Wu Kaichun: 23 minutes to talk about "green cancer"-inflammatory bowel disease

2019-09-13 | Mr. Zeal |

Introduction: What is inflammatory bowel disease? Why are more and more people, especially young people suffering from this stubborn disease known as "green cancer"? How to diagnose, identify, treat and manage inflammatory bowel disease? New research andWhat new hope does technology bring to patients?


Telegraph

Good evening everyone! Let me talk about IBD today, and IBD, as the name suggests, is caused by inflammation of the intestinal tract.

It's very simple to say, but it was a particularly unforgettable experience for me. It was also an experience that changed my life. I graduated from a master's degree 32 years ago and was selected by the school to study at Oxford University for two years.

It's such an exciting time, but when I heard that what I was going to learn was about inflammatory bowel disease, I couldn't help but drum up.

Because although I had graduated from medical school at that time and already worked, I have not seen, diagnosed, or treated a case of inflammatory bowel disease, but only seen it in the book.

I went to the UK to study and research on inflammatory bowel disease. What will be the result? With this question, I arrived in the UK. But the situation there surprised me.

You can see this picture of me, which was taken on the top of a church in Oxford University. In the UK, Oxford University is one of the research and clinical centers of inflammatory bowel disease.

There, we can see patients with inflammatory bowel disease every day. The instructor took me out of the clinic and had a colonoscopy. I almost went to the operating room every day. When I met patients with inflammatory bowel disease, I had to do it painfully.Surgery removed large sections of the intestine.

I also use these surgically excised tissues, specimens, and cells to do some research, such as studying the role of macrophages, lymphocytes, and immunoglobulins.

It is also such a period of experience that made me have a strong interest in inflammatory bowel disease, so that after I returned to China, although there were few cases and very difficult cases, I was able to say that it was our National Natural Science FoundationThe first fund on inflammatory bowel disease.

After that, I kept going all the way. Now, as the leader of the inflammatory bowel disease group of the National Digestive Society of China, I am working with my colleagues in the country to make continuous efforts in clinical research.Shock.

What exactly is inflammatory bowel disease? If you give it a definition, it is an intestinal inflammation mediated by abnormal immunity. This inflammation recurs and can even accompany patients throughout their lives.

Inflammatory bowel disease can include at least two diseases, one is ulcerative colitis, Ulcerative Colitis, we usually call it UC, the other is Crohn's disease, which is Crohn's Disease, we usually call CD.

This is a colonoscopy picture. From this picture we can see that the red ones are all inflammations. Go in and take a look at it. It ’s rotten, eroded, bleeding, and the patient is very painful.

So the general characteristic of inflammatory bowel disease is that the disease course is very long, and various complications can occur, even disability and death.

Some people call it "green cancer". Once a patient has this disease, it will be very painful. Its diagnosis and treatment will cost a lot of money, and it will bring a great burden to patients, family members and society.

We are also calling on the state to pay enough attention to this disease and treat it as chronic disease so that this part of the patients can get better diagnosis and treatment.

Thirty years ago, we haven't seen inflammatory bowel disease. But thirty years later, this is not the case at all. When I just returned from the UK, I went to our hospital to retrieve it and passed our hospital.50 years of medical records were turned out, and less than 50 cases of inflammatory bowel disease were found.

But now, I may have more than 50 patients diagnosed and treated in a week. From this picture, you can also see that the first case of ulcerative colitis in China was reported in 1956, a full night later than in the West.For 100 years.

Although there is a time gap, but since then, with the development of the country's economy, the rise of industrialization, and the improvement of people's living standards, the incidence of inflammatory bowel disease is also out of control. NowMore and more patients, more and more difficult and complicated.

According to incomplete statistics, the incidence of inflammatory bowel disease-ulcerative colitis and Crohn's disease-in our country is increasing year by year. Although the absolute value of our incidence is still not up to Europe and the United States,It might be one-fifth to one-tenth of it, but it's growing at an alarming rate.

