Le malattie infiammatorie croniche intestinali: aspetti clinici

Abstract

Inflammatory bowel diseases (IBD) are chronic diseases of the gastrointestinal tract that have been steadily increasing in recent years, particularly in pediatric age. The clinical manifestations of IBD differ according to the forms (Crohn’s m., ulcerative rectocolitis, undifferentiated colitis), and can be distinguished into intestinal and extra-intestinal. The laboratory contributes at various levels in the diagnosis of IBD, from the use of inflammation markers, to the most commonly used serologic markers (ASCA and p-ANCA), to fecal markers (calprotectin). Ultrasonography of the bowel loops is the most recommended noninvasive instrumental investigation to date because of its noninvasiveness, safety, and low cost. The major limitation of ultrasonography is operator-dependent variability, although recently, the use of new technique, SICUS (small intestine contrast ultrasonography), has been shown to greatly improve the sensitivity of the examination and reduce inter-operator variability. Endoscopic investigation coupled with histologic analysis of biopsy specimens is, to date, the gold standard for making a diagnosis of IBD, playing a key role in the diagnosis and therapy of these conditions. The primary goals of pediatric IBD therapy are to induce and maintain a sustained remission with prevention of clinical relapse, optimize growth and pubertal development, and improve the patient’s quality of life. The importance of the genetic and epigenetic component in the phenotypic expression of IBD is increasingly widely demonstrated. These aspects will be the subject of a forthcoming contribution.