Vitamins And Minerals you shouldn’t miss in your treatment

Inflammatory Bowel Disease (IBD) —which includes Crohn’s disease and ulcerative colitis— does not only affect the intestine: it can also have a major impact on the absorption of essential nutrients.

Intestinal inflammation, surgeries, restrictive diets, or certain medications can lead to vitamin and mineral deficiencies, that affect the patient’s overall well-being, energy levels, and quality of life.

Among these we highlight:

Essential Vitamins

VITAMIN B12: energy, nervous system, and red blood cells

Vitamin B12 is vital for red blood cell formation and for maintaining a healthy nervous system.It is absorbed in the terminal ileum, so patients with Crohn’s disease affecting this area or who have undergone ileal resection may develop significant deficiencies.

Recent studies show that 33–40 % of patients with ileal Crohn’s disease may develop B12 deficiency if not adequately supplemented.

Common symptoms of vitamin B12 deficiency:

• fatigue, paleness, tingling in hands or feet, difficulty concentrating.

Recommendation:

• monitor B12 levels regularly and
• supplement orally, sublingually, or intramuscularly depending on severity.
  

VITAMIN D: strong bones and inflammation control

Vitamin D regulates calcium metabolism, strengthens bones, and also has immunomodulatory effects.

In IBD, deficiency is common due to reduced intestinal absorption, reduced sun exposure and prolonged corticosteroid use

Consequences of vitamin D deficiency: possible osteopenia, osteoporosis, and —according to emerging evidence— increased intestinal inflammation.

A study in Gastroenterology showed that correcting vitamin D deficiency improves intestinal function and may reduce relapse risk.

Recommendation:

• Determine serum levels (25(OH)D) periodically.
• Maintain values above 30 ng/mL using vitamin D₃ supplements if needed, and
• Combine with calcium when bone risk is present.

VITAMINS A, E, and K: vision, immune system, and blood coagulation

These fat-soluble vitamins rely on proper fat absorption. Deficiencies are common in patients with chronic diarrhoea or malabsorption (due to inflammation or intestinal resection).

• Vitamin A: essential for vision and mucosal integrity.
• Vitamin E: antioxidant and neuroprotective.
• Vitamin K: involved in blood clotting.

Recommendation:

• Test levels of these vitamins in patients with active IBD or significant weight loss.
• Supplement under medical supervision if deficiency is confirmed.
  

Essential Minerals That Make a Difference

IRON

Iron deficiency is one of the most common complications in IBD, especially in ulcerative colitis, due to losses from bleeding and malabsorption.

Symptoms:

• fatigue, paleness, tachycardia, shortness of breath.

Recommended treatment:

• Oral iron may cause gastrointestinal discomfort; many patients benefit from intravenous (IV) iron, which is more effective and better tolerated. Always under medical supervision, adjusting doses according to ferritin and hemoglobin levels. ECCO Guidelines (2015) recommend IV iron when ferritin < 30 μg/L or in moderate–severe anaemia.

CALCIUM

Calcium is crucial for bones, muscles, and nerve transmission, and works hand-in-hand with vitamin D.Patients taking corticosteroids have a higher risk of osteoporosis.

Advice: 

• Ensure a daily intake of 1000–1200 mg through dairy products, green vegetables, or supplements;
• Combine with vitamin D to enhance absorption.

ZINC

Zinc plays a role in healing, immunity, and tissue repair.Frequent diarrhea and intestinal inflammation reduce its absorption, leading to deficiency.

Consequences:

• hair loss, delayed healing, increased susceptibility to infection.

Studies in Clinical Nutrition show that zinc supplementation can improve intestinal permeability and reduce inflammation in IBD.

Recommendation:

• Monitor serum zinc levels and supplement if necessary (8–11 mg/day in adults, under medical supervision).
  

Some General Practical Advice

1. Have regular blood tests to detect vitamin and mineral deficiencies.
2. Follow a varied and balanced diet adapted by a dietitian specialized in IBD; and if this is restrictive, combine it with supplements.
3. Take advantage of remission periods to improve your nutritional status.
4. Avoid self-medication — excessive vitamins can be harmful.
5. Talk to your doctor before taking supplements: each patient has different needs, and supplements should be personalized.

Conclusion

Nutrition is an essential part of IBD management. Caring for your gut means caring for every cell in your body. IBD treatment is not only about medication but also about knowledge, prevention, and smart nutrition.

Detecting and correcting vitamin and mineral deficiencies early on can make the difference between a patient with fatigue, frequent flares, and bone loss, and one with energy, immune balance, and a better quality of life.

References:

1. Dignass, A. U., et al. (2015). European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases. Journal of Crohn’s and Colitis, 9(3), 211–222.
2. Pappa, H. M., et al. (2019). Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics, 118(5), 1950–1961. https://doi.org/10.1542/peds.2006-0904
3. Battat, R., et al. (2014). Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management. Inflammatory Bowel Diseases, 20(6), 1120–1128.
4. Yasuda, T., et al. (2021). Zinc supplementation modulates intestinal barrier function in inflammatory bowel disease. Clinical Nutrition, 40(10), 5487–5495.
5. Crohn’s & Colitis Foundation. (2023). Diet and Nutrition: Supplementation. Disponible en: crohnscolitisfoundation.org.
6. ECCO Guidelines. (2023). Nutrition in Inflammatory Bowel Disease. J Crohn’s Colitis, 17(1), 27–42.
7. Martínez de Haro, L., et al. (2021). Nutrición en la Enfermedad Inflamatoria Intestinal. Saludigestivo. Recuperado de

https://www.saludigestivo.es/wp-content/uploads/2021/09/mes-saludigestivo-nutricion-EII-mi n.pdf

Crohn’s & Colitis Foundation. (s.f.). Nutrition and Ulcerative Colitis (Spanish). Recuperado de https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/Diet-Nutrition-S panish.pdf

Imbalances in the intestinal flora have been linked to autoimmune diseases such as Crohn’s disease, multiple sclerosis, obesity, and heart disease.

The gut flora is a collection of bacteria known as microbiota. They are found in our intestines and play a crucial role in our digestion, as they break down the food we eat into smaller particles that are easier to digest and absorb, as well as being involved in the production of vitamins necessary for health.

Up to 2,000 different species of bacteria can be found in our digestive system, most of which are beneficial. However, around 100 species could represent a risk.

It is sometimes difficult to identify if something is wrong with our gut flora, but there are several symptoms that indicate if it is damaged.

