Understand what inflammatory bowel diseases are

IBDs (inflammatory bowel diseases) are still taboo. With difficult diagnosis, it affects about 5 million people worldwide. They can appear under the name of Crohn’s and ulcerative colitis, chronic diseases that have no cure.

In Brazil, the prevalence increased from 30 per 100 thousand inhabitants in 2012, to 100 per 100 thousand inhabitants in 2020, according to the Brazilian Society of Coloproctology.

Treatment involves corticosteroids, immunosuppressants and an intestinal healing agent.

To make the population aware of the dangers of the disease, it was established that May 19 would be World Inflammatory Bowel Disease Day. Since 2010, experts, patients and activists have come together around the world to raise awareness of the condition.

Student Joice Cruz, 24, is one of those affected by the disease. Since 2012 she has been living with Crohn’s disease. Symptoms started at age 11 with severe anemia, but she was not diagnosed until a year later, when she began to experience a lot of intestinal discomfort.

Joice, who lives in Uberlândia (MG) has had more than 20 surgeries. One of the procedures was a colostomy, an intervention that externalizes part of the intestine into the abdomen when the person has any problem that prevents them from having a bowel movement.

At the beginning of the disease, Joice spent 6 months suffering from an abscess – a painful anal inflammation – because she was too embarrassed to talk about it.

Today, after ten years of treatment, Joice is in remission – when the disease no longer generates inflammatory crises and the use of corticosteroids is no longer necessary. Now, she intends to finish her Biomedicine course, live a life without thinking about the disease and pursue a scientific career in order to help other people.

Causes and symptoms

IBDs are chronic autoimmune diseases that affect the digestive tract. While rectocolitis is more superficial and primarily affects the large intestine and rectum, Crohn’s disease can cause deep inflammation from the mouth to the anus.

There is no single cause for disease. The patient must have a genetic predisposition, but factors such as diet, alcoholism and dysregulation of the human microbiota (bacteria, viruses and fungi that live throughout the body) also play a crucial role. Cigarette smoking is the main driver known to trigger Crohn’s disease.

According to the doctor Rogerio Serafim Parra, responsible for the IBD outpatient clinic at the Hospital das Clínicas de Ribeirão Preto, a specialist should be sought when diarrhea lasts for more than 3 weeks, progressive weight loss, bleeding in the stool, anemia and wounds in the mouth or anus.

Recommended specialist physicians are gastroenterologists and coloproctologists.

Treatment

Initial treatment is with corticosteroids, immunosuppressive drugs that do not harm the intestine, and Mesalazine, an intestinal healing agent.

Patients with more severe symptoms need to receive immunobiologicals. These drugs act against specific molecules in the body. The main one is the anti-TNF, which acts against a molecule of the inflammatory system involved in autoimmune diseases.

Medicines for the treatment of IBD can cost more than 10 thousand reais. Some of them are offered by the SUS (Unified Health System), but according to Parra, the guidelines are not updated frequently. This makes newer and more effective drugs unavailable.

To have access to the latest drugs, patients need to resort to justice or private plans, whose guidelines are more advanced.

Patients diagnosed early are less likely to need surgery, but some may need a colostomy, even for a short time, the doctor says.

auxiliary measures

In addition to drug treatment, other measures can also help patients. The help of nutritionists, nutritionists and psychologists makes a big difference in quality of life.

As these diseases can be associated with comorbidities such as autoimmune diseases and heart disease, follow-up by rheumatologists and cardiologists is also essential.

In addition, associations of patients with inflammatory bowel diseases also play an important role in the feeling of welcoming these people. In these groups, socialization events, exchange of experiences, professional referrals and drug donations take place.

“As for the people who come to us, we refer them to state leaders, where they can interact with other carriers who work as a support network, including to gain access to doctors and treatments” says Patrícia Mendes, president of the Association of People with Crohn’s and Ulcerative Colitis.

Search

Both basic research and clinical research are important for understanding the causes of inflammatory diseases and for developing new drugs.

Anderson dos Santos Ramos, a master in Cellular and Molecular Biology from the UFPB (Federal University of Paraíba) and a doctoral candidate in Immunology from the USP (University of São Paulo), studied the role of the microbiota in the treatment of IBDs and is currently investigating the role of the immune system in the development of diseases. According to him, a specific treatment for each patient is necessary and this can only be developed with investment in research.

For Parra, clinical research developed in centers such as Unesp (Universidade Estadual Paulista) in Botucatu and Hospital das Clínicas in Ribeirão Preto are the main way of offering new treatments to patients, especially for those who do not respond to traditional therapy.

remission and healing

Inflammatory bowel diseases still have no cure, but when the doctor finds the best treatment for the patient, he can go into a state of remission.

“If we treat it properly, at the right time and with good drugs, most patients can have a life close to normal”, adds Parra.