What is the cause of such a disease? It can be said that the cause of inflammatory bowel disease is not very clear. But the common pathogenesis of inflammatory bowel disease is its pathogenesis and several importantRelated factors.

One is genetic susceptibility, that is, it will have familial aggregation, or have a certain genetic background. Another factor is the immune response, which is affected by heredity and environment-especially the intestineEnvironmental impact.

Another is the intestinal microorganism, which also plays a very important role as a medium and carrier between the external environment and the host that causes immune response or inflammation.

Of course, there are also some environmental factors, such as our daily diet. Each of us has different habits and eats different things. What we eat now is much different from what we ate 30 years ago.Same. There are also some psychological factors as environmental factors.

In short, it is the inflammatory bowel disease caused by the combined action of internal and external causes. As a result, there is a continuous immune response in the local intestine, which causes damage to the intestinal mucosa, causing intestinal inflammation, ulcers,A series of symptoms such as erosion, bleeding, etc.

There are some differences between ulcerative colitis and Crohn's disease.

As you can see from this picture, ulcerative colitis only occurs in the colon, and Crohn's disease is not a classic colitis and can occur in any section of our digestive tract.

Although the main and most common part of it is our ileum and ileocele, where the large and small intestines meet, but it can occur in the large intestine, it can also occur in the small intestine, or evenDuodenum, stomach and esophagus in the upper digestive tract.

The symptoms caused by it are different because of the different parts.

For example, ulcerative colitis mainly causes inflammation of the mucous membranes, so its most common symptoms are diarrhea, which is the diarrhea that our people say, and pus and bloody stools. These symptoms can be repeated, light and heavy.

There is also a feature that it usually occurs in young people. Twenties and thirties are the most common. It is a peak of good hair and will affect patients' work, study and life.

Crohn's disease can occur in any part. It is not only characterized by superficial inflammation of the intestinal mucosa, but also can cause inflammation throughout the intestine, which can cause intestinal stenosis and perforation.The main symptoms are abdominal pain, diarrhea, and abdominal mass.

If it penetrates, it can form a fistula, which can accumulate in the anus and rectum, causing lesions around the anus. Patients can often have anal fistula, anal fissure and perianal abscess.

In addition, because it can accumulate in the small intestine, it can affect digestion and absorption, leading to nutritional disorders. If it is onset in children or adolescents, it may affect development, retard development, and stagnate. Sometimes we encounter teenagersPatients, they may be as tall as children five or six years old.

Crohn's disease can also cause symptoms other than the intestinal tract. Sometimes the earliest manifestations are not diarrhea or abdominal pain, but joint pain, rash, and recurrent oral ulcers. These are all intestines.Performance.

In addition to diarrhea and abdominal pain, various complications can also occur. In severe cases that cannot be controlled, moderate megacolon can occur, long-term, such as more than ten years, twenty or thirty years, This ulcerative colitis may become cancerous.

Severe can also cause bleeding, perforation, intestinal obstruction, abdominal abscess, malnutrition, etc., all need urgent and powerful treatment.


How to confirm a patient with diarrhea, pus, blood, stool, or abdominal pain that comes to the outpatient hospital?

Because it is a lesion in the intestine, colonoscopy plus biopsy is a very necessary test. We can see the inflammation of the intestine under the colonoscope, which can be mild, moderate, and severe.There can also be very deep ulcers, even fistula formation, etc.

It is difficult to diagnose without colonoscopy and biopsy. Of course, sometimes these are not enough, and other imaging and biochemical tests are needed to help us diagnose and differentiate.

To confirm the diagnosis, it needs to be excluded or differentiated from other diseases. Because many intestinal diseases can appear abdominal pain, diarrhea, pus and bloody stools. For example, our infected diarrhea, did not eat well, diarrheaBoth dysentery and dysentery can show symptoms like this.

