How to Improve Outcomes
Jamie Bussin and Dr. Vipul Jairath
Inflammatory bowel diseases (IBD) are chronic immune-mediated disorders affecting the gastrointestinal tract. Ulcerative colitis (UC) and Crohn’s disease (CD) are the most common IBDs. The symptoms of IBD include abdominal pain, vomiting, diarrhea, and in the case of UC specifically, rectal bleeding. In the long term, patients with IBD have an increased risk of cancer. The origins of IBD can be traced to a complex interplay of genetic and environmental factors coupled with abnormal immune responses to microbes in the gut. According to 2019 estimates, there are about 4.9m people with IBD in the world. Canada has among the highest rates of IBD in the world for reasons that are not fully understood.
One of the key challenges to treating IBD is the delay in diagnosis. People can have symptoms for a year or more, before they get the diagnosis. According to Dr. Vipul Jairath, “That’s because some of the symptoms can be quite non-specific to start with – vague abdominal pain, gas or slight change in the bowel habit. We typically put this down to ‘something that we ate’ or a bug.” But when the symptoms persist, or present as “red flags” (ie. blood in the stool, significant weight loss) medical attention must be sought.
If IBD is suspected, the gold standard test is a colonoscopy. A flexible camera, under anesthesia, is inserted into the large bowel (colon), through and to the small bowel, so that the area can be visualized. If it looks like UC or CD is present, tissue samples are taken. Some people may have CT or MRI scans (particularly with CD) which can take a picture of the whole bowel for diagnostic purposes.
Dr. Jairath recently co-authored a report which shows early interventions to patient care will improve outcomes and save our healthcare system millions. On episode #285 of The Tonic Talk Show, Dr. Jairath discussed the key takeaway points from the report:
- There is an increasing number of people in Canada living with UC and CD -currently over 300,000 (0.8% of the population). That is expected to increase to 1% of the population by 2035
- Accordingly, care needs to improve. We need streamlined pathways of care so that people suffering with IBD can access specialists earlier (circa diagnosis) and have good access to the good therapies that exist. Early access to good treatments can prevent complications
- Within the treatment pathway Canada needs not only specialist MDs but also specialist nurses. They can be crucial access points for patients, prevent hospitalization and provide education. There are many other allied health care practitioners such as dieticians, mental healthcare professionals relevant to effective treatment
- We need to better engage technology:To better provide information to patients, but also to monitor patients remotely. Via telehealth, patients can better connect with their treating practitioners and perhaps earlier during flare-ups of the condition and initiate therapy
- Lastly, more investment in research is needed. Although there are very good treatments available, some are expensive to develop and patients react differently. Getting effective treatment for a patient is still a matter of trial and error. The “holy grail” would be personalized treatment -which currently doesn’t exist for immune conditions like IBD.
Dr. Vipul Jairath is a professor of medicine and chair in IBD clinical research at Western University.