 Symptoms of damaged intestinal flora.

Intestinal flora can be damaged in many ways, including consumption of antibiotics, intake of too much saturated fat, toxins such as tobacco, lack of nutrients, foods with too much added sugar, spoiled foods, etc.

The most common symptoms of damaged intestinal flora are:

• – Abdominal bloating without cause and with the presence of gas.
• – Alternating periods of constipation and diarrhoea.
• – Intestinal cramps, abdominal pain and discomfort in the stomach.
• – Stools and gas with an increased foul odour.
• – Increased infections and illnesses.

When the intestinal flora is damaged, an imbalance between beneficial and harmful bacteria occurs. This imbalance between the microorganisms that make up the microbiota is known as dysbiosis. Dysbiosis causes inflammation and increased permeability of the intestinal barrier, which affects the immune system.

 
Foods for good gut health

A balanced diet is the basis for the proper formation and restoration of the microbiome or gut flora. It is crucial to maintain a varied diet that includes fruits, vegetables, legumes, and seeds. Foods high in fibre are allies in restoring and maintaining a healthy microbiota.

To restore the gut quickly, it is necessary to modify eating habits and diet.

The first thing you should do is:

• eliminate processed foods as they can quickly decrease the amount of beneficial bacteria in the gut.
• limit your intake of red meat, sugars, saturated fats, dairy products, pre-cooked, frozen and canned foods.
• It is also recommended to avoid alcohol, smoking and artificial sweeteners.

You can also use natural probiotics and consume prebiotic foods to achieve this.

Prebiotic foods act as food for beneficial bacteria, promoting their growth and development and thus increasing their presence in the colon (e.g. lactobacilli and bifidobacteria).

Foods rich in prebiotics include:

• – bananas,
• – artichokes,
• – tomatoes,
• – whole wheat,
• – onions,
• – leeks
•  -Oats and barley
• -Apples
• -Legumes (lentils, chickpeas)

Natural probiotics are living organisms (bacteria and yeasts) with anti-inflammatory and antioxidant properties that help repopulate the intestinal flora and strengthen beneficial bacteria, improving digestive health and helping to prevent intestinal inflammation. They are usually found in foods that have undergone a natural fermentation process.

Foods rich in probiotics include:

• – Yoghurt.
• – Kefir.
• – Kombucha.
• – Sauerkraut.
• – Pickles.
• – Miso.
• – Tempeh.
• – Kimchi.
• – Sourdough bread.
•  Some cheese. made with raw, unpasteurized milk.
  

 
Animals, your gut flora’s best friends

Our immune system and microbiome need to be exposed to multiple bacteria, viruses and fungi to strengthen themselves, so spending a lot of time at home reduces or eliminates our contact with important microorganisms that our body needs. This is where animals play an important role.

Living with domestic animals or pets could have a beneficial effect by promoting greater microbial diversity and a more tolerant immune response, with potential immunological benefits at different stages of life.

Studies published in scientific journals show that pet owners have a more diverse microbiota compared to those who do not have animals at home and have a lower risk of developing IBD. Having pets increases the amount of beneficial bacteria, thus reducing the risk of developing allergies, asthma, atopy and obesity.

If your dog comes home covered in dirt and mud after a walk, don’t be alarmed, as it is bringing with it a plethora of microbes that strengthen our immune system from an early age onwards.

These are very recent studies, but some scientists already suspect that exposure to animal bacteria may influence the way our gut bacteria metabolize the neurotransmitters that regulate mood. In other words, spending time with animals has an antidepressant effect and also reduces stress and anxiety.

4. Conclusion

The more we study the human gut microbiome, the more evident it becomes that a healthy gut needs nature. It doesn’t matter whether it’s through the food we eat, our outdoor activities or our relationship with animals. Life in large cities or urban environments, which is the norm for the vast majority of people today, has a significant impact on our gut health: the stress that many people are under is linked to poor digestive health and inflammation.

The best thing is to learn from the past. For example, in prehistoric times, our ancestors ate soil as a supplement, as it was rich in minerals and trace elements and was taken as a detoxifying agent. It is true that today it is not necessary to do this, but it is advisable to get out into nature more, spend more time with your dog or other animals and, from time to time, get dirty in a puddle.

References:

• Fermented foods and gut health: what science is uncovering
• Mukherjee, A., Breselge, S., Dimidi, E. et al. Fermented foods and gastrointestinal health: underlying mechanisms. Nat Rev Gastroenterol Hepatol 21, 248–266 (2024). https://doi.org/10.1038/s41575-023-00869-x
• Maftei, N.-M.; Raileanu, C.R.; Balta, A.A.; Ambrose, L.; Boev, M.; Marin, D.B.; Lisa, E.L. The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties. Microorganisms 2024, 12, 234. https://doi.org/10.3390/microorganisms12020234
• Valentino V, Magliulo R, Farsi D, Cotter PD, O’Sullivan O, Ercolini D, De Filippis F. Fermented foods, their microbiome and its potential in boosting human health. Microb Biotechnol. 2024 Feb;17(2):e14428. doi: 10.1111/1751-7915.14428. PMID: 38393607; PMCID: PMC10886436

A high percentage of patients diagnosed with inflammatory bowel disease (IBD) are of childbearing age, as these diagnoses usually occur between the ages of 15 and 35. Therefore, there is a need for the doctor to assess whether the disease or treatment may influence pregnancy and vice versa: how pregnancy may affect IBD.

Below are some issues that patients with IBD should consider during pregnancy and breastfeeding:

1. Can I get pregnant?

In general, patients with IBD have the same fertility rates as the rest of the population, especially if the disease is inactive or in remission. However, there are some factors that reduce fertility, such as intestinal surgery or decreased libido.

In any case, it is important to plan your pregnancy when the disease is in remission in order to reduce obstetric complications such as low birth weight. It is also advisable to have a consultation prior to conception in order to address any potential risk factors on an individual basis and to advise the patient on the necessary vitamins and supplements.

2. What should I do when my pregnancy is confirmed?

The first thing the patient should do when she finds out she is pregnant is to contact her doctor and midwife, as well as the IBD unit, in order to schedule visits to the gynaecologist and gastroenterologist during pregnancy. This follow-up should be coordinated by both specialists, and under no circumstances should the medication be suspended or modified on her own.

3. Can IBD affect my pregnancy?

When the disease is in remission, there is no evidence to suggest increased obstetric risks such as a higher risk of miscarriage, fetal death or congenital malformations. Only in a third of cases does a flare-up of the disease usually occur, normally in the first trimester of pregnancy.

