Inflammatory bowel disease is a broad name used to describe different disorders related to the digestive tract that have inflammation in common. Some of the symptoms related to this disease are diarrhea, rectal bleeding, abdominal pain, fatigue or weight loss. It is a disease that, if not treated properly, can cause complications that can be life-threatening. It is also a chronic disease for which there are currently no curative treatments and, therefore, it is very important to learn to live with it.
Many factors interact in its development. Environmental conditions, such as alcohol intake or tobacco consumption, stress, diet, air pollution or genetic predisposition, among others, combine into a complex picture in which there are different mechanisms that can end up generating a crisis.
Dr. Maria Esteve, head of the Inflammatory Bowel Diseases Unit at the Mútua Terrassa University Hospital of Catalonia, in Spain, explains that despite all this complexity, its diagnosis is currently not difficult. “The main diagnostic test is a colonoscopy that allows the visualization of the lesions at the end of the small intestine and colon, and the taking of a tissue sample or biopsy. The problem lies when the symptoms that patients present are mild or can be attributed to other diseases and a diagnosis is made late.”
Joaquín Hinojosa, president of the Spanish Digestive System Foundation (FEAD), agrees that one of the problems of patients with inflammatory bowel disease is the delay in diagnosis. “This occurs less in ulcerative colitis, because they present rectal bleeding that makes them consult earlier. There have been many actions for Primary Care doctors, as well as education and training of Digestive residents, so that they are aware of this situation. Also being able to have a biomarker in feces such as calprotectin has helped reduce underdiagnosis.”
Dietary advice for patients
Currently, no food has been clearly identified that can trigger or worsen inflammatory activity in these patients. What there is is advice that can help control and minimize its effects, paying special attention to the moment of the illness, since the advice is the same when a crisis is occurring as when it has already ended.
During the acute phase it is important to avoid irritating foods, such as citrus or spicy foods, and drink plenty of fluids to prevent dehydration, even with the administration of an oral solution if the stools are very liquid. “In addition, you should avoid large meals, recommending between five and six meals a day, rest after meals and pay attention to the way you cook, with the use of the griddle and the oven being more preferred,” explains Dr. Hinojosa.
After this acute phase, the specialist considers that patients can freely eat everything, avoiding those foods that they detect from their own experience that they do not tolerate well. “It is also important that the diet is rich in fiber. Many times patients identify fiber with diarrhea and this is not necessarily the case. “Fiber absorbs liquids from the intestine and will help improve stool consistency.”
Dr. Hinojosa emphasizes the need to convey the message that it is not necessary to avoid dairy products. “Only in those who have lactose intolerance they should be avoided, as well as when the patient is in an acute phase. Outside of these cases, its inclusion in the diet is recommended due to the calcium contribution."
The importance of physical exercise
The symptoms of this disease, such as fatigue, abdominal pain, periods of disease outbreak and defecation urgency, among others, limit the performance of this physical exercise. But despite all this, it is important to remember the benefits that practicing physical activity has for these patients.
“There are studies that demonstrate a significant improvement in the quality of life of patients with mild or moderate inflammatory bowel disease compared to patients without physical exercise,” says Olga Benítez, nurse at the Inflammatory Bowel Diseases Unit of the Mútua Terrassa Hospital (Spain). who adds how this activity also helps to improve bone density and reduce mortality.
When giving guidelines for carrying out physical exercise, a series of conditions must be taken into account, as Olga Benítez explains. “The intensity should be mild or moderate, with aerobic and isotonic exercise predominating. When there is fecal incontinence that does not present anal hypertonia, that is, less relaxation and less capacity of the sphincter of the year to distend when defecating, exercises to strengthen the pelvic floor can be recommended. When planning physical activity, locating the closest public toilets can also provide greater peace of mind and comfort, explains the nurse.
Probiotics and prebiotics, a promising option
The imbalance in what is known as the microbiome, which is the set of microorganisms that live in our intestine, has been related to this disease. For this reason, one of the avenues that is now being investigated and which is expected to soon achieve important results, precisely addresses recovering this balance through the use of two products: probiotics and prebiotics.
The former consist of foods or supplements that contain microorganisms intended to maintain or improve the body's “good” bacteria. Prebiotics, for their part, are foods, generally high in fiber, that act as nutrients for the human microbiota and are used with the intention of improving the balance of these microorganisms.
Dr. Joaquín Hinojosa points out that there is beginning to be evidence of the beneficial effects of these products, which have the advantage that they do not present negative effects. "It is best to use the combination of probiotics and prebiotics, which are called synbiotics, since a synergistic effect occurs between them that enhances their benefits."
However, this route still needs more research and development, as Dr. Hinojosa himself explains. “Although there are currently many products of this type, the main problem with them is that most of the microorganisms that make them up end up being transients, that is, few adhere to the wall of the intestine. So for now I would always advise them as a complementary treatment, never as something isolated.”
