Can colitis be cured through Ayurvedic treatment
Reduce suffering in the case of chronic intestinal inflammation
Chronic inflammatory bowel disease (IBD) are usually associated with high levels of suffering. What happens in the body with Crohn's disease and ulcerative colitis?
Prof. Stallmach: In the case of inflammatory bowel disease, the immune defense of the gastrointestinal tract gets out of hand. The so-called gastrointestinal barrier, which is actually supposed to prevent pathogens from entering the body, is defective. There are excessive inflammatory reactions against actually harmless substances that damage the intestinal mucosa. The result is frequent, often bloody diarrhea, abdominal cramps, sometimes with high weight loss and general weakness. In severe cases, however, not only the intestine is affected. Rheumatic joint problems, fever or skin changes can also occur - sometimes even without intestinal symptoms.
The diseases run in episodes, they are not curable. Therapy is about keeping the inflammation in check, alleviating the symptoms and preventing complicated processes with sometimes life-threatening complications. The aim is to largely maintain the quality of life. How common are inflammatory bowel disease?
Prof. Stallmach: It is estimated that there are around 200 to 250 sick people for every 100,000 people. Converted to Thuringia, that would mean that 4,000 to 5,000 people are affected.
What are the causes behind these diseases?
Prof. Stallmach: The sick person has a genetic predisposition. It is noticeable, for example, that siblings of those affected have a significantly increased risk of illness. There is a whole range of so-called IBD risk genes, i.e. genetic information that favor the development of intestinal inflammation. If, for example, infections or certain lifestyle factors are added, these can "get the disease rolling" and trigger acute attacks. These “triggers” include, for example, diet, alcohol and cigarettes, but also antibiotics. Environmental factors and getting used to certain environmental stimuli also have an influence. It is known from studies, for example, that people in rural areas are less affected. Your immune system probably comes into contact with harmless pathogens and foreign substances at an early stage, is thereby trained and develops what is known as "tolerance".
How are IBD sufferers cared for at the UKJ?
Prof. Stallmach: The focus is on continuous outpatient treatment of those affected, but in-patient admission is also required in severe cases. Our clinic has an outpatient department in which around 1,400 IBD sufferers are cared for every year - 800 of them with Crohn's disease and 600 with ulcerative colitis. Of course, this can only be achieved through the dedicated work of doctors and nurses in the outpatient department. Cooperation with colleagues from visceral surgery is also important; for this purpose, we have established a joint interdisciplinary conference similar to the tumor board. In our outpatient department, the focus is on continuous support with drug treatment.
That is called cortisone?
Prof. Stallmach: Cortisone works well in the acute episode, which is why this drug still has an important place in therapy. However, because it also has very strong side effects when taken for a long time for weeks, we are increasingly relying on innovative drugs - and the IBD outpatient department works together with our study outpatient department. So-called biologicals have been available for a number of years. These are biotechnologically produced substances that are able to specifically intervene in the inflammation cascade. The biologicals block certain messenger substances that set the inflammation in motion. Unlike cortisone, which suppresses inflammation quite broadly and not specifically, these new active ingredients regulate the immune system and thus pre-empt the inflammation.
When is the best time for treatment with biologicals, in the early stages or only as the disease progresses?
Prof. Stallmach: The earlier, the better the chances of a long period of symptom-free life. In patients who have been treated with various other drugs for a long time, the intestines usually already show structural damage. Biologicals do not yet work in every patient, however. Clinical research, in which our outpatient department is also involved, is trying to find out why this is so. If you know why the new drugs work better for some than for others, you could use them much more precisely.
When is surgery necessary for inflammatory bowel disease?
Prof. Stallmach: In the case of severe disease that can only be temporarily alleviated with medication and in which the intestinal structure is damaged - for example due to constrictions, fistulas or threatened malignant degeneration - an operation may be indicated. This is not so rare with Crohn's disease. A good third of those affected are operated on at least once, with ulcerative colitis it is around one in twenty. The decision in favor of such a minimally invasive procedure is made jointly by gastrointestinal specialists (gastroenterologists) and surgeons in the interdisciplinary case conference.
How good are the chances of success in an operation?
Prof. Stallmach: Actually more of a question for a surgeon; So the attempt of an internist to answer this: A complete cure of chronic inflammatory bowel diseases is not possible even with an operation. Depending on which part of the intestine is affected and how severe the inflammation is, patients can then live largely symptom-free for up to three to five years. This significantly improves their quality of life. Many patients report after an operation that they would have had an operation earlier if they had known how well they are now.
What role does diet play in the treatment of inflammatory bowel disease?
Prof. Stallmach: Inflammation of the intestine impairs food intake, frequent severe diarrhea deprives the body of fluids and minerals, and those affected often restrict eating due to abdominal pain. In the acute episode, this leads to deficiencies, underweight and sometimes even to life-threatening malnutrition. Around a third of patients therefore need a special, very high-energy food with a particularly high content of vitamins and minerals. Nutritional therapy by trained nutritionists or advisors makes sense for every IBD patient.
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