However, in patients with active inflammatory bowel disease during pregnancy, there has been evidence of increased premature births, fetal growth retardation and low birth weight.

Surgery for complications associated with IBD (e.g. fistulas, abscesses, intestinal obstruction, etc.) increases the risk of premature birth and miscarriage. Despite this, if doctors suggest this option, it is because the benefits are significant.

4. Does pregnancy affect IBD activity?

The progression of IBD during pregnancy is more closely related to the state of the disease at the time of conception. This means that if conception occurred while the disease was in remission, the pregnancy will proceed normally, although there is a possibility of a flare-up in the first trimester.

If, on the other hand, if conception took place at a time when IBD was active, it will be more difficult to control. 70% of women continue to experience or worsen their symptoms during pregnancy, thus increasing possible complications for both the mother and the baby. Hence the importance of planning conception during a period of remission of the disease.

5. Can I take my IBD treatment if I want to become pregnant, am pregnant or want to breastfeed?

In most cases, IBD treatments can be continued during pregnancy and breastfeeding because they are safe. In fact, it is not the treatment that poses the greatest risk to pregnancy, but rather the active disease. That is why it is important to inform your IBD specialist before trying to conceive so that they can review your treatment, ensure that the disease is under control, and assess whether your medication needs to be adjusted. The goal will always be to maintain remission of IBD with the safest regimen for you and your baby.

During pregnancy, you should avoid stopping your medication without consulting your doctor, due to the risk of a new flare-up.

So, in general, it is safer to continue treatment than to interrupt it

In summary, most treatments can be continued, and in the few cases where this is not possible, there are safe alternatives.Planning, medical support and disease control are the keys to a peaceful and complication-free pregnancy, both for you and your baby.

6. Necessary check-ups during pregnancy

During pregnancy, general pregnancy check-ups will be carried out:

• one visit per month to the midwife until week 28, at which point these check-ups will become more frequent, depending on the progress of the pregnancy and the IBD. It is common for vitamin supplements such as folic acid, iron and vitamin D to be recommended during the pre-conception consultation.
• The first visit to the gynecologist should take place before week 12 of pregnancy, at which point an ultrasound scan will be performed. In the case of patients with IBD, it is necessary to correctly date the week of pregnancy.
• After week 20, check-ups are carried out every 4 weeks to assess fetal growth, especially in women with active disease or undergoing treatment with corticosteroids.
• As for the gastroenterologist, the consultation should be made as soon as possible in case the medication needs to be adjusted or modified. Subsequent visits will depend on the severity of the disease and whether it is in the active phase or in remission.

Maintain the hygiene and dietary measures recommended for any pregnant woman (avoid alcohol and tobacco, engage in regular physical activity whenever possible, and get plenty of rest…).

In case of complications with IBD, your doctor will recommend endoscopies or imaging tests, always attempting to perform them after the second trimester.

7. Can I have a vaginal delivery?

As with any other delivery, whether it is vaginal or by caesarean section depends on the obstetric conditions of each woman.

However, some patients with active perianal disease or activity in the rectum, in Crohn’s disease (due to the risk of damage to the perineal area); or ileo-rectal anastomosis or in patients with ileo-anal reservoir (due to the likelihood of developing or worsening incontinence problems after delivery), an elective caesarean section should be considered in each individual case.

In women with an ileostomy or colostomy, vaginal delivery is not contraindicated, as it is not associated with an increase in complications. It is also advisable not to perform an episiotomy due to the risk of perianal involvement.

8. Is there a risk of transmitting the disease?

The causes of inflammatory bowel disease are not fully understood. The current hypothesis is that IBD develops in genetically predisposed individuals, where environmental factors interact with the gut microbiota and the immune system.

That said, the risk of developing IBD is higher for those with a family history of the disease. In Crohn’s disease, for example, if one parent suffers from it, the risk of transmission to their offspring is 5%. In ulcerative colitis, the risk is 2%, and if both parents suffer from one of these two conditions, the possibility of transmission increases to 30%.

9. Can I breastfeed?

Breastfeeding is recommended in all pregnancies because of the benefits it brings to both the mother and the newborn. Furthermore, there is no evidence to suggest that breastfeeding has a negative effect on IBD, provided that the disease is under control and the treatment is compatible (as is the case in most instances). In the case of the newborn, breast milk promotes beneficial intestinal microbiota, with regard to the risks associated with the mother’s IBD treatment, the dose can be adjusted to avoid any impact on the baby.

Medications used during pregnancy are also safe during breastfeeding, as the doses of medication that reach the fetus through the placenta are higher than those that reach it through breast milk.

It should be noted that if the mother has received biological treatment (except certolizumab) during the third trimester of pregnancy (i.e. from week 27 of gestation onwards), it is recommended to avoid administering vaccines with live attenuated microorganisms during the first 6 months of the baby’s life (usually the oral rotavirus vaccine). However, other vaccines with live attenuated viruses, such as the MMR (measles, mumps and rubella) or chickenpox vaccines, which are administered around the first year of life, can be given as normal.

In any case, mothers with IBD who wish to breastfeed their babies should follow the general recommendations for nutrition:

• Caloric intake should be 450 to 500 additional kcal per day.
• Add 200 to 300 mg of omega-3 fatty acids.
• Hydration is very important, which can be difficult for mothers with IBD, especially those with an ostomy or active disease. If this is the case, the mother should receive nutritional advice.

References

• Brondfield, M.N., Mahadevan, U. Inflammatory bowel disease in pregnancy and breastfeeding. Nat Rev Gastroenterol Hepatol 20, 504–523 (2023). https://doi.org/10.1038/s41575-023-00758-3 /
• Pregnancy and birth. Crohn’s & Colitis UK Pregnancy and birth with Crohn’s Disease or Ulcerative Colitis (IBD)

The gut microbiota is an organ that, until now, has been ignored but is vital to our physical and mental health.

This group of microorganisms, mainly bacteria, viruses and fungi, live in our digestive tract and their functions are key in our body. It is an organ that we do not see or feel directly, but its balance, or lack of it, can influence everything from digestion and the immune system to mood, weight and risk of chronic disease.

1. What is the microbiota?

The gut microbiota is an ecosystem made up of all the microorganisms in the gut, especially in the colon. It is estimated that there are more than 40 trillion bacteria in our body, which can weigh between 1 and 2 kilos. We have more bacteria in our body than cells (30 trillion), most of them beneficial.

