On the occasion of World Digestive Health Day, it is worth remembering that the number of people with inflammatory bowel disease (EII) continues to grow in Spain. Every year, 10,000 new cases are diagnosed in our country. About 400,000 people suffer from it, although the number does not stop growing. Worst? Although it is also diagnosed at older ages, it usually debuts in young people, between 20 and 30 years old.
As it is a chronic pathology, people who suffer from it are forced to live with inflammatory bowel disease for many years. For this reason, IBD is usually characterized by a great loss in quality of life. Manage your symptoms (including intestinal cramps or diarrhea) is essential to living fully. However, half of patients with inflammatory bowel disease they do not achieve control of the disease in Spain.
This is the main conclusion of recent international research published in the scientific journal Digestive Diseases and Sciences and promoted by the biopharmaceutical company AbbVie. Spain has played a prominent role in her. Not in vain the sample includes patients from 10 countries, of which ours has contributed more than 18% of the study population with 396, being the second country to participate that contributes the most volume. Hence its results are also so relevant.
«The conclusions of the study are very interesting because they reflect a inadequate control of the disease in approximately 50% of treated patients, despite having received first-line treatments and advanced therapies in a high percentage,” reveals Dr. Maribel Vera, Section Head of the IBD Unit in the Gastroenterology and Hepatology Service of the Puerta de Hierro University Hospital (Madrid), who has contributed to the analysis.
In view of the results, it seems that clinical response to treatment is not sufficient to find out if people respond to drugs or therapy. «This shows that perhaps we have to do things differently; “The monitoring of patients after treatment would have to be carried out with more objective means when deducing at what point of response the patient really is,” warns the specialist.
«Our medical assessment should be even more incisive, before deciding whether to intensify the treatment or change it. This would lead us to rethink changes in our clinical practice», he points out. Perhaps, he says, the use of objective techniques should be expanded to assess the response to treatment, such as intestinal ultrasound, fecal markers (fecal calprotectin) or endoscopy, “which is the most effective weapon we have to know if there has been “There was a response at the intestinal level.”
Doctors specializing in the digestive system have increasingly more monitoring tools available, such as the aforementioned ultrasounds or fecal calprotectin, which facilitate non-invasive monitoring of the disease. “Nonetheless we use them less than we shouldso in some patients we are not able to detect this suboptimal control,” adds Dr. Rocío Plaza, from the Digestive Service of the Infanta Leonor University Hospital (Madrid).
Types of intestinal disease: Crohn’s and colitis
IBD includes two types of pathologies: Crohn’s disease and ulcerative colitis. Although both are characterized by chronic inflammation of the gastrointestinal tract and the high effect they have on quality of life, they are differentiated by the area of the digestive system that they affect. The small intestine and colon in the case of Crohn’s disease or the large intestine in the case of colitis
The results of this study “are significant, since a large proportion of the patients included were treated with advanced therapies,” says Dr. Fernando Gomollón, professor of Medicine at the University of Zaragoza, head of the Section of Inflammatory Bowel Disease at the University Clinical Hospital of Zaragoza and coordinator of the work in Spain.
Specifically, the 72.7% of patients with Crohn’s and 40.9% of patients with ulcerative colitis who participated were currently being treated with advanced therapies. Even so, in half of them the disease had not been controlled.
«In clinical practice, we have to see if the patient has improved serologically and through fecal markers, but there are also other markers, such as endoscopic and radiological markers, that make us see if medication or advanced therapy is really enough. Therefore, it is not that they do not receive the therapies, but that the disease with these therapies should be more controlled of what it is”, returns Dr. Vera.
It is estimated that in Spain around 1% of the population has inflammatory bowel disease (IBD). As Dr. Plaza points out and, according to data from the Ministry as of 2019, the prevalence in the community of Madrid would be 0.6-0.7%. “Therefore, calculating indirectly this would be about 40,000 patients,” she muses.
«We are currently trying to continue increasingly personalized strategieswith the help of biomarkers in blood, feces, genetic factors of the patient, endoscopic or ultrasound findings, which allow us to choose the best treatment for each patient at each moment of their illness,” says Dr. Plaza.
Excess corticosteroids in treatment
Regarding treatment, the study [llamado IBD Podcast] demonstrated a excessive use of corticosteroids, a result that is confirmed with the recent publication of the Spanish cohort of another international study, DICE CAPTURE. Among its authors is also Dr. Gomollón, and it was concluded that, in Spain, 31% of patients who receive corticosteroids end up being corticosteroid dependent.
Within this percentage, 86% have moderate to severe disease activity. As Dr. Gomollón points out, “this means that the long-term use of corticosteroids continues to be common in practice, which could result in avoidable side effects and a false sense of control of the disease, since this supposed stability presented by the patients is not because they are in remission, but because of the continued use of corticosteroids, with the risk that entails.
Many patients with inflammatory bowel disease are not cured
On the other hand, the IBD PODCAST also reflected that a large percentage of patients do not achieve mucosal healing. «Despite being treated, the fact that they do not achieve control of the disease highlights the need for closer monitoring and to continue having therapeutic options that allow us to achieve more demanding objectives to improve the quality of life of patients. », reiterates Gomollón.
One in three people with Crohn’s disease and one in four with ulcerative colitis who did not achieve control of the disease had lesions or alterations outside the gastrointestinal tract, the most common being psoriasis, peripheral arthritis and axial arthritis.
Inflammatory bowel disease and quality of life
The IBD PODCAST study also addresses aspects related to quality of life, through questionnaires that evaluated factors such as the burden of the disease, pain (both joint and abdominal) or fecal urgency, among others. As expected, patients who do not achieve control of their disease showed a lower quality of life, more pronounced in ulcerative colitis patients.
In them, in addition, the evaluation of fecal urgency revealed that 1 in 3 patients with ulcerative colitis (specifically 33.2%) could not contain their stools for at least 15 minutes. They also reported modifications to their activities to ensure a bathroom was nearby. In turn, these patients showed a significant impairment in daily activities in aspects such as tiredness or fatigue, pain, sleep or emotional state.
Finally, the study also demonstrated a greater consumption of healthcare resources and direct costs when inflammatory bowel disease is not controlled, especially in the case of ulcerative colitis. Likewise, a loss of work productivity was demonstrated in those patients who do not achieve control, compared to those who do.