Each patient is different, and the diseases show up in different places
En silencio, dos enfermedades inflamatorias intestinales —la enfermedad de Crohn y la colitis ulcerosa— reconfiguran la vida cotidiana de miles de chilenos, sin que la medicina haya podido aún señalar una causa única y definitiva. Su origen entrelaza genética, inmunología, flora intestinal y factores ambientales aún no del todo descifrados, lo que convierte cada diagnóstico en un ejercicio de paciencia y escucha. Aunque la mortalidad directa es baja, el peso real de estas enfermedades se mide en dolor crónico, nutrición comprometida y la constante negociación entre el cuerpo y la vida que se quiere vivir.
- Las hospitalizaciones por estas enfermedades han aumentado sostenidamente en Chile, y los diagnósticos ya no respetan la franja etaria clásica de los 20 a 40 años: hoy afectan también a menores de 15 y a adultos mayores de 60.
- La enfermedad de Crohn puede estrechar el intestino delgado o formar conexiones anómalas entre órganos, mientras que la colitis ulcerosa provoca diarrea crónica con sangrado abundante, anemia y desnutrición.
- La ausencia de una causa clara obliga a los médicos a construir cada diagnóstico como un trabajo de detective: historia clínica, colonoscopía, biopsias e imágenes, sin que ninguna prueba aislada lo confirme todo.
- El tratamiento no puede estandarizarse: cada paciente responde de manera distinta según dónde se manifiesta la enfermedad en su intestino, lo que hace del monitoreo continuo una necesidad y no una opción.
- La meta no es la cura —aún inalcanzable— sino una gestión suficientemente eficaz para que la persona pueda trabajar, comer, dormir y relacionarse sin que la enfermedad dicte cada decisión del día.
Dos enfermedades inflamatorias intestinales avanzan en silencio entre la población chilena: la enfermedad de Crohn y la colitis ulcerosa. Ninguna tiene una causa única identificada. La gastroenteróloga Dra. Figueroa lo resume con claridad: intervienen factores genéticos, inmunológicos, relacionados con la flora intestinal y probablemente ambientales que aún no se han precisado. Esa incertidumbre no las hace menos graves —aunque la muerte directa por estas condiciones es poco frecuente, su impacto en la vida diaria es profundo y persistente.
Históricamente diagnosticadas entre los 20 y los 40 años, estas enfermedades aparecen hoy en franjas etarias más amplias: algunos pacientes tienen menos de 15 años y otros superan los 60, lo que sugiere que algo en el entorno o en los hábitos de vida ha cambiado, aunque nadie sabe exactamente qué.
Las dos enfermedades atacan zonas distintas del tubo digestivo. Crohn se concentra en el intestino delgado y puede provocar estrechamientos o conexiones anómalas entre órganos. La colitis ulcerosa afecta el colon y el recto, generando diarrea crónica con sangrado intenso, y con el tiempo puede derivar en anemia, desnutrición o un colon peligrosamente dilatado. Evaluar los niveles de proteínas y hierro en sangre es, según la Dra. Figueroa, una parte esencial del seguimiento.
Diagnosticarlas exige combinar historia clínica, colonoscopía, biopsias e imágenes. No existe una sola prueba que lo confirme todo. Y una vez establecido el diagnóstico, el tratamiento tampoco puede ser uniforme: la enfermedad se manifiesta de forma distinta en cada persona y en cada tramo del intestino, por lo que el monitoreo continuo y los ajustes terapéuticos son indispensables. El horizonte no es la cura, sino lograr que el paciente pueda vivir —trabajar, comer, dormir, relacionarse— sin que la enfermedad lo gobierne todo.
Two diseases are quietly reshaping the lives of thousands of Chileans, yet their origins remain largely mysterious. Crohn's disease and ulcerative colitis—the two most common inflammatory bowel conditions in the country—strike without a clear cause, though doctors know that genetics, immune system dysfunction, intestinal bacteria, and possibly environmental factors all play a role. The exact combination that triggers the illness in any given person remains elusive.