In general, beneficial or ‘good’ bacteria multiply frequently, leaving little room for harmful or ‘bad’ bacteria. Without the gut microbiota it would be very difficult to survive, because of the number of key functions they perform for the body.

Each person has a different composition of microbiota, which is formed from birth and is altered by our diet, lifestyle, the use of drugs and other environmental factors.

2. What happens if there is an imbalance?

When the so-called good bacteria decrease and the bad bacteria increase, dysbiosis occurs.

This complication is linked to a number of diseases such as:

• Inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis.
• Irritable bowel syndrome (IBS).
• Obesity.
• Type 2 diabetes.
• Cardiovascular disorders.
• Depression and anxiety.

One example is the production of the substance TMAO (trimethylalanine-N-oxide), produced by certain micro-organisms when red meat or eggs are eaten. Excess of this substance can affect the accumulation of cholesterol in the arteries, thus increasing the risk of heart attack and chronic kidney disease.

3. How close are the gut and the brain?

It may seem that, because they have different functions, the gut and the brain have no relationship beyond the transmission of commands and information, but this is not the case. Both organs are linked by millions of neurons through the gut-brain axis.

The microbiota, in addition to digestion, also influences the production of neurotransmitters such as dopamine and serotonin, which are vital for regulating mood and sleep. In fact, up to 90% of serotonin is produced in the gut.

There is also believed to be a connection between the gut and memory and cognitive skills, hence the name ‘second brain’.

Research has found differences in the microbiota of people with anxiety, depression, chronic pain or autism compared to mentally healthy people. In addition, some probiotics may be beneficial in reducing mild depressive symptoms.

4. The relationship between the microbiota and the immune system

The immune system and microbiota are in constant communication. A healthy microbiota not only reinforces the intestinal barrier but also educates the immune system to act correctly.

In the case of dysbiosis, uncontrolled inflammations can occur, such as those that occur in autoimmune diseases. An imbalanced microbiota produces gas and chemicals that contribute to intestinal discomfort but can also increase the risk of leaky gut, allowing toxins into the bloodstream and triggering systemic inflammation.

5. Food and probiotics to improve microbiota

There are natural (and effective) ways to restore the balance of gut bacteria:

• With a diet rich in fiber: dominated by legumes, fruits, vegetables, oats and seeds, which feed the ‘good’ bacteria; and fermentable fiber, which produces fatty acids that protect the intestinal mucosa, prevent weight gain, diabetes and the risk of heart disease or cancer.
• Fermented foods: kefir, yoghurt, miso, kimchi, etc. provide natural probiotics.
• Prebiotics: the food of probiotics found in garlic, onions, bananas, leeks, asparagus, artichokes, soya, whole wheat and, in general, whole grains.
• Symbiotics: a combination of probiotics and prebiotics.
• Eat diets rich in plants and/or polyphenols.
• Reduce stress and get plenty of sleep.
• Moderate physical exercise.
• Take drugs such as antibiotics, proton pump inhibitors or anti-inflammatory drugs only when necessary.

Probiotics are supplements with live ‘good’ bacteria. Not all work the same, but most have been shown to be beneficial in improving irritable bowel symptoms, reducing intestinal inflammation, strengthening the immune system (including alleviating allergy or lactose intolerance symptoms) and preventing diarrhoea after antibiotic use. As everyone’s microbiota is different, its effect is not the same for everyone.

In short, to improve our energy, our immune system, our skin… it is important to listen to our gut.

References:

• Clemente, J. C., Ursell, L. K., Parfrey, L. W., & Knight, R. (2012). The impact of the gut microbiota on human health: an integrative view. Cell, 148(6), 1258–1270. https://doi.org/10.1016/j.cell.2012.01.035
• Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. Biochemical Journal, 474(11), 1823–1836. https://doi.org/10.1042/BCJ20160510
• Carding, S., Verbeke, K., Vipond, D. T., Corfe, B. M., & Owen, L. J. (2015). Dysbiosis of the gut microbiota in disease. Microbial Ecology in Health and Disease, 26(1), 26191. https://doi.org/10.3402/mehd.v26.26191
• Cryan, J. F., et al. (2019). The microbiota-gut-brain axis. Physiological Reviews, 99(4), 1877–2013. https://doi.org/10.1152/physrev.00018.2018
• Valdes, A. M., Walter, J., Segal, E., & Spector, T. D. (2018). Role of the gut microbiota in nutrition and health. BMJ, 361, k2179. https://doi.org/10.1136/bmj.k2179
• Arboleya S, et al. Gut Bifidobacteria Populations in Human Health and Aging. Front Microbiol. 2016 Aug 19;7:1204.
• O’Mahony SM, et al. Serotonin, tryptophan metabolism and the brain-gut-microbiome axis. Behav Brain Res. 2015 Jan 15;277:32-48.
• Cardona F, et al. Benefits of polyphenols on gut microbiota and implications in human health. J Nutr Biochem. 2013 Aug;24(8):1415-22.

Sexuality is a central aspect of being human as it encompasses not only sex, but also gender identities and roles, eroticism, pleasure, intimacy, reproduction and sexual orientation.

Inflammatory Bowel Disease (IBD) often impairs the sexual function of patients suffering from IBD. This means their sexual health. Sexual health is understood as a state of physical, mental and social well-being in relation to sexuality. All chronic diseases can cause disturbances in sexual health; it is not a problem unique to IBD.

Some studies indicate that IBD affects sexuality in the following ways.

– In 50% of patients there is a decrease in libido.

– In 45% it prevents them from continuing intimate relationships.

– 50% of women and 33% of men report a worsening of sexual activity.

– 75% of women and 51% of men see changes in their body image. This is also more prevalent in patients who have had surgery (81%) versus non-surgical patients (51%).

– 67% of patients in active IBD and 19% in remission choose abstinence.

Despite these data, only 20% of physicians (according to patients) address body image and sexuality issues in consultation with their IBD patients, with patients themselves proactively raising the issue.

Both health professionals and patients do not feel comfortable talking about sexuality, as it is a taboo subject because it belongs to the ‘intimate life’ of the patient. However, it is very important to do a communication exercise, rejecting stereotypes related to sexuality, broadening knowledge about the impact of IBD on the sexual life of IBD patients and training communication strategies and skills.

Factors that may affect the sex life of patients with IBD

PHYSICAL FACTORS

The active presence of the disease, i.e. flares, is one of the key factors affecting sex life. Fatigue, abdominal pain or diarrhoea are common factors affecting general health and the desire and enjoyment of sexual activity.

