Inflammatory Bowel Disease in 2023 : It ’ s Not Just Bugs and Drugs
On Tues ., Oct . 3 , the GLMS Foundation Senior Physicians Speaker Series welcomed Dr . Tad Dryden to speak on inflammatory bowel disease ( IBD ). Dr . Dryden is a Professor of Medicine in the Division of Gastroenterology , Hepatology and Nutrition and Director of the IBD Program at the University of Louisville .
There are two faces of IBD : ulcerative colitis ( UC ) and Crohn ’ s disease ( CD ). UC is focused on the colon and is a mucosal disorder ; while the mucosa may be thickened and have ulcerations , the bowel wall is not nearly as impacted as with CD . The peak onset of UC is 30-40 years . Conversely , CD most commonly affects the small and large intestines . The peak onset of CD is 20-30 years . In the U . S ., approximately 1.2 million individuals carry a diagnosis of IBD , and that total increases by over 70,000 new patients each year .
Baseline symptoms of the two diseases are the same : abdominal pain , change in stool frequency / consistency and altered bowel habits . But there are distinct differences . CD causes intermittent pain in the right lower quadrant . The pain of UC is less frequent , is crampy in nature and is often in the left lower quadrant . Stool frequency is variable in both disorders , but CD is less likely to
by KATHRYN VANCE contain blood , whereas blood is one of the hallmarks of ulcerative colitis . In CD , there may be pain or rectal bleeding , while UC can present with constipation , tenesmus or severe urgency .
Though their acronyms sound similar , it is important to differentiate between IBD and IBS ( irritable bowel syndrome ). IBS is about 10 to 30 times more common than either form of IBD , though they have similar symptomatology . Mucus production is common in IBS but if there is blood in the mucus , that ’ s indicative of IBD . Blood in the stool favors IBD and is more likely in UC than CD . It ’ s important to look for evidence of systemic , extraintestinal manifestations because those would be absent in IBS , but present in many cases of IBD . Many patients with IBD will have a preceding perianal abscess , fistula or fissure that may predate onset of IBD by many years . In looking at extraintestinal manifestations , about a quarter of IBD patients will have symptoms such as anemia , fever , malaise , fatigue , eye , skin and joint symptoms up to a couple of years before the onset of IBD . About 75 % will manifest these months to years after the diagnosis .
With many medications on the market , there are varying levels of remission in trials . One of the problems in the world of IBD is measuring efficacy - clinical endpoints are not hard and fast . For example , when using the Mayo score to assess disease severity , it
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