So, it is necessary to identify infectious diseases and some non-infectious intestinal inflammation. For example, intestinal lesions caused by ischemia in the elderly also need to be identified.

There are also some special infections, such as tuberculosis, some special tumors, and lymphomas, which need to be identified from Crohn's disease.

For both ulcerative colitis and Crohn's disease, if both occur in the colon, it is sometimes difficult to distinguish.

Of course, we have a series of methods for identifying ulcerative colitis and Crohn's disease. For example, according to the symptoms and signs, imaging findings, performance under colonoscopy, and some pathological features, weCan be identified, these are very important clinically.

So how do we treat a inflammatory bowel disease with a clear diagnosis?

First of all, it is mainly medical and drug treatment. The purpose of treatment is to alleviate the symptoms of patients. In clinical practice, we usually call it induced remission. Once the symptoms have resolved and the pain has resolved, we still have to maintain this link. WeThere is no cure, but remissions should be maintained to minimize recurrence.

In addition, we must pay attention to the prevention and treatment of its complications. As mentioned earlier, some complications are still very serious, such as bleeding, perforation, obstruction, and canceration. These complications can be life-threatening.

In this process, to improve the quality of life of patients, these are the goals we want to achieve in treatment.

For drug treatment or medical treatment, we can also divide it into several steps.

First of all, we should pay attention to and pay attention to our general treatment, or basic treatment. For patients with inflammatory bowel disease, we must give adequate nutrition, and if there is nutritional deficiency or malnutrition, we must correct it in time.

Because his condition is directly related to nutrition, if the malnutrition is not corrected, it will be difficult to correct it. We must pay attention to many details of the patient's life, including diet, living and proper rest, which are necessary.of.

Also, these patients are a long-term or even life-long disease. The patients' psychological and psychological aspects during a certain period of time are a very large stress or trauma, so we must also pay attention.

For drug treatment, we generally divide into these categories of drugs. One is for mild to moderate patients, we can give him 5-aminosalicylic acid drugs, such as mesalazine, salicylazineThese drugs are sulfadiazine.

But if it is moderate to severe patients, 5-aminosalicylic acid may not be enough. At this time, corticosteroids, prednisone, methylprednisolone, hydrocortisone, and dexamethasone may be needed. These hormonesClass of drugs.

Of course, the anti-inflammatory effect of these drugs is very strong, but its side effects are also very large, and it cannot be used for maintenance treatment for a long time.

For these treatments are more difficult, especially these hormone treatments do not get good results, or have good results but cannot be removed, and those side effects cannot be avoided, we also need to use immunosuppressants.

The so-called refractory IBD requires immunosuppressants, such as azathioprine, 6-mercaptopurine, methotrexate, etc.

Biological agents that have appeared in recent years, that is, new drugs that target some of the corresponding targets in these intestinal inflammations, such as drugs using antibodies, some small molecule drugs, to target these targets.

The effect of biological agents is relatively strong, and its indications may be more used for moderate to severe refractory IBD, which can achieve better results, of course, its cost is also very expensive.

Then, these drugs or medical treatments, if the effect is not good, or there are complications, such as bleeding, perforation, obstruction, canceration, etc., we need to go to surgery for surgical treatment.

But don't forget, with the advancement and development of science, some new methods and technologies now will also play a very important role in the treatment of IBD in the future.

For example, intestinal flora-related fecal transplant treatment, stem cell treatment, these may all play a very important role in the treatment of IBD.


The biotherapy just mentioned should be said to be a revolution in IBD treatment. It is based on our clear understanding of the pathogenesis of IBD. It is a more precise and targeted treatment method.

In the case of inflammatory bowel disease, due to the weakening of the intestinal mucosal barrier, a large amount of food or bacterial-derived antigens enter the intestinal wall, inducing and triggering these intestinal inflammatory reactions, causing a large number of inflammatory cellsAnd cytokine accumulation, causing immune response, leading to damage caused by intestinal inflammation.