In diseases such as Crohn’s disease or perianal conditions (such as fistulas or fissures), they can cause pain.

Body image also plays an important role, as IBD patients may experience alterations in body perception due to scarring, weight changes or the side effects of treatments. All this creates anxiety, embarrassment and lowers the patient’s self-esteem.

A possible solution would be to surround oneself with a good support network, practice self-care and focus on one’s positive qualities.

PSYCHOLOGICAL FACTORS

In patients with IBD, depression, anxiety and low self-esteem are the most common factors that have a major impact on sexual function.

Between 60-80% of patients experience episodes of anxiety and/or depression during flares, and 29-35% in periods of remission.

The solution is to identify negative thoughts and replace them with positive thoughts to help combat these moods. If the symptoms are severe and prolonged, it is advisable to seek professional help from a psychologist.

 Can medication affect my sex life?

25% of erectile dysfunction cases are associated with medecine use.

Yes, drugs used to treat IBD can have adverse effects that affect sexual function.

Corticosteroids are a good example, causing mood swings, weight gain and cosmetic changes that affect body image and thus sexuality.

Sulphasalazine (salicylates or 5-ASA) can affect male fertility, but this effect is reversible when the drug is stopped.

Decreased libido induced by antidepressants, beta-blockers, opiate analgesics, depressive syndrome and/or anxiety.

Despite this, the improvement in IBD symptoms due to treatment often has a positive impact on sexual function by counteracting the above

Surgery and ostomies and their effects on sex life

Although surgery improves a patient’s health, due to remission of flare-ups and elimination of complications such as abscesses and fistulas, it can alter the patient’s body image and, consequently, self-esteem.  

Removal of the rectum can very rarely affect the pelvic nerves, which may cause erectile dysfunction in men or lubrication problems and dyspareunia (painful intercourse) in women.

In the case of an ostomy, patients may face difficulties with self-esteem and, above all, concerns about leakage of faecal material during intercourse. To minimize these concerns, it is advisable to empty the ostomy pouch before sexual intercourse.

The key in both cases, surgery and ostomy, is communication with the doctor and with the partner, considering, for example, the use of special underwear or girdles to hide the stoma if that is what the patient needs.

You might find it helpful to connect with other patients who have undergone similar procedures and their experiences with sexual activity after recovery.

IBD sexuality and adolescence

 Adolescence is a phase in the evolutionary cycle of our lives in which self-concept and personal identity develop. It is often a time of fragility and emotional disturbances which, if accompanied by a diagnosis of IBD, can have a significant impact on self-esteem.

Some of the difficulties that adolescents may encounter are:

• problems in initiating new friendships, more aware of the problems and consequences of IBD,
• fear of rejection or compromising situations,
• changes in body image…

Talking to people you trust (friends), carrying a change of clothes and learning to manage your activities according to the level of energy you have each day can help improve your self-confidence and well-being.

Ultimately, although sexual disturbances associated with IBD are common, sex and sexual relationships are an important part of health, and it is possible to maintain a satisfying sex life with IBD with appropriate treatment and attention to the psychological effects. Open communication, both with partners and medical professionals, is a key factor in resolving and addressing IBD-related sexual problems as early as possible.

References:

• https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/ibdsexuality.pdf
• EducaInflamatoria. (s.f.). Vida sexual. https://educainflamatoria.com/vida-sexual/

With winter behind us and summer approaching, patients with Inflammatory Bowel Disease (IBD) are wondering whether it is a good idea to go out in the sun while taking medication.

It should be borne in mind that most of the vitamin D in our bodies comes from ultraviolet radiation from the sun, followed by the intake of vitamin D-rich foods. In Crohn’s disease, for example, 60-75% of patients are vitamin D deficient. In the case of Ulcerative Colitis, 55% of patients are deficient.

The entire population should always take preventive measures to avoid damage from exposure to the sun, but, in addition, people who are being treated with certain drugs should take into account the characteristics of these drugs, as their properties or effects may be altered.

This is why IBD patients, in particular, should avoid overexposure to the sun, while still achieving appropriate vitamin D levels.

1. Vitamin D and IBD

Vitamin D promotes the absorption of calcium, a mineral that is very important for maintaining healthy bone structure. That’s why adequate sun exposure helps our body to provide itself with the necessary levels of vitamin D. In addition, vitamin D may have beneficial effects on the progression of IBD.

Vitamin D not only regulates calcium metabolism, but also plays a crucial role in the modulation of the immune system with potential beneficial effects on the course of IBD. Through its anti-inflammatory, immunoregulatory and epithelial actions, it helps to control disease activity and improve clinical outcomes.

In IBD, vitamin D plays a number of roles, including:

• Immunoregulation: Vitamin D reduces the activity of pro-inflammatory T cells (Th1 and Th17), and promotes regulatory T cells (Treg), which help maintain immune tolerance in the gut and control inflammation.
• Reduction of inflammatory substances or cytokines: Inhibits the production of TNF-α, IL-6 and IL-17, which are elevated in active IBD flares.
• Strengthening the intestinal barrier: Improves intestinal epithelial integrity by increasing the expression of cell-binding proteins, thus preventing the entry of bacteria and antigens that exacerbate inflammation.

Clinical studies have found that adequate levels of vitamin D are associated with:

• Reduced clinical disease activity.
• Lower relapse rate in patients in remission.
• Reduced need for hospitalisation and surgery.
• Improved patient-reported quality of life.

For example, a randomised clinical trial published in the Journal of Crohn’s and Colitis (2013) showed that vitamin D3 supplementation (up to 5,000 IU/day) in patients with Crohn’s disease helped maintain remission and reduce inflammatory markers.

It is recommended to maintain serum 25(OH)D levels above 30 ng/mL in IBD patients. Therefore, oral supplementation is often necessary, especially in winter or in patients with impaired absorption or low sun exposure.

2. IBD medications and sun exposure

Some studies have suggested that increased sun exposure may be associated with a lower risk of developing Crohn’s disease. In particular, a prospective study in France found that women with higher sun exposure had a significantly lower risk of developing Crohn’s disease, although the same association with ulcerative colitis was not observed.

However, some IBD drugs are photosensitisers. This means that they can produce photosensitivity reactions, resulting in abnormal skin damage caused by the interaction between a photosensitising chemical agent (some drugs) and solar radiation.

