Guest blog written by Ryan Ungaro, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology, The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center.
More than 3 million people in the United States alone suffer from inflammatory bowel disease (IBD) and thousands of new cases are being diagnosed every year. Worldwide, more than 5 million people are living with IBD, according to the Crohn’s & Colitis Foundation of America. In 2011, the U.S. Senate passed a resolution making December 1-7 Crohn’s & Colitis Awareness Week. Chances are that even if you do not have the disease, you know someone who does. But there is hope.
First, what exactly is IBD? There are two main types of IBD: Crohn’s disease and ulcerative colitis. Crohn’s disease leads to inflammation anywhere in the gastrointestinal tract, though most commonly in the small intestine, whereas ulcerative colitis causes inflammation in the large intestine or colon. Both cause a variety of symptoms—including chronic diarrhea that may or may not go into periods of remission, mild to severe abdominal pain, fatigue, and malnutrition— and can have a major impact on quality of life. While the cause of IBD is still unknown, it involves the interplay of genetic predisposition, an abnormal immune system response, and environmental factors.
It was previously thought that IBD patients experience periodic flares that could be treated to eliminate inflammation and return the gastrointestinal system to a normal state. However, we now understand that IBD is a progressive disease. Over time, inflammation can cause irreversible damage to the intestines, culminating in structural and functional complications such as surgery (bowel resections), abscesses, fistulas, abnormal intestinal motility, and malnutrition.
IBD treatment is now shifting to an early intervention approach. Emerging evidence suggests that there may be a “window of opportunity” early in the course of IBD during which treatment is most effective and can decrease the chance of serious, longer-term complications. The most effective medications, specifically anti-tumor necrosis alpha (anti-TNF) agents such as infliximab and adalimumab, work better when used earlier in the disease course during this “window of opportunity.”
Analyses of clinical trials have demonstrated significantly higher response rates to anti-TNF agents when used within 1-2 years from diagnosis. One study based on national health claims data compared Crohn’s disease patients who used anti-TNF agents early with those treated with a “step up” approach in which less potent medications were used first and advanced as needed at a later stage. Patients who were treated within one year of diagnosis (defined as the early approach) were less likely to need surgery during the first two years of disease. In addition, a study that randomized entire physician practices to use either early anti-TNF treatment or the conventional management approach also found that IBD patients treated early had fewer hospitalizations, surgeries, or disease-related complications over a two-year period.
We now have a better appreciation for the progressive nature of IBD and that we should be using the most effective medications earlier in the disease course. An early intervention approach can ultimately improve IBD patients’ lives and potentially alter the natural history of the disease.
If you have been recently diagnosed with IBD, or are currently struggling with these diseases and want to learn more about new therapies, please feel free to make an appointment to consult with me at the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center.