Diagnosis and Management Inflammatory bowel disease: What clinicians need to know
Inflammatory bowel disease(IBD) is a chronic disease of the gastrointestinal tract, characterized by recurring incidents of inflammation triggered by an abnormal immune response to gut microflora. The location of the lesion and depth of involvement in the bowel wall helps differentiate Crohn's Disease (CD) and Ulcerative Colitis (UC), the two forms of IBD. India tops the list in Southeast Asian (SEA) countries and is second globally only to the US in prevalence and continued rising incidence of the disease. There appears to be a North-South divide with more UC in north India and CD in south India.1
The age distribution of IBD is bimodal, with a presentation from the population in the age brackets of 15 to 30 years and the second peak after the age of 60 years.2 The epidemiology and disease characteristics of IBD mirrors the patterns observed in the West. The disease characteristics, long-term outcomes including the risk of colorectal cancer, effect of pregnancy on the disease and vice versa in Indian patients with IBD are much like those seen globally.2 Thus, learnings presented from global institutions such as Mayo Clinic, who are pioneers in innovative diagnostic techniques and development of new treatment modalities, are bound to add to the ever-expanding knowledge pool of healthcare practitioners.
Diagnosis of IBD involves a blend of clinical findings, inflammatory biomarkers, imaging findings, colonoscopies, and endoscopic biopsies. Yet, in India, nearly a third of CD patients get anti-tuberculosis drugs and a considerable number present with small intestinal bleeds which is predominantly afflicted by aggressive inflammation.1 Also, appropriate diagnosis requires to ruling out common infectious intestinal conditions such as parasitic diseases like giardia, amoebiasis, strongyloides, and tuberculosis. Fecal calprotectin levels are used as a marker for intestinal inflammation, however, they have inadequate diagnostic sensitivity and specificity for both UC and CD. The disease definition and treatment continue to be challenging and evolving. In India Colitis & Crohn's Foundation India (CCFI) is actively involved in providing the education centred around this challenging disorder, with the goal being improved patient outcomes.
There are several challenges in the management of patients diagnosed with IBD. Clinical decisions such as the use of biologic agents, step-down step-up approach, target clinical or deep remission, management of patient co-morbidities, non-response, loss of response, or adverse reactions further increase the complexity of the condition for the treating doctor. Further, these patients need a life-long follow-up, proper care and management. There is a considerable knowledge gap surrounding the care of patients with IBD, which makes education in this domain even more important.
Physicians are usually the first line HCPs that encounter patients with IBD, and a considerable amount of time is lost in detecting the cause of continued GI symptoms and failure to improve the condition. Association of Physicians of India (API) has also taken an initiative to educate physicians to increase awareness around the disease.
Keeping in mind the challenges that are faced in the management of IBD, several efforts are coming forward to supporting healthcare practitioners through enhanced learning and awareness about the condition. To start a dialogue among healthcare practitioners, three well-curated unique educational programs are currently being hosted online on MYSENSEI.TV , facilitated by Insignia learning and supported by an educational grant from Takeda India. Through these programs, recent updates from the most credible institutions such as Mayo Clinic, CCFI, and API have been made accessible for clinicians involved in the diagnosis and management of IBD.
Links to access these educational programs can be found below for your easy access:
1. Ray G. Inflammatory bowel disease in India - Past, present and future. World J Gastroenterol. 2016 Sep 28; 22(36): 8123–8136.
2. McDowell C, Farooq U, Haseeb M. Inflammatory Bowel Disease. 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470312/