Dr. Figueroa, a gastroenterologist, is direct about this uncertainty. "We don't have a specific origin," she explains, "but we know multiple factors are involved—genetic ones, immunological ones, related to intestinal flora, and probably environmental ones we haven't clearly identified yet." This lack of precision doesn't mean the diseases are harmless. While death from these conditions is rare, the toll on daily life is severe. Patients endure chronic pain, unpredictable flare-ups, and the constant negotiation between their bodies and their plans.
The age at which someone receives a diagnosis has shifted over recent decades. Historically, these diseases appeared most often in people between 20 and 40 years old. But hospital admissions and new diagnoses have climbed steadily, and the disease is now appearing in younger patients—some under 15—and in older adults past 60. The pattern suggests something in the environment or in how we live has changed, though what exactly remains unclear.
The two diseases, while related, attack different parts of the digestive tract. Crohn's disease targets the small intestine, producing intense abdominal pain and cramping that can lead to serious complications: the intestine can narrow abnormally, or abnormal connections can form between the intestine and other organs. Ulcerative colitis affects the colon and rectum, manifesting as chronic diarrhea with heavy bleeding. Over time, patients may face severe bleeding episodes, a dangerously enlarged colon, anemia, or malnutrition. "Many of these diseases bring about drops in nutritional status and in blood levels of protein and iron," Dr. Figueroa notes. "So evaluating those levels is very important."
Diagnosis requires patience and multiple tools. A doctor must piece together the patient's medical history, perform a colonoscopy to visualize the intestines, take tissue samples for examination, and sometimes order imaging studies like MRI or CT scans. It is detective work, not a single test that confirms everything.
Treatment, once a diagnosis is made, cannot follow a template. "Each patient is different," Dr. Figueroa emphasizes, "and the diseases show up in different places in the intestine." A therapy that works for one person may fail for another. This means ongoing monitoring is not optional—it is essential. Doctors must watch how patients respond, adjust medications when needed, and remain alert to new complications. The goal is not a cure, which remains out of reach, but a life where the disease is managed well enough that a person can work, eat, sleep, and spend time with others without constant disruption. For many, that balance is hard-won and fragile.
Citações Notáveis
We don't have a specific origin, but we know multiple factors are involved—genetic ones, immunological ones, related to intestinal flora, and probably environmental ones we haven't clearly identified yet.— Dr. Figueroa, gastroenterologist
Each patient is different, and the diseases show up in different places in the intestine. The idea is that evaluations are continuous to see if the person had a good response or if we need to change therapy.— Dr. Figueroa
A Conversa do Hearth Outra perspectiva sobre a história
Why do you think these diseases are showing up more often now than they did decades ago?
That's the question everyone's asking. We know genetics hasn't changed that fast. Something about how we live—maybe our food, our stress, our antibiotics, the bacteria in our guts—has shifted. But we can't point to one thing and say that's it.
So a 25-year-old gets diagnosed. What does that actually mean for their life?
It means their body is attacking itself in the intestines. Some days they're fine. Other days they can't leave the house because of pain or diarrhea. They have to think about where bathrooms are. They might lose weight, feel exhausted, miss work. And it's not something that goes away.
Can they be cured?
Not yet. The goal is remission—getting the disease quiet enough that they can live normally. But it requires finding the right medication, which takes trial and error, and staying on top of it forever.
What happens if someone ignores the symptoms?
The disease keeps progressing. The intestine can scar and narrow. Bleeding can become severe. Malnutrition sets in. You end up in the hospital. Early diagnosis and treatment prevent those complications.
Is this something people should be screening for?
Not everyone. But if you have persistent abdominal pain, chronic diarrhea, blood in your stool, or unexplained weight loss, you should see a doctor. Don't assume it's just stress or something you ate.