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Understanding the
pathophysiology can help
bring
further clarity to IBD

Overview of IBD: Characteristics, symptoms, and complications

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of idiopathic conditions characterized by chronic gastrointestinal (GI) tract inflammation.1 The most common subtypes are Crohn’s disease (CD) and ulcerative colitis (UC).2

Click to view CD and UC characteristics, symptoms, and complications

Crohn’s disease
Silhouette of person with GI tract highlighted

Click to view CD characteristics, symptoms, and complications

Characteristics

  • Can affect any portion of the GI tract, predominantly the ileum3,4
  • Potential transmural involvement of all tissue layers (full-thickness inflammation)3

Symptoms

Symptoms may include diarrhea, abdominal pain, weight loss, fever, rectal bleeding, perianal disease, signs of malnutrition, abdominal mass, and growth failure in children and adolescents.4,6

Complications

Ulcerative colitis
Silhouette of person with ulcerative colitis highlighted

Click to view UC characteristics, symptoms, and complications

Characteristics

  • Limited to the colon and rectum3,5
  • Inflammation is limited to mucosal layer of colonic tissue3,5

Symptoms

Symptoms may include bloody diarrhea, abdominal pain, weight loss, fever, anemia, rectal bleeding, and signs of malnutrition.5,6

Complications

Prevalence and costs: The burden of IBD

Prevalence of IBD

IBD affects millions of people, not just in the United States, but worldwide as well.

Map showing IBD cases per country

Click to view economic burden

Economic burden

  • In the United States, the public health burden of IBD, including economic costs (direct and indirect) is quite substantial10
  • Annual indirect costs are estimated at an additional $5.5 billion in the United States, between €8 billion and €28 billion in Europe, and more than $1 billion in Canada11-14
  • In addition, productivity losses due to absenteeism and short-term disability also contribute to the indirect costs of IBD15

Estimated 2007 direct costs of IBD in the United States

IBD direct costs ($5.2 billion in United States*)10

Inpatient costs

  • Medical
  • Surgical

Outpatient costs

  • ER visits
  • Office visits
  • GI endoscopy
  • Lab pathology
  • Radiology

Medication costs

  • Outpatient
*$3.1 billion for CD; $2.1 billion for UC10

Managing IBD: Multiple therapeutic options

IBD can be managed through several options, including therapeutic, dietary, and surgical.

Click to view therapeutic options and other considerations

Therapeutic agents for IBD

Aminosalicylates

Target

  • MOA undetermined16

Safety profile

  • Nausea4
  • Vomiting4
  • Heartburn4
  • Diarrhea4
  • Headache4
Corticosteriods

Target

  • Glucocorticoid receptors17

Safety profile

  • Weight gain5
  • Acne5
  • Facial hair5
  • Hypertension5
  • Diabetes5
  • Mood swings5
  • Bone mass loss5
  • Increased risk of infection5
Immunomodulators

Target

  • Purine biosynthesis18
  • Cell proliferation18

Safety profile

  • Nausea4,5
  • Vomiting4,5
  • Diarrhea4
  • Fatigue5
  • Pancreatitis5
  • Hepatitis5
  • Reduced white blood cell count5
  • Increased risk of infection4
Biologics

Target

  • TNF-α18
  • a4 integrins18

Safety profile

  • Increased risk of infection, including opportunistic infections19
  • Tuberculosis19
  • Increased risk for lymphoma development
Antibiotics

Target

  • Luminal bacteria20

Safety profile

  • Metallic taste20
  • Coating of the tongue20
  • Nausea20
  • Vomiting20
  • Diarrhea20
  • Abdominal pain20
  • Headache20
  • Dark urine20
  • Lightheadedness20
  • Anxiety20
  • Agitation20
  • Confusion20
  • Photosensitivity20
Antidiarrheals

Target

  • Gut motility18

Safety profile

  • Constipation21
  • Flatulence21
  • Bloating21
  • Euphoria21
  • Excessive caloric intake21
  • Gastrointestinal discomfort21

Other IBD management considerations

Diet

  • No single diet or eating plan exists that will work for every patient22
  • Patients should follow a normal, healthy diet as tolerated22
  • Certain foods (eg, caffeine, fresh fruit, raw vegetables, foods that are high in fiber, fat, and sugar, etc) should be avoided to alleviate diarrhea and cramping related to IBD22

Nutrition

  • Smaller, more frequent meals are recommended for patients23
  • Oral liquid supplements during CD and UC flares23
  • A daily multivitamin/mineral complex may be beneficial in patients with IBD23
  • If required, enteral tube-feeding supplementation or parenteral nutrition may be necessary23

Surgery

  • Approximately 25% to 40% of patients with UC will require surgery at some time during the course of their illness24
  • Approximately 70% to 80% of patients with CD will require surgery within their lifetime25

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View complete references

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