What they are
Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the digestive tract. Ulcerative colitis affects the colon and rectum continuously; Crohn's can affect any segment from mouth to anus, in a patchy distribution.
Both run in flares and periods of calm. The aim of modern treatment is no longer simply that you feel well, but that the lining heals, because that is what prevents long-term complications.
When to suspect them
- Diarrhoea lasting more than four weeks, particularly if it wakes you at night
- Repeated blood or mucus in the stool
- Recurrent abdominal pain with weight loss
- Lesions or fistulas around the anus
- Anaemia or inflammation on blood tests with no clear cause
- Manifestations outside the gut: joint pain, skin lesions, eye inflammation
How it is diagnosed and monitored
Diagnosis combines the clinical history, blood tests with inflammatory markers, faecal calprotectin, endoscopy with biopsies and, depending on the case, MRI or intestinal ultrasound.
- Colonoscopy with biopsies, which I perform personally
- Faecal calprotectin for follow-up without repeating endoscopies
- Drug levels and antibodies when biologics are used
- Infection screening and vaccination before starting immunosuppressants
- Bowel cancer surveillance in long-standing colitis
Treatment
The range of options has changed completely over the past fifteen years. Alongside aminosalicylates, steroids and the classic immunosuppressants, we now have several families of biologic drugs and oral small molecules.
The decision that matters is usually not which drug exists, but when to escalate and when not to. That is where close follow-up makes the greatest difference.
Bone health, an aspect that gets forgotten
My doctoral thesis studied precisely the course of osteopenia and osteoporosis over five years in patients with inflammatory bowel disease, with results published in Inflammatory Bowel Diseases. It is a common, silent and preventable problem that is rarely assessed in clinic.
My work in this area
My doctoral thesis, supervised by Dr Javier P. Gisbert and Dr José Maté, was awarded Summa Cum Laude by the Autonomous University of Madrid.
I have also contributed to work on the cellular and molecular mechanisms of the disease published in Mucosal Immunology, Biomedicines and the International Journal of Molecular Sciences, and to studies on the natural history of Crohn's disease over more than ten years of follow-up.