“I will always remember that when he came to see the doctor, he was already a big boy in his twenties, but he only weighed 40 kilograms!” recalled Dr. Cai Tizhen, Department of Gastroenterology, Hepatobiliary and Gastroenterology, Kaohsiung Veterans General Hospital, “He had been suffering from abdominal pain repeatedly for five years. For a long time, I often had diarrhea and even bloody stools, and later because of Crohn’s disease, I had to undergo surgery to remove part of the intestine.”
“After the operation, he can eat and absorb nutrients better, and he continues to receive biological treatment.” Dr. Cai Qizhen said that following half a year of stable treatment, the patient’s weight slowly recovered, and now he has more than 70 kilograms, and he can also recover. Go to the workplace and work as an engineer.
The three points of abdominal pain and diarrhea are not irritable bowel syndrome!
Inflammatory bowel disease (IBD) is an autoimmune disease that seriously affects physical health and imposes a heavy burden on individuals and families. Common symptoms include abdominal pain, diarrhea, bloody stools, black stools, and weight loss.
Many people ask, “I often have diarrhea and stomach cramps. Is it irritable bowel syndrome? Acute gastroenteritis? Or inflammatory bowel disease?”
Dr. Cai Qizhen explained that irritable bowel syndrome can also cause abdominal pain and diarrhea, but there will be no bloody stools, fever, and weight loss. As for acute gastroenteritis, it may be a bad stomach, which lasts for two to three days, usually no more than two weeks; if it is long-term repeated diarrhea and abdominal pain, it needs to be carefully followed up for more than a month.
Inflammatory bowel disease can cause many tricky complications. Dr. Cai Qizhen said that inflammatory bowel diseases can be divided into “ulcerative colitis” and “Crohn’s disease”. Patients with ulcerative colitis often resolve bloody stools, which leads to anemia, dizziness, and shortness of breath. The bigger the swelling, the more perforation and the rupture. Long-term follow-up results show that patients with ulcerative colitis are 20 to 100 times more likely to develop colorectal cancer than the general population.
Because Crohn’s disease invades the small intestine, it is often malnourished, including problems with the absorption of nutrients such as vitamin B12 and iron, and malnutrition can also lead to anemia. After repeated inflammation of the patient’s intestine, it is prone to narrowing, perforation and fistula, and the risk of cancer is also increased.
“Because there are many complications of inflammatory bowel disease, we hope to be able to diagnose it early,” said Dr. Cai Qizhen, “If we can diagnose early and use appropriate drugs at the right time, we can reduce the occurrence of complications and reduce the chance of undergoing surgery. “
The condition is not simple, and it takes an average of two years to determine the diagnosis
Clinically, a variety of examinations are needed to diagnose inflammatory bowel disease. Dr. Cai Qizhen said that blood tests can evaluate CRP, ESR and other inflammatory indexes; imaging examinations include gastrointestinal photography, computed tomography, MRI, etc., which can evaluate whether stenosis occurs , perforation, fistula and other complications.
Because it is an intestinal disease, endoscopy will be done to check the lesions of the large intestine, and colonoscopy and sigmoidoscopy can be done; to examine the small intestine, enteroscopy and capsule endoscopy can be done to help evaluate the situation of intestinal inflammation.
There are many types of small bowel examinations, the most common being barium photography to see if there are any stenosis or dilation. If lesions are suspected, small bowel endoscopy can be considered, such as balloon-assisted enteroscopy, which can enter the small intestine for observation. If lesions are seen, they can be directly sliced. If you do not want to do enteroscopy, you can swallow a capsule endoscopy, which can help evaluate small bowel lesions. If the capsule endoscopy finds a problem, it is still necessary to go in with a balloon-assisted enteroscopy to do a biopsy, and then there is a way to diagnose it.
Sections obtained by endoscopy will be examined by a pathologist to see if there are features of inflammatory bowel disease, other infections, and cancer.
These inspection tools are used from diagnosis to follow-up. Dr. Cai Qizhen said that sometimes a simple stool test can be used to test the inflammation index from the stool, which is called “fecal calprotectin (Fecal Calprotectin).”
“Inflammatory bowel disease is actually not easy to diagnose. It takes an average of two years from the onset of symptoms to the diagnosis. The longest I have encountered is five years before the diagnosis.” Dr. Cai Qizhen said, “There have been patients who have undergone gastroscopy 9 times, 4 In the second colonoscopy, the cause was not found. Later, due to intestinal perforation, the diagnosis was Crohn’s disease of the small intestine following emergency surgery. We hope to make the diagnosis time as short as possible, and the target is within one year. Scabs and scarring will occur repeatedly, and over time, it will be easy to stenosis and perforation, requiring surgery. Early diagnosis and early treatment can reduce complications and maintain the patient’s quality of life.”
Make good use of biological agents to help the intestinal mucosa heal
Dr. Cai Qizhen pointed out that the traditional treatment of inflammatory bowel disease includes 5-ASA anti-inflammatory drugs, steroids, immunosuppressants, etc. If the treatment effect is not as expected, biological agents will be used.
During an acute attack, steroids may be used to control inflammation. Dr. Cai Qizhen explained that steroids will not be used for a long time. We hope to stop steroids in a short period of time to avoid side effects such as moon face, buffalo shoulder, edema, and easy infection. In the long term, immunosuppressive drugs are required to help maintain a stable condition.
If the traditional medicine does not respond well, or when the attack occurs frequently, biological agents will be used. Dr. Cai Qizhen said that there are several types of biological agents, which can be roughly divided into two categories. One is to inhibit cytokines, which can be used throughout the body. Play a role, such as anti-tumor necrosis factor preparations or anti-interleukin 12/23 preparations; the other type is lymphocyte migration blockers, which are specific to the intestine and only target the receptors on the intestinal mucosa. Plays an anti-inflammatory effect.
“Systemic biologics can improve intestinal inflammation and extraintestinal symptoms at the same time. Intestinal-specific biologics only act on the intestines, with fewer systemic side effects and can reduce the recurrence of infectious diseases, such as hepatitis B and tuberculosis. Reduce the risk of cancer.” Physician Cai Qizhen analyzed, “Clinically, the patient’s age, physical condition, severity of gastrointestinal symptoms, and whether there are extra-intestinal symptoms, such as arthritis, thrombosis, skin symptoms, etc., will select the appropriate biological preparation.”
In addition to improving symptoms, biological agents can also help to achieve intestinal mucosal healing. Dr. Cai Qizhen emphasized that we must not stop the drug without authorization following symptoms are relieved. Our treatment goal is to achieve intestinal mucosal healing to reduce intestinal stenosis and perforation. , fistula and other complications, and reduce the chance of needing surgery.
Inflammatory bowel disease is currently a serious injury in Taiwan, and most of the patients are young or middle-aged. Both physical and psychological. But as long as it is well controlled and tracked, life can be the same as ordinary people.
Intimate reminder
In daily life, patients must maintain a healthy lifestyle, normal work and rest, avoid staying up late, exercise regularly, quit smoking, and quit drinking. Dr. Cai Qizhen reminded that in terms of diet, you should eat fresh ingredients and try to avoid processed foods. Because inflammatory bowel disease is related to diet and the environment, too many additives may increase the chance of inflammatory bowel disease!
