World IBD Day 2024 | Know theme, causes, symptoms, treatment of IBD with PGIMER
World IBD Day 2024 | World IBD day is celebrated across the globe on May 19 every year. It is led primarily by patient organizations in the hope of uniting all stakeholders including patients, caregivers, and doctors in fighting this ever-rising disease.
The theme for 2024 is that “IBD has no borders”. This emphasises that IBD, once considered a Western disease, is now truly a global disease and is found in all inhabited continents. The rise of IBD in the developing countries and the global south poses challenges in care of these patients because of less available infrastructure for diagnosis, lack of access to newer therapies and the cost that comes with the diagnosis and its treatment. A recent systematic review published in the Lancet Gastroenterology and Hepatology emphasized the lack of representation of populations in South Asia, Africa and South America in global trials on IBD.
IBD, used for inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) are two serious, lifelong digestive diseases that affect around five million people worldwide. India is believed to have the second highest number of IBD cases across the globe. There is no permanent cure, no clearly established cause, and little or no public awareness of the pain and chronic suffering with which IBD patients face in their day-to-day life.
IBD is believed to be result from a number of causes. The inflammation of the gastrointestinal tract, ulcers, intestinal narrowing can occur in IBD. These are believed to result from an autoimmune attack on our guts which is mounted in response to inciting environmental stimuli in individuals who may have some genetic predisposition to IBD. The environmental stimuli believed to be responsible primarily are related to the dietary influences.
Anecdotally, gastroenterologists caring for IBD across the country speak of increasing numbers being seen in their OPDs. A recent analysis published in the Indian Journal of Gastroenterology suggests that the number of IBD patients has doubled in last three decades and the rise in numbers seems to be relentless. Epidemiologically, India is in the rising incidence phase of IBD i.e the numbers are likely to continue rising for few decades because they stabilise.
There is no certain reason why the number of IBD patients are increasing. In part, imrpvoed access to diagnostic services and increased penetration of gastroenterologists may have played a role. However, Westernisation of lifestyle and diet are believed to be the major factors responsible. In recent years, the diet and lifestyle of Indians has undergone a sea change- there is an increased intake of high fat and carbohydrates, increased intake of ultra-processed foods with exposure to food additive and a concurrent reduction in intake of fruits and vegetables. Studies in immigrants from South Asia including India to the Western countries have shown that they acquire a heightened risk of IBD clearly pointing to a role of environmental factors.
IBD can present in nonspecific manner. The symptoms are often confused with other diseases. Most patients would have chronic diarrhea (for >4 weeks), bleeding per rectum, abdominal pain, intestinal obstruction (abdominal pain with inability to pass faeces or wind), weight loss etc.
The diagnosis requires the performance of colonoscopy and sigmoidoscopy. These help the doctors see the mucosa of the gut and take biopsies. Pathological examination of these biopsies helps in making the diagnosis and also ensuring that there is no other disease that mimics IBD. Patients often need to undergo these endoscopic procedures multiple times over their lifetime to establish the extent of disease, or find out the reasons for worsening. There is an interest in establishing non-invasive strategies to monitor IBD patients. Role of certain fecal tests like fecal calprotectin is well established while there is an upcoming role of techniques in bowel ultrasound, generating hope that in future the need for endoscopy may be reduced.
IBD, although primarily a disease of the gastrointestinal system, is limited to the gut. Many extraintestinal manifestations are recognised including joint pains/arthritis, liver disease, anaemia, skin diseases, etc. Over years, there is accumulating bowel damage due to ongoing inflammation that may result in strictures or narrowing of the intestine, fistulas (abnormal communication of bowel with another organ), and there is an increased risk of colon cancer after years of disease. In fact , uncontrolled disease increases the risk of colon cancer, need for hospitalisation and risk of surgery.
The goal of treating patients with IBD is to ensure that patients are able to lead a normal life with some dietary precautions. Patients will need to be on some medication all their life as is true for many other chronic diseases. There is no known cure of IBD. Many drugs are available and the doctors endeavour to use the safest and cheapest therapies initially for the control of disease. Drugs like 5-aminosalicylates are often the most commonly prescribed. Short courses of steroids may be needed in those who do not respond and there may be a need to maintain disease control with use of immunomodulators like azathioprine. Multiple courses or prolonged use of steroids is risky as it may result in complications like diabetes, cataract, reduced immunity, acne, bone loss etc.
Many new therapies have become available in recent times. These targeted therapies are a result of decades of research that identified the molecules that are responsible for the inflammatory processed in IBD. Some of these targeted therapies are costly and put an enormous cost on the patients’ pocket. Some of the available biologics are infliximab, vedolizumab and ustekinumab. Some new oral small molecules, like tofacitinib, have also become available which are cheap but can be used only in a subset of the patients. Decisions to use these therapies are often taken after a discussion about pros and cons, costs and benefits with the patient. There is a need to expand access to these therapies by reducing costs and expanding access via insurance for these therapies.
Surgery has an important role in management of IBD. For some situations like intestinal structures, perianal fistulae complicated with abscess, severe bleeding, perforation of intestine or dilatation of the intestine may warrant surgery. There is a growing role of surgery in certain situations like limited involvement of some parts of intestine in Crohn’s disease especially if patient may not afford or prefer costly biological therapy. Surgery also be needed in patients who develop colon cancer.
In a study from PGIMER, stopping or non-adherence to therapy was one of the most common reasons of flare. The patients may stop therapy because of the costs, rampant beliefs about side – effects of drugs or when they get better believing they have been cured. Many fall prey to quacks promising permanent cure and return with a worse clinical situation. Use of painkillers, certain antibiotics, stress and gastrointestinal infections are also recognized as causes of disease flare.
We encourage patients to be active and follow their normal lifestyle. Patients should take hygienic well cooled food and avoid eating out. Eating a diet rich in fiber, vegetables and fruits is beneficial while high fat and high sugar diet should be avoided. Patients should consider getting vaccinated for various diseases for which adult vaccination is available and suggested by doctors. Patients should also pay attention to their bone health and follow the advice by their doctors in this regard.
A patient education program which will educate IBD patients is planned on 18th May, 2024 at 3 PM in Bhargava auditorium. The program will include lectures on what is IBD, therapies for IBD, dietary precautions in IBD and preventive care in IBD. We invite all patients with IBD to attend this program and benefit from the interaction with experts.
- PTC NEWS
