inflammatory bowel disease treatment
Divided into Crohn’s disease and ulcerative colitis
Suspicion when abdominal pain or diarrhea persists for more than 4 weeks
Medication should be continued even if symptoms improve
Inflammatory bowel disease (IBD), in which inflammation and ulceration occur repeatedly in the digestive tract, is a representative intractable disease. The internal mucous membranes of the esophagus, large intestine, small intestine, and anus, which are the digestive organs responsible for digestion and absorption of nutrients, are constantly inflamed, resulting in abdominal pain, diarrhea, and bloody stools. As the inflammation repeats, the cells of the intestinal mucosa change and the probability of developing colorectal cancer increases. Recently, it attempts to heal the damaged intestinal mucosa with targeted therapy that blocks the cause of inflammation. It is an advanced concept in clinical symptom relief. Endoscopic remission maintenance minimizes the occurrence of complications due to inflammatory bowel disease.
Inflammatory bowel disease is an autoimmune disease in which an abnormality in the immune system that protects the body causes repeated inflammation in the intestines, which is a digestive organ. In general, it is divided into Crohn’s disease and ulcerative colitis according to the extent of inflammation. If inflammation occurs in the entire digestive tract, from the mouth to the esophagus, stomach, small intestine, large intestine, and anus, it is Crohn’s disease, and if it is only in the large intestine, it is ulcerative colitis. Outward symptoms vary. Blood in the stool or diarrhea that does not stop. Severe abdominal pain that wakes me up for no apparent reason. Loss of appetite and loss of more than 10% of body weight in 6 months. It is also accompanied by anal diseases such as fissures and fistulas. It’s also psychologically depressing. His personality becomes timid when he rushes to the bathroom at an important moment and ruins his presentation or exam. Wherever they go, they first check the location of the bathroom or are extremely reluctant to go out. Inflammatory bowel disease usually develops between the ages of 10 and 40. It is easy to ignore abnormal signals from the intestines because they are young, have symptoms similar to enteritis caused by bacteria or viruses, and irritable bowel syndrome, and are concerned about social life such as schoolwork, employment, and marriage. In some cases, the hospital is belatedly visited only after an emergency situation in which the intestine is blocked or perforated due to the accumulated inflammatory response. If gastrointestinal symptoms such as abdominal pain and diarrhea of unknown cause persist for more than 4 weeks, inflammatory bowel disease should be suspected. It is more fatal if you think that it will get better with time or if you hide the disease in shame. It progresses to intractability, which is difficult to treat. Inflammatory bowel disease is characterized by repeated progression of symptoms, like riding a roller coaster, getting better and worse. As inflammation occurs repeatedly in the same area, damage to the intestinal mucosa accumulates and turns into a pathological condition. Inflammation in the intestines can cross the intestinal wall and spread to joints, eyes, and skin. The risk of colorectal cancer is greater than the general population because the intestinal mucosa is sensitive due to chronic inflammation. When the intestinal mucosa repeatedly breaks down and heals, the intestine changes structurally. In the end, recovery is impossible and the intestines have to be amputated. This is the background that emphasizes continuous inflammation management in the treatment of inflammatory bowel disease. Treatment consists of step-by-step drug therapy to suppress inflammation in the intestinal mucosa. It is difficult to cure, but it is possible to lead a normal life by controlling the symptoms. Recently, we pay attention to mucosa healing damaged by inflammation. There are also oral medications (Rinvoq, etc.) that target Janus Kinases (JAK), which is a signal transduction pathway inside cells that causes inflammation. When examining the mucous membrane of the digestive tract with a gastrocolon endoscope, all inflammation on the surface remains in a state of disappearance. It is endoscopic remission. The longer this condition is maintained, the more likely it is to minimize the occurrence of complications such as stenosis, perforation, and obstruction caused by inflammatory bowel disease. In addition, it is maintained and induced so that there are almost no clinical symptoms in the acute phase of severe abdominal pain and diarrhea. It also has the effect of preventing intestinal mucosal damage caused by inflammation. Unlike injectable biologics, it is an oral drug that is taken every day and is highly convenient to administer. Several clinical studies have confirmed that patients with inflammatory bowel disease who achieve intestinal mucosal healing have a low risk of recurrence and a positive long-term prognosis. Professor Kim Sang-wook of the Department of Gastroenterology at Chonbuk National University Hospital said, “With the continued introduction of new drugs that have shown mucosal healing effects in the treatment of inflammatory bowel disease, we can look at fundamental treatment.”
Treatment of inflammatory bowel disease is a long-term battle. It is dangerous to voluntarily stop drug treatment just because the symptoms have improved. About 30 to 50% of patients had a recurrence of inflammatory bowel disease 1 to 2 years after discontinuation of the drug. This recurrence can make treatment more difficult. Inflammatory bowel disease is an accumulation of intestinal mucosal damage due to repeated inflammation. It is important to continue treatment while discussing any changes in your condition with your medical staff.
Diet management is also necessary. If the nutritional status is poor, the effectiveness of treatment is reduced. When you eat, eat small amounts of soft, nutrient-dense foods frequently. You can prevent worsening of symptoms by reducing the burden on the intestines. Drinking 1-2L of water a day replenishes lost moisture due to frequent diarrhea. It is also good to increase the intake of vegetables that improve the intestinal environment.
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Infographic = Designer Sukyung Jeong
Supervision = Professor Kim Sang-wook, Department of Gastroenterology, Chonbuk National University Hospital
Reporter Seonmi Kwon kwon.sunmi@joongang .co.kr
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Seonmi Kwon kwon.sunmi@joongang.co.kr
2023-08-26 13:21:00
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