Treatment of chronic inflammatory bowel disease (IBD)

In addition to standard treatment, our chronic inflammatory bowel disease (hereinafter referred to as IBD) patients at Diagnostični center Bled can also receive treatment with biological medicinal products in addition to standard treatment when standard treatment is not successful.

What is IBD?

Chronic inflammatory bowel disease is a long-term (chronic) inflammatory disease of the bowel. IBD includes two diseases, namely ulcerative colitis and Crohn’s disease. There is also an intermediate form of the disease called intermediary colitis, when the disease cannot be classified into any one group. In ulcerative colitis, the inflammatory process is generally limited to the colon, while in Crohn’s disease, the inflammation can affect any part of the gastrointestinal tract, from mouth to anus.

What causes IBD?

Unfortunately, the causes of chronic inflammatory bowel disease are unknown, but it is clear that some people are genetically predisposed to the disease, and they have an inappropriate immune response of the mucous membrane to external factors. The problems can be also caused by stress, unbalanced diet, smoking, insufficient sleep, excessive hygiene and excessive use of antibiotics. More cases are observed in the developed countries.

Who are patients with IBD?

IBD is most common among young people and mostly occurs in people between the ages of 15 and 40. Crohn’s disease occurs earlier and with younger people, while ulcerative colitis is more common among men.

What are the symptoms of IBD?

• abdominal pain and diarrhoea are the most common signs of the disease,
• bloody stools,
• weight loss and poor weight gain,
• growth failure and delayed puberty,
• fever,
• fatigue,
• nausea and vomiting.

What to do if you experience the above-mentioned problems?

If acute problems (abdominal pain and diarrhoea) persist for more than 24 hours, you should consult your doctor. In case of severe pain or worsening discomfort, you should consult your doctor immediately. Early detection of the disease and initiation of appropriate therapy are essential. An early initiation of therapy has a beneficial effect on the incidence and severity of complications. Severe complications are treated by a surgical procedure or by removal of the affected part of the intestine.

How to get diagnosis?

An examination at the doctor’s office and discussion about the problems helps in further diagnosis; therefore, this examination is very important. The disease is confirmed with an endoscopic examination – a colonoscopy and histological examination of mucous membrane samples.

How is it treated?

The purpose of the treatment is to reduce the issues and improve the patient’s wellbeing. IBD is treated with anti-inflammatory drugs: corticosteroids and medicines from the family of medicines called immunomodulators which satisfactorily stabilise the disease in most cases. Patients who do not respond to standard treatment can also be treated with biological medicinal products.

Treatment with biological medicinal products

In recent years, biological medicinal products have significantly changed the way we treat IBD and represent an important advancement in medical treatment. There are several types of biological medicinal products available.

Biological medicinal products are complex molecules of proteins obtained by biotechnological processes using live cell cultures. They act on various inflammatory mediators and thereby inhibit the inflammatory response in the tissue, in this case in the mucous membrane of the digestive tract. They can be administered intravenously in the form of an infusion, subcutaneously with an injection under the skin, and certain medicines (so-called small molecules that are not directly included to the biological medicines) may also be taken in the form of pills.

• When can we prescribe biological medicinal products?

Treatment with biological medicinal products must always be approved by the medical consultation of IBD at the clinical department for gastroenterology of Ljubljana UMC or Maribor UMC.

• Which patients can receive biological medicinal products?

Eligible patients are primarily those whose disease does not respond to so-called conventional treatment, patients with risk factors for the development of complications, or those with certain complications and extensive mucosal involvement.

• Is treatment with biological medicinal products expensive?

Biological medicinal products are fully covered by health insurance, and in recent years, a significant reduction in the cost of treatment has been reached with the use of high-quality biosimilar medicinal products or so-called biosimilars, which can be registered by manufacturers after the drug patent expiration. Therefore, a referral is necessary for the treatment.

What are the effects of appropriate treatment?

The disease can be controlled with appropriate treatment, and patients can carry out daily activities, attend school, go to work and take part in sport without any restrictions. It is important that patients avoid foods that can exacerbate the condition, saturated fat and refined sugar. It is also essential to quit smoking.

Who can patients turn to after diagnosis?

In Slovenia, there is the Association for IBD, which has been active since 2004 and has more than 1740 members that are organised into 11 sections across Slovenia. More information about the Association can be found on their website http://kvcb.si.