About IBD

Inflammatory bowel disease (IBD), an idiopathic and inflammatory disorder of the gastrointestinal tract, comprises primarily two disorders: ulcerative colitis and Crohn's disease (1). Approximately 1 million people in the United States have been diagnosed with IBD and an additional 30,000 people are newly diagnosed each year. The incidence is evenly divided between ulcerative colitis and Crohn's disease. Approximately 10%-20% of patients will present with an initial diagnosis of indeterminate colitis, because a primary diagnosis is not possible (2). As the following diagram illustrates, there is considerable overlap between the 3 entities (2).

Illustration 1 : Overlapping clinical features of Crohn's disease, indeterminate colitis and ulcerative colitis (3)
overlap

While IBD may be diagnosed at any age, the peak age of onset is between the ages of 15 and 30, with 10% of cases occurring in patients less than 18 years of age (1). The prevalence of IBD is higher in people with Caucasian and Ashkenazic Jewish origin (1). Ulcerative colitis occurs slightly more frequently in males; whereas Crohn's disease occurs slightly more often in females (1). IBD can cause significant morbidity and results in 700,000 physician visits and 100,000 hospitalizations each year in the United States (1).

Uncontrolled inflammation of the intestinal mucosa in IBD causes ulceration, edema, bleeding, and other symptoms of IBD (4, 6). Ulcerative colitis is limited to inflammation in the colon and rectum while Crohn's disease can involve any segment of the gastrointestinal tract from the mouth to the anus (5). Transmural inflammation is typical of Crohn's Disease, whereas in UC the inflammation is limited to the mucosa (6). Multiple factors including environmental triggers, genetic predisposition, immunoregulatory defects, and microbial exposure are likely involved in the development of mucosal inflammation (1).

Because objective measures are inadequate to completely assess the overall well-being of a patient with a chronic illness (i.e., social, cultural, psychological, and disease-related factors), health-related quality of life (HRQOL) instruments have been developed to provide insight into the nature of the disease experience from the patient's perspective. One such instrument is the Inflammatory Bowel Disease Questionnaire (IBDQ) which is disease specific and has been validated for its use in IBD (6).

Use of the IBDQ has shown that patients with IBD have an impaired quality of life compared with the general population (6). Additionally, in two surveys conducted on behalf of the Crohn's and Colitis foundation, one for UC patients and the other for CD patients, patients reported that the symptoms of IBD (such as severe abdominal pain and sudden, uncontrollable urge for bowel movements) can significantly affect their physical, emotional, and social well-being (7, 8). According to CD patients in one of these surveys, the disease has an impact on virtually every aspect of their lives. Increasing the quality of life in IBD patients is a major treatment goal.


References

  1. Hanauer SB. Inflammatory Bowel Disease: epidemiology, pathogenesis, and therapeutic opportunities. Harrison's Internal Medicine Online. 2006: The McGraw-Hill Companies; 12 (Suppl 1): S3-S9. Available at: http://www.ccfaprofessionals.org/site/
    c.fqKLLSOvElH/b.1428201/k.58F4/Advances_in_Treatment.htm.
  2. Schölmerich J, Warren B. Differential diagnosis and other forms of inflammatory bowel disease. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 199-217.
  3. Adapted with permission from: Schölmerich J, Warren B. Differential diagnosis and other forms of inflammatory bowel disease. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 199-217.
  4. Pallone F, Monteleone G, Monteleone I, Biancone L. The immune system in inflammatory bowel disease. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 85-93.
  5. Rowe WA. Inflammatory Bowel Disease. Emedicine from WebMD. Available at: http://www.emedicine.com/med/topic1169.htm. Accessed June 23, 2006. Last updated May 23, 2006.
  6. Friedman S, Blumberg RS. Inflammatory Bowel Disease. In: Harrison's Internal Medicine. McGraw-Hill Access Medicine. 2006. The McGraw-Hill Companies. Available at: http://www.accessmedicine.com/content.aspx?aID=90323.
  7. The Voices of Crohn's. Available at: http://www.crohnsresource.com/voices/about.html. Accessed June 25, 2006.
  8. The Voices of UC. Available at: http://www.livingwithuc.com/voices/survey_findings.jsp. Accessed June 25, 2006.
Previous Page | Next Page