Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) associated with alternating periods of flare-ups and periods of remission. Their incidence is increasing, and a multidisciplinary approach is essential in managing them.
What Are the Causes of Chronic Inflammatory Bowel Disease?
The reasons behind these diseases are not yet well understood: Several concomitant causes have been identified, from a broad genetic predisposition to many environmental factors. These would cause, at some point in a predisposed person, the change of the intestinal bacterial flora, resulting in an aberrant immune response in the intestines. This is the biological beginning of the disease. Subsequent flare-ups and remissions lead to intestinal damage, ulcers, and symptomatology that leads to consulting a doctor. For this reason, the diagnosis is often delayed.
Chronic Inflammatory Bowel Diseases: Who They Affect and How Widespread They Are
The peak of incidence is during late adolescence and young adulthood; only about 20% of patients are diagnosed in pediatric age.
The incidence of these diseases has been gradually increasing for about 30-40 years. An interesting finding, from the point of view of pathogenesis, is that the most significant increase in incidence is in countries that have had more remarkable development from an economic and industrial point of view, such as China, India, and Brazil. This is probably related to changes in lifestyle, diet, and other environmental factors.
There are several hypotheses about it: Other factors that could trigger the mechanism behind these diseases are improved hygienic conditions, cold chain food storage, and pollution, which trigger the immune response in the gut but also other organs, in the case of other immune-mediated diseases such as rheumatoid arthritis or psoriasis.
Chronic inflammatory bowel disease and the impact on quality of life
Emerging at a young adult age, Chronic inflammatory bowel disease affects the person in the prime of their daily life. The main characteristic of these diseases is that the risk of death is not increased compared to the general population, but the impact on the quality of life adapted to the individual is very heavy.
The burden of these diseases is considerable regarding direct costs, including everything related to managing the condition and any associated extraintestinal manifestations, visits, medications, and sometimes even surgery. Up to 40% of patients with Crohn’s disease go through bowel resection within ten years, and up to 20% of patients with ulcerative colitis can go through colectomy within ten years.
But as per the indirect costs, which are estimated to be even higher than the direct costs, such as productivity at work, disability pensions, absenteeism, and presenteeism, everything that falls on the patient’s life is often not calculable even though it constitutes a cost.
The Multidisciplinary Approach in Chronic Diseases
In more than 40% of chronic inflammatory bowel disease cases, we find extraintestinal immune-mediated manifestations. Up to 30% of patients may have arthritis, 10% may have immune-mediated skin manifestations, 2-3% eye inflammation, and 5-6% biliary tract and liver inflammation. When these extraintestinal manifestations are found, the impact on quality of life is even worse, and multidisciplinary management becomes even more critical.
In modern chronic disease management, a multidisciplinary approach cannot be ignored: A team of specialists brings better outcomes in identifying possible comorbidities – some studies estimate a diagnosis increase of 25%- but also in managing them.
Prolonged Remission Over Time: A Key Goal
Prolonged remission over time is the goal physicians and patients want to achieve. After being offered a treatment, the patient with ulcerative colitis generally hopes that the treatment works quickly, lasts as long as possible, and has an acceptable safety profile.
Unfortunately, prolonged remission over time cannot always be achieved, and therefore, not only new therapeutic solutions are desirable, but also new treatment strategies that can allow a patient to remain asymptomatic for years in terms of both symptoms reported by the patient and the anatomy of the disease, which is taken into significant consideration today.
Thus, the restoration of normal intestinal mucosal integrity is wished. Diarrhea and bleeding, which are characteristic symptoms of ulcerative colitis significantly impairing the patient’s quality of life, should be treated.
