Microbiota intestinală - o ţintă terapeutică raţională în colitele severe.

Inflammatory bowel diseases are chronic diseases that affect an increasing number of individuals. The etiopathogenesis of these diseases is not clearly established, with several theories from genetic susceptibility to the involvement of environmental factors, an exaggerated immune response or even intestinal bacterial flora impairment (quantitative, qualitative or metabolic). From the point of view of clinical manifestations, these are various, but they have a significant impact on the general well-being and on psychological status of the affected person. Within inflammatory bowel diseases, therapies are various, starting from intestinal anti-inflammatory drugs, corticosteroids and anti-TNF agents up to surgery in case of severe cases. Taking into consideration the possible bacterial etiopathogenesis, which is lately more and more evident, probiotics and/or antibiotics are now frequently used. Regarding antibiotics, rifaximin-α is the preferred one due to its wide spectrum, low intestinal absorption (less than 1%), low side effects and promising results. On the intestinal level, there is possible to face chronic inflammation in the absence of an inflammatory bowel disease, the most representative example being segmental colitis associated to diverticular disease. The prevalence of diverticular disease cannot be clearly determined because in many cases there are no symptoms for a long time, some of them being diagnosed accidentally by routine colonoscopy or due to colon cancer screening national programs, where this kind of projects are supported by the health authorities. Maybe that's why there is an increased prevalence of diverticular disease in Western countries, most of the time in people over 65 years of age. The presence of diverticula creates stasis of feces and bacterial multiplication with reactive inflammation of the intestinal wall and high risk of infectious (segmental colitis, diverticulitis, abscess, perforation with peritonitis) or hemorrhagic complications. Due to disease characteristics, its symptoms may be initially less severe, associated to segmental colitis (abdominal pain, bloating, abnormal bowel movements), but without any medical intervention they could become more severe (increased pain, fever, leukocytosis, sepsis, rectal hemorrhage) reflecting infectious disseminated complications. Therefore, to avoid severe complications (some of them even lethal), treatment of diverticular disease should focus on alleviating the symptoms right from the beginning, on prevention of diverticulum stasis (using soluble fibers) and on controlling the intestinal bacterial multiplication (using non-absorbable antibiotics). [ABSTRACT FROM AUTHOR]