms (abdominal pain, nocturnal diarrhea, low-grade fever or complications such as fistulas for Crohn’s disease), then it is necessary to proceed with further tests.”

Most often Crohn’s disease is confused with irritable bowel syndrome: what are the consequences to such a mix-up? “When symptoms are overlapped, Crohn’s disease may be diagnosed after an average delay of 3-5 years. So it is best to diagnose the disease as early as possible and treat it with the right therapies, in order to guarantee the patient a life expectancy comparable to that of a healthy person.”

In some cases involving Crohn’s disease and ulcerative colitis, it is advised to eat small amounts of fiber

Recently, a new treatment has been presented with the latest generation of biopharmaceuticals: “We can block inflammation and the molecules responsible for the transfer of white blood cells into the intestines, which in turn irritate the tissues,” says the professor.


(For further information, click here: Soon new biologics for treating Crohn’s disease)


When it comes to managing a disease, many patients are curious as to what diet to follow; however, – he concludes – there are no specific contraindications. It is best to limit the intake of fiber when diarrhea is present and in the case of Crohn’s disease with narrowed lumen. Alternatively, gluten is not contraindicated.”