23.1
Trastornos intestinales crónicos: Introducción
Las enfermedades intestinales crónicas son un grupo de afecciones a largo plazo que afectan el tracto digestivo y se caracterizan por la inflamación y…
Los trastornos intestinales crónicos son afecciones médicas a largo plazo que afectan el tracto digestivo, incluidos trastornos como el síndrome del intestino irritable o SII y la enfermedad inflamatoria intestinal o EII.
El síndrome del intestino irritable implica dolor abdominal crónico y hábitos intestinales alterados.
Se manifiesta como SII-C con predominio de estreñimiento con frecuencia de deposiciones reducida o como SII-D con predominio de diarrea caracterizado por molestias abdominales recurrentes y heces blandas frecuentes.
LaEII implica una inflamación intestinal crónica recurrente debido a los ataques inmunitarios de un sistema inmunitario que responde en exceso a las bacterias residentes en el intestino.
Esto desencadena diarrea, dolor abdominal y sangrado intestinal. Los principales subtipos de EII son la colitis ulcerosa y la enfermedad de Crohn.
La colitis ulcerosa afecta predominantemente al recto y al colon con inflamación continua de la capa mucosa rectal.
Por el contrario, la enfermedad de Crohn afecta a todo el tracto digestivo, siendo el íleon terminal el más comúnmente afectado. Causa inflamación transmural discontinua en todo el tracto gastrointestinal, lo que conduce a fibrosis, estenosis o fístula.
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Q1: What is the difference between IBS-C and IBS-D?
IBS-C, or constipation-predominant IBS, is characterized by reduced bowel movement frequency. IBS-D, or diarrhea-predominant IBS, involves recurrent abdominal discomfort and frequent loose stools. Both manifest chronic abdominal pain but differ in bowel habit patterns and require distinct treatment approaches for symptom management.
Q2: How does ulcerative colitis differ from Crohn's disease in terms of inflammation?
Ulcerative colitis causes continuous mucosal inflammation limited to the rectum and colon. Crohn's disease features discontinuous transmural inflammation affecting the entire digestive tract, with the terminal ileum most commonly involved. Transmural inflammation in Crohn's damages all intestinal layers, potentially causing fibrosis, strictures, or fistulas.
Q3: What role does the immune system play in inflammatory bowel disease?
IBD involves an abnormal immune response to gut microbiota in genetically predisposed individuals. Ulcerative colitis exhibits TH2 and TH17-mediated inflammation with lymphocytic and neutrophilic infiltrates. Crohn's disease shows TH1-mediated inflammation with elevated IL-12, IL-23, IFN-γ, and TNF-α levels, causing macrophage and lymphocyte infiltration.
Q4: Why do psychological factors influence IBS symptoms?
IBS pathophysiology involves visceral motor and sensory dysfunction linked to the gut-brain axis, connecting gastrointestinal function with mood and stress. Heightened visceral sensitivity in IBS responds to both normal physiological stimuli and harmful stimuli, with psychological stress amplifying symptom severity. This complex interplay requires dietary, stress management, and drug therapy.
Q5: What complications can develop from chronic inflammatory bowel disease?
IBD can lead to extraintestinal manifestations involving joints, skin, or eyes, and increases colorectal cancer risk. Crohn's disease may develop fibrosis, strictures, or fistulas from transmural inflammation. Ulcerative colitis can rarely progress to primary sclerosing cholangitis, causing inflammation and fibrostenosis of the biliary tree.
Q6: What are the primary treatment goals for inflammatory bowel disease?
Medical treatment for IBD aims to suppress the inflammatory response, achieve mucosal healing, and maintain remission. Specific complications such as fistulas require targeted intervention. Treatment strategies vary based on disease subtype and severity, with drugs for treatment of Crohn's disease in IBD using biologic agents anti TNF and other approaches available.
Q7: How does IBS pathophysiology differ from IBD pathophysiology?
IBS involves visceral motor and sensory dysfunction with heightened sensitivity to normal and harmful stimuli, often linked to mood disorders and the gut-brain axis. IBD involves chronic intestinal inflammation from immune attacks on gut bacteria, causing structural damage. IBS lacks the immune-mediated inflammation and tissue damage characteristic of IBD.