Explosion of cases of inflammatory bowel disease

Explosion of cases of inflammatory bowel disease
Explosion of cases of inflammatory bowel disease

It is a modern and Western disease. Modern, because its incidence It started to be relevant just 30 years ago.; Western, because its appearance seems to be closely linked to the environment and diet. We are talking about inflammatory bowel disease (IBD) which, if nothing remedies it, is going to become one of the main and most urgent health challenges, given the sustained increase in its incidence and which today celebrates its World Day.

In Spain the figures are worrying: Nearly 400,000 people suffer from it and 4,000 new cases are currently diagnosed. «We estimate that around 0.8% of the Spanish population is affected. However, it is expected that, in the next five years, the percentage will increase to 1% of the population. That is, almost half a million people with IBD that affects both adults and children and adolescents,” warns Iago Rodríguez-Lago, doctor at the Digestive System Service, IBD Unit, at the Galdácano Hospital and member of the board of directors of the Spanish Working Group on Crohn’s Disease and Ulcerative Colitis (Geteccu).

«What is growing is the prevalence, that is, the number of cases we have in each population, because it is a chronic disease that mainly affects young people and has a very low associated mortality. This makes people live with it for many years.. As long as the incidence continues to increase slightly, the number of cases that we have to deal with in hospitals, and that will be seen in the population, will be increasing. That is the great challenge: if we are going to have more patients in the coming years or decades, how to cope to maintain quality care for all of them and offer the best treatment for everyone equally.

This upward trend highlights the urgent need to better understand the reasons leading to this increase. Because, although it is known that there are diverse Risk factors influence this fact, such as dietary habits, tobacco, genetic predisposition, some medications and others related to lifestyle, Its exact cause is unknown.

It is precisely described as a modern disease because it has state associated with the processes of industrialization, development, growth and acquisition of Western habits related to diet, lifestyle, etc. “We could say that in Spain the turning point could be between the 80s and 90s,” says Rodríguez-Lago.

But, What is this increase due to? «It is closely linked to risk factors, lifestyle… We know that diet is an important aspect. The foods we eat, how we preserve them, how we process them, how we cook them… This influences the intestinal microbiota. Life habits such as physical exercise, smoking habits, etc. also have an impact. In reality, the genetic predisposition or the genes we have have not changed that much, but our environment has changed much more than we have. Everything around us has changed and this causes the body, when faced with certain stimuli such as infections, certain foods and changes in the microbiota, to become inflamed,” continues the expert. These factors include the increase in the consumption of pre-cooked foods and smoking.

Chronic and complex

IBD is a chronic disease and encompasses two pathologies: It can cause inflammation of the large intestine and colon, leading to ulcerative colitis (UC), or it can cause inflammation in any part of the digestive tract, causing Crohn’s disease (CD).. Symptoms can vary in intensity, but frequently include diarrhea, abdominal pain, rectal bleeding, or general symptoms such as fatigue or weight loss. However, they all impact the quality of life of patients and their daily lives. And, although it can affect people of any age, it most often begins around 20-40 years of age.

It is also a complex disease. «In addition to the symptoms it produces, the inflammation associated with the disease and the outbreaks of activity cause progressive damage to the intestinal wall, which causes complications such as stenosis, abscesses or fistulas, which can appear both abdominally and perianally, which causes an even greater decrease in quality of life,” says Dr. Rodríguez-Lago.

The good news is the revolution that is being experienced in the field of treatments: from new pharmacological options to innovative biological therapies, they are making it possible to optimize care for people with IBD. “There is an incredible explosion of treatments,” says Yamile Zabana, vice president of Geteccu and assistant doctor of the Digestive System Service at the Mútua de Terrassa Hospital. A significant fact that confirms this point is what Rodríguez-Lago points out: «80-90% of the medications we use today have not been studied in our studies. And I can be considered young. Hence the importance of being up to date and transmitting information about the disease.

And the fact that the incidence continues to increase underlines the urgency of advancing a therapy that can cure the disease. Although Science has not found answers in this sense, it has taken great steps in addressing it. One of the advances in the field of research has been, as we said, the appearance of new drugs and, with it, the studies that allow us to compare the mechanisms of action of these new molecules.

«With the deepest knowledge of the pathophysiology of IBD new therapeutic targets have been generated, managing to optimize those already available so far,” says Dr. Zabana. And she adds: «Today, situations arise that force carry out a paradigm shift in IBD treatment. These paradigms include having an individualized therapeutic plan where the advantage of treating early with appropriate therapy must be considered; but also, the possibility of combining advanced therapies, doing cyclical treatments and even working with the ambitious goal of seeking the deepest remission possible.

And the arrival of biosimilars “which are going to revolutionize the biological market” or the use of so-called small molecules “which are a very interesting option for the treatment of IBD, even if it means that we learn to manage adverse effects “new ones” open the door to hope, as Zabana points out. Furthermore, he continues, ““We are learning that blocking IL23 seems to be the way.”.

In all this progress we must highlight the Spanish contribution, as an example Eneida, the largest database of IBD patients in the world. “It covers from 2012 to 2023. It is so important that the European Medicines Agency has recommended it as one of the most reliable when developing studies,” says Ana Gutiérrez, president of Geteccu.

Studies of all kinds, since IBD also has a high impact on people’s quality of life, becoming disabling in some cases. “Facing it involves dealing with challenges that transcend the physical, as it also has a profound impact on the emotional and social spheres,” says Marta Calvo, doctor attached to the Digestive System Service at the Puerta de Hierro-Majadahonda Hospital and member of the board. Geteccu directive. «In addition to this, social stigma linked to the disease can undermine mental health and hinder the social integration of those who suffer from it,” he acknowledges. Anxiety and depression are more prevalent in these people, and their social or sexual relationships are affected.

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