Ultraviolet (UV) radiation is highly associated with the development of skin tumours and photosensitivity reactions to drugs. In the case of tumours, radiation accumulates over the course of our lives in what is called the skin memory. The risk of skin tumours increases in patients treated with immunosuppressive drugs, especially those treated with thiopurines.

3. Sun prevention measures.

How to hydrate your skin after sun exposure | Beauty

• Avoid exposure to the sun at peak hours (from 12:00 to 16:00), as this is the time when there is maximum UV radiation.
• Wear clothing to protect yourself from the sun such as hats, T-shirts or sunglasses.
• Avoid the famous tanning booths.
• Apply creams with a very high protection factor (preferably 50+) and with UVA and UVB filters.
• For sunscreens to be effective you should use enough sunscreen to cover the entire surface of the body.

It is important to remember areas such as the ears or scalp.

• Apply the creams on dry skin, as the water droplets have a magnifying effect, thus increasing the risk of burns.
• Apply sunscreen 30 minutes before sun exposure.
• Replenish the sunscreen after each prolonged bath or every two hours.
• Use water-resistant creams and, if bathing for more than 20 minutes, reapply them after bathing.

4. The sun and the little ones

Vitamin D deficiency is common in the paediatric IBD population and is associated with increased disease activity. It is therefore critical to monitor and correct vitamin D levels as part of the comprehensive management of IBD in paediatric patients.

An observational study in children with Crohn’s disease found that approximately 19% were vitamin D deficient and 38% were vitamin D insufficient. This deficiency is attributed to factors such as intestinal malabsorption, chronic inflammation, reduced sun exposure and dietary restrictions associated with the disease.

At the Australian National University, researchers have reported that children who are exposed to the sun for half an hour a day reduce their risk of developing Inflammatory Bowel Disease (IBD) by 20 per cent.

Despite this, we need to be sun-smart and protect ourselves and our children from the sun’s rays with the measures mentioned above.

However, it is worth going outdoors, having a drink on a terrace… but always safely and with photoprotective creams on your body.

References

• Infosalud. (2019, 31 de mayo). Media hora de sol podría disminuir el riesgo de enfermedad inflamatoria intestinal en niños. Infosalus.com. Recuperado de https://www.infosalus.com/salud-investigacion/noticia-media-hora-sol-podria-disminuir-riesgo-enfermedad-inflamatoria-intestinal-ninos-20190531105229.html
• Asociación Española de Enfermos de Crohn y   colitis Ulcerosa (ACCU) / EII LAFE. (s.f.). Tomar el sol y la medicación en la EII. Recuperado de https://eiilafe.com/tomar-sol-medicacion-eii/
• EducaInflamatoria. (s.f.). Actividad física y exposición solar. https://educainflamatoria.com/actividad-fisica-y-exposicion-solar/
• Gisbert, J. P., Chaparro, M., Rodríguez, C., Bermejo, F., Barreiro-de Acosta, M., & Esteve, M. (2019). Exposición solar y enfermedad inflamatoria intestinal: más allá de la vitamina D. Gastroenterología y Hepatología, 42(8), 480–488. https://doi.org/10.1016/j.gastrohep.2019.04.006
• Prévost Jantchou, Francoise Clavel-Chapelon, Antoine Racine, et al., High Residential Sun Exposure Is Associated With a Low Risk of Incident Crohn’s Disease in the Prospective E3N Cohort, Inflammatory Bowel Diseases, Volume 20, Issue 1, 1 January 2014, Pages 75–81
• Raúl Vicente Olmedo-Martín,, Inmaculada González-Moleroc, Gabriel Olveirac, et al: Sunlight exposure in inflammatory bowel disease outpatients: Predictive factors and correlation with serum vitamin D. Gastroenterol. Y Hepatol. 2019 (42) 10: 604-613.
• Durá-Travé, Teodoro, Gallinas-Victoriano, Fidel, Chueca Guindulain, María Jesús, & Berrade-Zubiri, Sara. (2015). Deficiencia de vitamina D en escolares y adolescentes con un estado nutricional normal. Nutrición Hospitalaria, 32(3), 1061-1066.

Due to the systemic nature of inflammation in inflammatory bowel disease (IBD), the disease can affect more than just the gastrointestinal system. These symptoms are known as extraintestinal manifestations (EIM). Up to 50% of patients experience these manifestations, with skin manifestations being the two most common, along with joint and ocular manifestations.

Between 6% and 47% of people with these diseases have been found to have symptoms outside the gut as well: 43% of patients with Crohn’s disease or 31% in those with ulcerative colitis. There may be percentage differences depending on the ethnicity or race of the patients or the geographical area of study.

1 – Eye Manifestations

What eye diseases can occur?

1. Uveitis:
   1. Inflammation of the middle inner part of the eye. 
   2. Can cause pain, redness, sensitivity to light and loss of vision if left untreated.
2. Episcleritis:
   1. Mild, superficial inflammation. 
   2. Causes redness but no visual damage.
3. Scleritis:
   1. Deeper and more painful inflammation that can affect eyesight.
4. Dry eye syndrome:
   1. Lack of tears or rapid evaporation, leading to discomfort and burning.
5. Keratopathy:
   1. Affects the cornea. 
   2. Can cause blurred vision and eye pain.

To prevent these symptoms from occurring or, if they do, to minimize their impact, we should have regular eye check-ups, look out for redness, pain and blurred vision, manage stress and take care of our gut, take supplements such as curcumin and seek help if symptoms occur.

2 – Skin Manifestations

There are several types of skin lesions in IBD:

1. Those directly associated with IBD: Related to chronic inflammation, typical in Crohn’s disease, e.g. erythema nodosum or cutaneous Crohn’s disease.
2. Lesions due to immune dysfunction: occur when the immune system is disturbed: Psoriasis or vitiligo.
3. Lesions secondary to treatment or malnutrition: acne, stretch marks, eczema or increased risk of skin cancer.

