“When a person starts to have abdominal pain, chronic diarrhea and persistent tiredness, I think that's the time to contact their general practitioner or gastroenterologist specialist.” Alessandro Armuzzi, head of the Ibd Unit – Chronic Inflammatory Intestinal Diseases (CID), Irccs Humanitas of Rozzano (Milan), said this this morning during an event on 'Crohn's disease and ulcerative colitis: we give light to the invisible', organized in Milan by Abbvie.
Even if the symptoms can be confused with an irritable colon, it can be an expression of the beginning of Crohn's disease, therefore “from a medical point of view – recommends Armuzzi – it is always advisable to start a diagnostic process, at least initially, with blood and stool tests, such as fecal calprotectin, or even a simple ultrasound of the intestinal loops. Because when these signs and symptoms appear, accompanied by some indication of inflammation at the level of the required tests, it is necessary to proceed with the procedure complete in order to make the diagnosis of Crohn's disease. In the case of ulcerative colitis, in the vast majority of cases there is also intestinal bleeding, an alarm symptom that must lead the patient, whatever the origin, to consult a doctor to proceed with an appropriate diagnostic procedure”.
To date, numerous therapies are available for the management of Crohn's disease and ulcerative colitis. Conventional treatments “such as mesalazine and steroids”, recalls the specialist, are accompanied by more recent ones, such as monoclonal antibodies. “We have various classes available – specifies Armuzzi – and much more recently also the so-called small molecules. Biotechnological therapies must be started when the patient is not kept perfectly under control with conventional therapy. It is better to immediately keep the affected patient under control or Crohn's disease or ulcerative colitis”. Corticosteroids, “when used excessively – highlights the expert – lead to non-control of the disease and numerous side effects”. Furthermore, “when the disease has unfavorable prognostic factors, it is better to keep it under control with the achievement of the main objectives that can be achieved with advanced therapies, such as mucosal healing”.
“Mucosal healing is an endpoint that we aim to reach in the majority of patients, in all if possible – remarks Armuzzi – Clearly the most classic way to evaluate it is that of endoscopy, colonoscopy and perhaps, within the year from the beginning of a therapy, colonoscopy is necessary. Subsequently, there are many other non-invasive methods that can be surrogates of colonoscopy, for example monitoring with fecal calprotectin or ultrasound of the intestinal loops which can allow monitoring the patient in the long term without use the invasive method”.
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