Identifying and understanding disease burden in patients with inflammatory bowel disease

After a brief break we return in November for a new blog focusing again on inflammatory bowel disease. In this article the authors take a novel approach to determining the disease burden on patients. Rather than focusing on factors linked to clinician measurable markers of disease activity, such as blood results, faecal calprotectin or endoscopic/histological measures, the team determine what matters most to patients. We also take a quick look at a recent article in Gut looking to delineate the causes and treatment of irritable bowel syndrome, and treat patients with a personalised approach. As always, there are a fantastic range of articles published in BMJOG within the last month and these can all be accessed free-of-charge on the website.

In their BMJOG article Christensen et al focus on identifying and understanding disease burden in patients with inflammatory bowel disease, using a patient centred approach. There is an understandable temptation for clinicians to focus on measurable targets when treating patients with IBD. The team aimed to identify the concepts most important for patients using a survey targeting patients with IBD currently on biologic therapy. They report the findings of 172 completed surveys included 13 questions on attitudes toward symptoms and issues related to IBD. The majority of patients had Crohn’s disease, were female and were around 40 years of age. Interestingly fatigue (57%) and stool frequency (46%) were the most important factors identified that affected quality of life. This highlights the important of not solely relying on numerical markers of disease activity, or purely on gastrointestinal symptoms, when assessing the impact of IBD on patients. Discussing general emotional health and specifically addressing issues around fatigue remains vitally important for the clinician when consulting with a patient.

Camilleri and colleagues have published a recent article in Gut focused on targeting treatment in IBS based on pathophysiology and biomarkers. This fascinating article, performed in the style of a systematic review, highlights the availability of non-invasive clinical tests that may be employed to determine the underlying cause for IBS symptoms. These include assessing for rectal evacuation disorders, abnormal transit, visceral hypersensitivity or hypervigilance, bile acid diarrhoea, sugar intolerances, barrier dysfunction, the microbiome, immune activation and chemicals released by the latter mechanism. The authors infer that treatments could now be individualised to the cause of the symptoms, guided by pathophysiology and clinically identified biomarkers. It is also really important to remember the functional and psychological aspects of IBS and GI illness, and to assess the patient in a holistic way. Not becoming overly focused on continued tests remains vital if there are ways of addressing the symptoms and improving the patient’s quality of life.

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