Dr. Gines Martínez explains that the detection of the disease includes the patient’s history, the colonoscopy examination and the biopsy.
Dr. Gines Martínez, gastroenterologist. Photo: University of Puerto Rico Comprehensive Cancer Center.
Dr. Gines Martinez, gastroenterologisthas more than 30 years of experience in this medical area and spoke with the Journal of Medicine and Public Health, on the endoscopic and histological evaluation of the Ulcerative colitisa Inflammatory Bowel Disease which is highly prevalent in the population.RELATED
In this regard, he highlighted that “the greatest advances in the detection and treatment of ulcerative colitis have been: the patient’s access to endoscopic studies and new drugs to treat the condition.
According to the specialist, the evaluation of patients with colitis begins with the patient’s history, as is done in any branch of medicine. Usually, patients have diarrhea for more than two or three weeks, have bleeding, abdominal pain, colic and straining, which “motivates the doctor to refer them to a gastroenterologist,” he said.
“When we are faced with a patient with ulcerative colitis, apart from the examinations of laboratory that must be done, the patients deserve an endoscopic evaluation, there we perform the colonoscopy, a study where we visualize the large intestine complete and we also try to enter the terminal thread” explained Dr. Martínez.
In turn, he indicated that ulcerative colitis has differences with the Crohn’s disease and that in general, the gastroenterologist can identify a patient with one of the two conditions, since there are particular endoscopic characteristics.
Patients with ulcerative colitis present an involvement of the rectum and from there the rest of the intestine is involved, towards the left side, mainly, the specialist points out. “We are going to look at the injuries of the intestine that are basically inflammation of the mucous membranes, this inflammation is usually circumferential, and there is granularity of the tissue, and we show a continuity of this inflammation that begins in the rectum, sometimes it is limited to the rectum and the sigmoid, which is a part of the large intestine,” he added. .
Likewise, it emphasizes the importance of the clinical part, in the process of diagnosing the condition, since “in 90% of cases, patients with ulcerative colitis and Crohn’s disease can be identified with the clinical examination,” he indicated. . However, he emphasizes that laboratory tests help to differentiate the conditions and detect the disease.
In this regard, he explained that “the pathology helps us a lot, where we are going to have a distortion of the crypts, with abscesses in the crypts that give us an idea of what we really have. The problem with all this, in terms of the biopsies refers, is that sometimes they are pathological findings that are not specific and can be confused with conditions such as infectious colitis and others that inflame the intestine,” he pointed out.
The difference between the two diseases: ulcerative colitis and Crohn’s disease is that in patients with Crohn’s disease, the specialistsshow intermittent lesions, inflammation and deeper ulcerations that do not involve the entire large intestine and can see normal mucosa interspersed with abnormal mucosa, explains the gastroenterologist.
Due to the above, he states that Crohn’s disease is “a disease behind the wall, where the patient can develop fistulas, perforation and narrowing in the intestine, unlike patients with ulcerative colitis, who can develop inflammation, and even narrowing, but In general, the patient who develops it must think that he may have a malignancy of the large intestine”.
In the diagnosis of ulcerative colitis, three complementary processes are taken into account: the patient’s medical history, the colonoscopy study, and biopsies.
For the specialist, complementing the biopsies with special stains such as indigo carmine and methylene blue, allows painting the intestine and directing the biopsies to certain specific places that help medical professionals to detect the condition.
In relation to the above, he points out that the current instruments have changes in light and color, that is, “it is like a stain that is made through the instrument and we can direct the biopsies to areas that are abnormal and help make a definitive diagnosis.
“Those of us who have been in the profession for more than 30 years, look at a colonoscopy study or are doing a procedure and just by looking at the intestine we can differentiate it. But we must always implement all the tools we have to reach a diagnosis,” he explained.
Clinical evaluation of the patient
Specialists categorize ulcerative colitis between: mild, moderate and severe, and for this, they use criteria according to an evaluation table. The criteria are related to the frequency of the patient’s bowel movements, bloody events, and endoscopic findings. For Dr. Martínez, patients with ulcerative colitis may have:
Recommendations for primary physicians
“The primary physician who is evaluating the patient should be aware of their bowel movements. This is a bimodal condition, since it can be seen in young patients between 18 and 30 years old, approximately as it can also be seen in patients above 50 years, however, it is more common to see it at an early age,” said the doctor.
In addition to that, the specialist indicates that primary care physicians can analyze the frequency of diarrhea in a young patient, since it is one of the most common manifestations, the pain it generates and bloody stools, “that will motivate the doctor to perform an evaluation of the inflammation of the individual in general and an evaluation of excreted occult blood and after having that evaluation send him to the gastroenterologist”.
IBD prevalence and advances in treatments
For Dr. Martínez, inflammatory bowel diseases have increased drastically in the last 30 years, since he indicates that since 1990, to date, they have doubled. “We have noticed an increase in the north and a decrease in the south, that is to say that it is generally more common in white and Jewish patients, and as we reach Latin American patients the incidence decreases, but it is still high,” he said. .
However, progress has also been made in treatments and medications for patients, since today there are intravenous, oral and even subcutaneous treatments, which have improved the quality of life of thousands of patients.
“One of the greatest advances we have had in the treatment of IBD has been the development of different types of medications,” he stated. On this, he explained that they are: