Inflammatory bowel disease, a complex present, an exciting future

“It was the best of the times, it was the worst of the times, it was the age of wisdom, it was the age of foolishness……”

in 1859 Charles Dickens Thus began his novel in installments “A Tale of Two Cities”, the same year that Charles Darwin published “The Origin of Species”. That year, on September 10 samuel wilksa famed English pathologist, signed an article titled “Morbid Appearances in the Intestines of Miss Banks” in what appears to be one of the first documented descriptions of a inflammatory colon disease.

In the 160 years that have passed the inflammatory bowel diseasesthe ulcerative colitis and the Crohn’s diseasehave gone from being rarities to be discussed among experts to very common disorders, which will affect one in every 100 people in 2030.

While advances in surgery and the use of corticosteroids already reduced mortality more than 50 years ago, they continue to be incurable entities that significantly condition the quality of life of millions of people in the world.

Although the salazopyrin and the mesalazine contributed (and contribute) to improving the chronic course of many people with ulcerative colitisthe necessary treatments in severe cases and in the Crohn’s disease (corticosteroids, surgery, immunosuppressants) had limited efficacy and/or major and often unavoidable adverse effects.

The introduction almost 25 years ago of the infliximab marked a turning point, the biotech revolution began to show its potential in controlling the chronic diseases immunological in nature.

Infliximab paved the way for monoclonal antibodies, which with their specificity show a much better benefit/risk ratio than corticosteroids; subsequently demonstrating the usefulness of selecting new targets as cytokines, integrinseither cell receptors.

In parallel, there were great advances in diagnostic procedures, both in the endoscopy and its variants, as in the various radiological techniques. In addition, more and more attention was paid to the real needs of patients.

When the path seemed to be finding the ideal monoclonal antibody, other lines of research showed that designer molecules that interfere in the biological processes They can also be very useful.

“Our immediate mission is to try to ensure that each patient receives the most appropriate treatment, at the most opportune and necessary moment”

inhibitors JAK-Kinases and the SP1 modulators have broken in with force, so that in 2023 the panorama is perfectly described by the phrases of dickens: we have more therapeutic options and much more effective (the best of the times) to treat many patients in a world where access to treatment is very limited, from a global perspective (the worst of the times); the knowledge in biology allows great advances (it was the ages of wisdom) that human stupidity prevents from applying in a world still marked by inequalities (it was the age of foolishness).

As physicians treating patients with inflammatory bowel disease, the future is exciting: never before have we had so many diagnostic and treatment tools. However, while continuing to investigate new lines in prevention, diet, microbiota, mucosal regeneration; Our immediate mission is to try to ensure that each patient receives the most appropriate treatment, at the most opportune and necessary moment.

It is not an easy mission, but we are not alone. The patient associations ( and scientific societies ( / we have shown in Spain what we are capable of, but we still have a long way to go way to go until healing.

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