The main dermatological manifestations are:

1. Erythema nodosum:
   1. This is the most common, affecting approximately 4% of patients, mainly young women with Crohn’s disease.
   2. These are painful red-violaceous nodules on the legs (thighs, ankles and legs).
   3. They improve with IBD treatment.
2. Pyoderma gangrenosum:
   1. More common in patients with ulcerative colitis, starting as a pustule and developing into a painful ulcer.
   2. Usually appears on the abdomen, thorax and/or legs, arms.
   3. It may appear after a trauma or surgery.
   4. Requires local treatment and intake of corticoids or immunosuppressants.
3. Psoriasis:
   1. Affects 7-11% of IBD patients, as it is genetically related to IBD, especially in CD.
   2. They share genetic factors, chronic inflammation and alterations in the intestinal microbiota.
   3. Some treatments for IBD can cause psoriasis.
4. Aphthous stomatitis:
   1. These are painful ulcers in the mouth, very common in patients with any IBD.
   2. They improve with control of intestinal inflammation.
   3. Some treatments for IBD can cause psoriasis.
5. Concomitant vasculitis:
   1. inflammation of blood vessels that may manifest on the skin as red-violaceous lesions of variable size and are usually not painful. 
   2. It can develop into a more serious condition if left untreated, and patients with this condition should seek prompt medical or emergency care. 
6. Sweet’s syndrome (SS)
   1. sudden onset of red or purplish bumps on the body, accompanied by fever, headache, joint pain and fatigue. 
   2. usually follows symptoms of intestinal inflammation in IBD, (if the patient experiences a flare-up, SS bumps may begin to appear on the skin).

3 – Osteoarticular Manifestations

1. Peripheral arthritis:
   1. It is the most common, affecting approximately 1 in 4 patients (20-25%), mainly women. 
   2. Painful inflammation of the joints, mainly in the knees, wrists, elbows and fingers.
2. Ankylosing spondylitis:
   1.  More common in men
   2. Affects the spine.
   3. Manifests itself with low back pain and morning stiffness.
3. Sacroiliitis:
   1. It is also very common (14%) 
   2. Inflammation of the sacroiliac joint (pelvis)
   3. Presents with pain in the lower back and radiates to the upper thigh.
4. Osteoporosis:
   1. Very common, affecting 30-50% of patients.
   2. Corresponds to a loss of bone mass 
   3. Risk factors may be: advanced age, family history, medication such as corticoids, or habits such as smoking or alcohol.

4 – Other IBD- associated diseases

Neurological manifestations

1. chronic headaches.
2. severe fatigue.
3. peripheral neuropathies.

Hepatic and biliary complications

4. Primary sclerosing cholangitis: chronic inflammation of the bile ducts.
5. Fatty liver disease.
6. Autoimmune hepatitis.

Cardiovascular and respiratory manifestations

7. Increased risk of deep vein thrombosis and pulmonary embolism.
8. Increased risk of cardiac disease in severe cases.

Nutritional complications

9. Neurological manifestations
10. chronic headaches.
11. severe fatigue.
12. peripheral neuropathies.
13. Hepatic and biliary complications
14. Primary sclerosing cholangitis: chronic inflammation of the bile ducts.
15. Fatty liver disease.
16. Autoimmune hepatitis.
17. Cardiovascular and respiratory manifestations
18. Increased risk of deep vein thrombosis and pulmonary embolism.
19. Increased risk of cardiac disease in severe cases.
20. Nutritional complications
21. Anaemia: due to lack of iron, vitamin B12 or folic acid.
22. Vitamin D, calcium or zinc deficiencies.
23. Weight loss or malnutrition.
24. Vitamin D, calcium or zinc deficiencies.
25. Weight loss or malnutrition.

References

1.-Hernández, V., & López-Sanromán, A. (2019). Manifestaciones extraintestinales de la enfermedad inflamatoria intestinal. Revista Médica Clínica Las Condes, 30(6), 571–580. https://doi.org/10.1016/j.rmclc.2019.06.005

2.-EducaInflamatoria. (s.f.). Manifestaciones extraintestinales. EducaInflamatoria.com. Recuperado de https://educainflamatoria.com/category/manifestaciones-extraintestinales/

3.- Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU). (s.f.). Otras enfermedades en la colitis ulcerosa. Recuperado de https://geteccu.org/contenidos/up/2015/07/Otras-enfermedades-CU.pdf

Over the past decades, therapeutic options for ulcerative colitis patients have expanded considerably, creating new challenges for both patients and physicians when deciding on treatment. A recent study conducted at Leiden University in the Netherlands investigated what priorities  ulcerative colitis (UC) patients have when choosing a treatment and at what point they would consider surgery after failing multiple treatment options, with the understanding that the decision is based on the clinical judgment of the healthcare professional.

What was investigated in this study?

The study included 172 adult patients with UC, who were asked to choose between different hypothetical treatment options based on several attributes:

• The route and site of administration (oral, subcutaneous injection, or intravenous infusion).
• The likelihood of short- and long-term symptom reduction (over eight weeks or one year).
• Risk of infections and other adverse effects.

Key findings: What matters most to patients?

Patients indicated that the most important feature when choosing a treatment was the reduction in symptoms after one year (27.7% importance). In second place, they mentioned the likelihood of infection (22.3%), and in third place, symptoms reduction in in the first eight weeks (19.5%).

In addition, it was found that:

• The route of administration is also an important factor, with preference for oral administration over subcutaneous or intravenous administration.

• 14.3 % of patients stated that they would not consider surgery, even if they failed eight medical treatments.
• Only 9 patients would opt for surgery, without trying any medical therapy.

In summary, the study highlights that long-term symptom reduction is the most important factor for UC patients when selecting a treatment, above adverse effects or route of administration. In addition, patients with no prior experience with biologics or small molecules were more likely to value route of administration compared to those with experience with these treatments.

Why is this study important?

These findings help clinicians understand what UC patients value most when choosing their treatment. Knowing that long-term symptom reduction is the top priority allows for the design of strategies that ensure individual preferences are taken into account to optimize treatment adherence and patient quality of life.

In conclusion, this study highlights the importance of prioritizing treatments with high long-term effectiveness and lower risk of infections as well as oral treatments. By better understanding patients’ preferences, clinicians can make decisions together with patients, ensuring a more appropriate and satisfactory treatment.

Reference

1. Tessa Straatmijer , M. Elske van den Akker -van Marle , Cyriel Y. Ponsioen , Danielle van der Horst , Menne PM. Scherpenzeel , Marjolijn Duijvestein & Andrea E. van der Meulen -de Jong (2024) Patient preferences in treatment options of ulcerative colitis: a discrete choice experiment , Scandinavian Journal of Gastroenterology , 59:3, 288-295, https://doi.org/10.1080/00365521.2023.2286191

What is a symptom diary?

So-called symptom diaries are daily records that the patient himself/ herself fills in to record the evolution of their illness, including aspects such as the presence or absence of symptoms, their intensity, and his/her response to various interventions.

