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IBD is misunderstood


Confusion around IBD usually stems from the “umbrella” disease encompassing two separate conditions.

Although a 2017 review forecasted that there will be about 2.2 million Americans and about 0.5% of Western Europeans living with IBD in 2025, other reports suggested that the disease is not universally understood.

“There are a lot of misunderstandings about IBD,” Paul Feuerstadt MD, FACG, AGAF said.

For example, a survey of 409 general practitioners in Australia showed that 37% felt uncomfortable managing IBD. In a separate poll of 39 general practitioners in central Italy, 71.8% said they “needed better instruction regarding IBD.”

According to the Mayo Clinic’s website, individuals most at risk for ulcerative colitis and Crohn’s disease are those aged younger than 30 years, with Ashkenazi Jewish ancestry and a family history of the disease. The risk factors that are more unique to Crohn’s disease include smoking cigarettes and consuming a diet high in fat or refined foods. Patients with ulcerative colitis and Crohn’s disease both experience abdominal pain and cramping, bloody stools, fever, fatigue and weight loss. However, patients with ulcerative colitis also tend to report rectal pain and an inability to defecate despite the urgency to do so, while patients with Crohn’s disease typically report mouth sores, pain or drainage near the anus and inflammation of skin, eyes, joints, liver and/or bile ducts.

PCPs that are concerned about abdominal pain in a patient with inflammatory bowel disease can conduct one of several tests to help tell which condition is afflicting their patient, according to Feuerstadt.

“The best test to determine the source of a patient’s abdominal pain is an abdominal CT scan,” he said. “If the test shows dilation throughout the small bowel and a decompressed colon, then the patient likely has small bowel Crohn’s disease that is either inflammatory or fibrotic. If it shows continuous inflammation of the colon starting in the rectum, the patient likely has ulcerative colitis. If there is inflammation of the colon without rectal involvement or segmental colonic involvement, Crohn’s disease might be the culprit.”

Treatments

According to the Mayo Clinic, patients — regardless of whether they have ulcerative colitis or Crohn’s disease — can take corticosteroids such as prednisone, prednisone intersol and budesonide to control an acute flare of their IBD symptoms. An acute flare might be the source of a small bowel obstructive process.

“Usually within 24 or 48 hours of a corticosteroid treatment, the obstruction opens up, leading to a passing of gas and of a bowel movement,” Feuerstadt said. “Those are signs that their obstruction has been relieved.”

There are a variety of more chronic treatments for inflammatory bowel disease. The immunomodulators azathioprine and mercaptopurine, and immune system suppressors such as Remicade (infliximab, Janssen) and Humira (adalimumab, AbbVie), can also be used in patients with either ulcerative colitis or Crohn’s disease.

Other treatments that are targeted toward patients with ulcerative colitis include biologics such as Simponi (golimumab, Janssen Biotech) and Entyvio (vedolizumab, Takeda); 5-aminosalicylic acids like sulfasalazine, balsalazide, Dipentum (olsalazine, Alaven Pharmaceuticals) and mesalamine; and the immunomodulator Xeljanz, (tofacitinib, Pfizer Pro), according to the Mayo Clinic.

Treatments more geared toward patients with Crohn’s disease include immune system suppressors like mercaptopurine, Cimzia (certolizumab pegol, UCB) and antibiotics such as ciprofloxacin and metronidazole.

Feuerstadt added that in the rare instances in which the inflammatory bowel disease obstructing lesion is fibrotic, and “not amenable to corticosteroid treatment, then surgery will be necessary.”

Full article by Janel Miller here.

Posted on: January 16 2020

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