Via practica 6/2023

Inflammatory bowel diseases from the perspective of general practitioners

Inflammatory bowel diseases (IBD) are immune-mediated systemic chronic inflammation. The etiology of the two main representatives - ulcerative colitis and Crohn‘s disease are unknown and the pathogenesis of both diseases is incomplete. The disease is heterogeneous, with a wide range of intestinal and extraintestinal manifestations. The incidence and prevalence of idiopathic intestinal inflammation are increasing and mainly affect young people of reproductive age. The diagnosis of idiopathic intestinal inflammation is based on a detailed history and a combination of clinical and biochemical examinations, stool tests, endoscopy, and cross-sectional radiological examinations (ultrasound, computed tomography - CT, and magnetic resonance - MR). Suspicious IBD is used to be diagnosed through a colonoscopy with terminal ileoscopy with a biopsy of the inflammatory and unaffected mucosa. C-reactive protein (CRP) is the most frequently determined serological marker. The fecal marker calprotectin (FC) has a high sensitivity in comparison with CRP. The average duration of diagnosis from the onset of symptoms to the diagnosis is up to 10 months. A detailed anamnesis, a laboratory examination with the determination of CRP and fecal calprotectin will enable the general practitioner to distinguish a patient with an irritable bowel syndrome and to correctly and timely indicate a colonoscopy examination. Special attention must be paid to high-risk patients. In patients at risk, highly effective drugs must be used to prevent permanent damage to the gastrointestinal tract. These highly effective drugs - immunosuppressants, biological therapy, and other small targeted drugs - can have side effects; which general practitioners can tackle with.

Keywords: Crohn’s disease, ulcerative colitis, epidemiology of IBD, CRP, fecal calprotectin, IBD therapy