There are various ways of keeping a symptom diary, from simple physical supports such as a notebook or calendar, to digital supports, such as easy and intuitive mobile applications¹ designed specifically for chronic disease monitoring that simplify disease tracking conveniently from a smartphone.

It is important to keep a daily record, so the patient can use different resources or methods that are easier for him/her to carry out, for example, if a notebook is used, try to always leave it in the same room.

And above all, it should be remembered that a symptom diary in no way replaces the close relationship that should exist between doctor and patient.

Usefulness of a symptom diary

Keeping a symptom diary is very useful for managing chronic conditions, especially those with flare-ups . This record allows:

1. Improve communication with your doctor. A diary provides detailed and objective information on the evolution of the disease. This helps your doctor make a more accurate diagnosis and assess your response to treatment and thus adjust it effectively. If new symptoms, worsening or significant changes are detected, it is essential to report them to your doctor as soon as possible.
   
2.  Minimize flares . Although most flare-ups are unrelated to anything the patient has done, some factors have been identified that can trigger a reactivation of the disease such as²: stressful life events, infections, interruption or incorrect dosing of medications, or recent use of certain medications such as nonsteroidal anti-inflammatory drugs or antibiotics. Recording this information in a diary allows preventive measures to be taken to reduce the likelihood of flare-ups.
   
3. Identify triggers and patterns. Keeping a diary allows you to recognize which factors that can provoke or aggravate symptoms, such as specific foods, emotional disturbances, lack of sleep or changes in routine and smoking or alcohol use.
   Identifying these factors helps to avoid them and, consequently, to reduce the frequency and intensity of symptoms, leading to remission or reduction of the disease. It also helps determine whether lifestyle changes are having a positive impact on the disease.

4. Self-awareness and empowerment. Keeping a symptom diary is an exercise in honesty. This helps people better understand themselves and their bodies better. It allows them to take a more active role in their treatment, improve their emotional well-being, and cope with their illness with greater confidence.

How to keep a symptom diary?

Keeping a symptom diary doesn’t need to be overly complicated. But the more details you record about the onset, intensity, and duration of symptoms, the easier it is to adjust treatment effectively. Further enquiry into habits, lifestyles, how patients react to their environment and stimuli provides invaluable information for fine-tunning and optimizing IBD treatment, as any information, no matter how small, can be relevant.

Below are some of the key elements suggested for consideration in a symptom diary ³:

1. Symptoms and their evolution

• Type of symptom: Abdominal pain, bleeding, diarrhoea, fatigue, among others.
• Intensity: Use a scale of 1 to 10 to indicate severity.
• Frequency: Number of daily bowel movements, frequency of outbreaks and episodes of rectal bleeding.
• Duration: Record how long symptoms persist and at what time of day they are most intense.
• Whether the symptom is constant or fluctuates.

For greater accuracy, it is helpful to note the date and time of onset of symptoms, as well as describe in detail how they affect you emotionally and physically.

2. Triggers and relief generators

• Situations or foods that worsen or improve symptoms .
• Consumption of alcohol, tobacco, beverages and types of food eaten.
• Physical exercise, medication and stress levels.
  

3. Impact on daily life

• Daily challenges: Sleep problems, refusal of social engagements, avoidance of pleasurable activities, loss of sexual desire, absences from work or school.
• Mood: Anxiety, irritation, helplessness, embarrasement, among others.
  

4. Other symptoms and complications

• Changes in appetite, nausea, or weight changes.
• Additional complications: Problems with skin, joints, liver, eyes, etc.
  

5. Treatment and evolution

• Use of medication and its effect on symptoms.
• Improvement, worsening or no change in the disease.
• Main concerns about treatment or symptoms.

For example^4, the next time a patient suffers a flare-up, they can review their diary and perhaps discover that their stress levels have been increasing each time their symptoms have flared up, which will help them consider whether to incorporate stress-reducing techniques into their daily routine.

Ultimately, keeping a detailed symptom record helps optimize treatment and improve patients’ quality of life. But remember, it is not a replacement for a medical consultation.

• Hamilton MJ. The Use of Mobile Applications in the Management of Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2018 Sep;14(9):529-531. PMID: 30364254; PMCID: PMC6194659.
• Singh S, Graff LA, Bernstein CN. Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD? Am J Gastroenterol. 2009 May;104(5):1298-313; quiz 1314. doi: 10.1038/ajg.2009.15. Epub 2009 Mar 31. PMID: 19337242.
• CROHN’S & COLITIS FOUNDATION
  https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/ibd-symptom-tracker.pdf
• https://www.healthline.com/health/ibd/ibd-journal#benefits

Inflammatory bowel disease (IBD), being an immune-mediated chronic disease, is associated with an increased risk of developing dysplasia and cancer, primarily due to chronic inflammation, which is an independent risk factor linked to the duration and extent of the disease¹.

However, the risk of patients with ulcerative colitis (UC) developing colorectal cancer (CRC) has steadily decreased over the past six decades due to therapeutic advances and close patient follow-up, but the extent and duration of the disease has been shown to increase this risk².

In addition, as with any person with or without other diseases, lifestyle, smoking, alcohol, diet, age or genetics are also factors to be taken into account when talking about the risk or tendency to suffer from some type of cancer. A healthy lifestyle incorporating a healthy diet, sport and avoiding alcohol and tobacco consumption is recommended.

Prevention, early detection and diagnosis

Chronic inflammation, a hallmark of IBD, has been identified as a key factor in the link to cancer. Constant inflammation can damage intestinal cells and increase the risk of genetic mutations that could lead to the development of cancer cells.

There are special situations where the risk of developing colon cancer is even higher, for example if you have primary sclerosing cholangitis, a family history of colorectal cancer or a personal history of colorectal cancer⁴. This raises a number of practical questions. The causes behind the changing trends in the epidemiology of UC-related CRC are complex. A key element may be early diagnosis and treatment of precancerous lesions by colonoscopic surveillance or, sometimes, prophylactic colectomy, while the third option is primary chemoprevention³.

Given this possible association, regular monitoring, colonoscopies to assess the status of the intestinal lining and/or incorporation into follow-up cancer screening programs may be recommended in some IBD patient profiles.

• https://pubmed.ncbi.nlm.nih.gov/32968366/
• https://onlinelibrary.wiley.com/doi/10.1111/apt.12651
• https://www.wjgnet.com/1007-9327/full/v14/i25/3937.htm
• https://pubmed.ncbi.nlm.nih.gov/35771958/