Developing drugs for these links can achieve this purpose. It should be said that there are already many such biotherapeutic preparations in clinical use.

One is the link that affects and blocks the accumulation of lymphocytes in the intestine, like these integrins and adhesion factors, which are all targets for treatment. There are also colony factors that can block these cells, which is to promoteThese inflammatory cells proliferate in this category.

There are also many cytokines in this process, that is, the factors secreted by these lymphocytes and immune cells, like interleukins: interleukin 6 IL-6, interleukin 12IL-12, interleukin 23 IL-23, interleukin 36 IL-36, etc.

And what we currently use most clinically is to target a cytokine that is very important in the inflammatory response, called tumor necrosis factor α TNF α, which is a core molecule that is very critical in generating the inflammatory response.If you suppress it, you can suppress the inflammatory response to a certain extent.

Now there are more new drugs with different targets and different mechanisms.


Inflammatory bowel disease can be improved after treatment, but we have no way to cure it.

In the entire course of the disease, the condition can also be relieved by itself, but for most patients, it is a recurring attack, it will be unresolved, and even continuous progress may lead to different complications, so in general,Its healing is not good. For this type of patients, we really need to give him extra care and care.


Generally speaking, today I talked to everyone about inflammatory bowel disease.

Inflammatory bowel disease includes ulcerative colitis, which is UC, and Crohn's disease, called CD. In our country, the incidence of inflammatory bowel disease is increasing year by year.

The most common symptoms of these two diseases are slightly different due to the location and characteristics of the disease. The most common UC ulcerative colitis is pus and blood, and the most common Crohn's disease is abdominal pain., Abdominal mass.

At present, for inflammatory bowel disease, because the etiology is not clear, there is no gold standard for diagnosis, which is more complicated and difficult, and requires comprehensive judgment.

So for this unexplained disease, inhibiting the intestinal inflammation is the main goal of our current treatment.

For this type of patients, because this is a long-term, even life-long disease, we need our medical staff, family members and society to give long-term treatment and more care and management.

In our hospital, my IBD patient has a very detailed health file. I will regularly come to the hospital to give him guidance in all aspects, including guidance in all aspects of life: when to take medicine, when to stop it, can IHaving a baby, these may all require a very correct or meticulous instruction.


I am from Xijing Gastroenterology Hospital, Air Force Military Medical University. This is our Xijing Gastroenterology Hospital building. The director of our Gastroenterology Hospital is Academician Fan Daiming.

Our bowel disease center is on the ninth floor here. We have a floor dedicated to bowel disease. Our clinical and basic research are done here.

I will share so much with you today.

Thank you all!

full text

"Gut · Tao" is a TED-like speech program recorded by the Enthusiastic Gut Institute. This article is the lecture content of the fifth speaker, Professor Wu Kaichun, please watch the video :

Introduction of Speaker

Wu Kaichun, leader of the inflammatory bowel disease group of the Chinese Digestive Society; deputy director of the Xijing Gastroenterology Hospital of the Air Force Medical University; enthusiastic gut think tank expert

Good at diagnosis and treatment of ulcerative colitis, Crohn's disease, gastric cancer, colorectal cancer, peptic ulcer, gastroesophageal reflux disease, gastrointestinal bleeding and other diseases, and master the technique of digestive endoscopy.

Presided over more than 20 topics such as the National Outstanding Youth Fund, the National "973" Plan, the National "863" Plan, the National Natural Science Foundation International Cooperation, the Army's Scientific and Technological Research, etc.. In 2000, he was selected into the first batch of "High School Backbone Teacher Funding Program", Won the National Outstanding Youth Fund in 2002.


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Mr. Zeal
Founder of Enthusiastic Bowel Research Institute, Tsinghua Life Science and Medical Alumni Association, Secretary-General of Health blogger, headline article author

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