Time-consuming, psychically and physically demanding occupations, together with stress and busy life take its toll. Present life-style, high pace of work, shortage of rest, irregular meals, lack of movement and sleep – all these factors affect our health. Gastroenterology deals with diseases of digestive tract. Both prevention and treatment of diseases of digestive tract is important. IBD Centre specializes on treatment of Crohn’s disease and ulcerative colitis.
Crohn’s disease and ulcerative colitis are chronic, inflammatory intestinal diseases designated by a summary term: Inflammatory Bowel Disease. These diseases belong to the group of so-called lifestyle diseases. Their cause is not totally clear but, without any doubt, it has to do with changes in our eating habits that have been apparent in the last one hundred years. These diseases typically affect mostly young persons between 20 and 30 years of age.
Both diseases were discovered in the first half of the last century. Crohn’s disease got its name after the American gastroenterologist B. C. Crohn, who first described it in 1932 and distinguished it from intestinal tuberculosis. Ulcerative colitis was recognized a bit earlier, it was first mention in the medical sources shortly before World War I.
The incidence of both diseases has been on the rise during the last thirty years, and it is estimated that they affect about 0.5% of population in economically developed countries of the world. We can assume that there are about 50.000 of such patients in the Czech Republic. Recently, the first clinical displays of these diseases have shifted down to younger age brackets, and it is not an exception if they are diagnosed even in children.
Ulcerative colitis displays itself by bleeding during stools, painful stools and in some cases by diarrhea with blood.
Crohn’s disease displays itself in many different ways, primarily by abdominal pain, loss of weight, diarrhea and fevers. Apart from intestines, both diseases affect also skin, joints and eyes. The treatment of both diseases is done with medicaments, in some cases it is surgical. The share of surgical treatment is different in both diseases. About 10-15% of patients with ulcerative colitis will need surgical treatment, while as much as 80% of patients with Crohn’s disease are operated on during their lives.
Neither of these diseases can be treated by medicaments definitively, fortunately, they can be treated very well. Present therapy by medicaments makes it possible for most patients to live normal lives without any major limitations. In moderate forms of these disease aminosalicylics are used, in more severe forms corticoids and immunosuppressants are utilized. Recently, a new therapy has been introduced – so-called biological treatment. Medicaments are administered that block the development of an inflammatory reaction during intestinal inflammations and lead to fast pacification of inflammation and decline of the complaints.
Infliximab is the first representative of biological preparations that has been used to treat the Crohn’s disease since 1999. This is a very effective therapy with a positive response (similarly to corticoids) in 90% of patients who use it. The preparation is administered in our out-patients room in the form of 2-hour intravenous infusion. In most patients, inductive (offensive) treatment is administered that includes three infusions in the regimen 0, 2nd and 6th week followed by a maintenance infusion therapy once after two months. Exceptionally, it is possible to administer the inductive phase only and then continue the therapy with immunosuppressants. Infliximab has been found to lead to a better clinical state, it lowers the need for surgery and improves the quality of life in a significant way. This type of treatment (in contrast to corticoids) has been found to lead to healing of a mucous membrane in the intestine. At present, a new generation of biological therapy is available, as well – Adalimumab. This preparation is administered by subcutaneous injection once in two weeks. This is a completely human anti-body. The effectivity of both preparations is comparable. Adalimumab has been approved for the Crohn’s disease in USA and Europe since 2007.
Infliximab is used since the beginning of Crohn’s disease and starting from 2006 also for diseases with ulcerative colitis. In 2007 an indication was approved for children with both diseases.
Biological preparations should be administered at a workplace with sufficient experience with both diseases and this type of medicine. At the beginning, the first thing is to know the extent and localization of the disease. Especially needed is detailed knowledge of the location of fistulas and exclusion of abscesses in the abdominal cavity and in the lesser pelvis.
Clinical and research centre for intestinal inflammation is a workplace of the clinical centre ISCARE Lighthouse, that focuses on diagnosing and treating patients with Crohn’s disease and ulcerative colitis. Besides these clinical activities, there are also intense research activities aimed at uncovering the causes and chronic behavior of intestinal inflammations, together with new possibilities of medicament treatment of these diseases. The Centre has a close co-operation with the 1st Medical Faculty of the Charles’ University in Prague, and it also takes part in solving several international European projects in co-operation with the universities in Barcelona, Regensburg and Nottingham. The Centre also took an active part in projects organizes by the European Community for Crohn’s Disease and Ulcerative Colitis (ECCO).
Besides a complex treatment of patients with inflammatory bowel diseases we also perform some specialist endoscopic procedures. These are especially curative procedures in the digestive tube – dilatation of stenoses, polypectomy and excision of mucous membrane and therapy of Zenker's diverticulum. Our workplace is equipped with the most modern endoscopic devices, including a single-balloon enteroscope.
Most of the diagnostic and treatment procedures are done in our clinical centre ISCARE Lighthouse in our Out-patient Ward. In case of more complex procedures it is possible for the patients to be hospitalized (usually till the next day) in our Patients Ward. Clinical centre ISCARE uses its own Patients Ward with 29 beds, right at the Lighthouse building. In case of more severe problems, the patients with Crohn’s disease and ulcerative colitis, as well as patients after special treatment and endoscopic procedures, a possibility to turn to this workplace anytime, 24 hours a day. You will be looked after to your complete satisfaction by a highly professional personelled by the Head Physician, Prof. MUDr. MilanLukáš, CSc.