The silence surrounding IBD has been plaguing patients who suffer from Colitis and Crohn’s disease. Symptoms are not only discomforting, but they are lifelong with complexities which have physical, psychological, and sociological impact. The result of an accelerated inflammatory immune response, the causes of IBD are still being studied with the current consensus of bacteria in the gut changing its morphology being a probable cause. According to experts, to treat IBD, complementary and alternative medicine therapies can be vital in creating a holistic approach to managing the condition in conjunction with conventional treatments.
What causes IBD?
According to Dr. Malik, Senior Associate Consultant, Assistant Professor of Medicine-Gastroenterology at the Mayo Clinic, and Director of Inflammatory Bowel Diseases
Gastroenterology and Hepatology Consultant Physician at Department of Medicine -
Sheikh Shakhbout Medical City, Abu Dhabi, UAE, while the cause of inflammatory bowel disease (IBD) is unknown, IBD describes two disease entities, Crohn's disease (CD) and ulcerative colitis (UC). These result from an uncontrolled immune mediated inflammatory response in genetically predisposed individuals to a still unknown environmental trigger that interacts with the intestinal flora and primarily affects the gastrointestinal tract.
Based on North American data, there is no consistent significant difference observed in the prevalence or incidence of IBD between males and females. However, some cohorts have indicated a female predominance in Crohn’s disease and a male predominance in ulcerative colitis. However, according to Dr Malik, these findings are not consistent.
While there is variation in data, estimates for point prevalence of IBD, based on North American is between 25-300 persons per 100,000. While IBD can occur at any age, the peak age of onset for Crohn’s is considered to be between 20-30 years of age and for ulcerative colitis, it is between 30-40 years. There is then another peak, especially for UC between 60-70 years of age based on some European studies.
“There are several potential risk factors for the development of IBD. These include peculiar environmental triggers, intestinal immune mechanisms, heritable factors, gut flora, diet, mesenteric fat, certain medications, nicotine (tobacco smoking), infectious agents, stress as well as lifestyle,” he explains.
Source: SSMC, https://ssmc.ae/
Numerous cases of patients across Middle East and Africa have described having IBD as inconvenient, painful, and embarrassing, with 84 per cent of adults living with ulcerative colitis saying the condition is mentally exhausting. Whereas 30 per cent of patients relayed that there was a gap in communication between physicians and patient in discussing how the IBD impacts their mental health.
“It’s a vicious cycle,” says Dr Malik, “from epidemiological data, people with genetic predisposition to IBD or people with higher stress levels in their life were more prone to being diagnosed with Crohn’s and Colitis. These pain inducing conditions can cause patients to feel stressed, anxious, and even suffer from depression. Specialists can attend to your colon health but that may still leave psychological needs unaddressed. As physicians, it is crucial for us to not only focus on the physical aspect but play close attention to emotional health as well. We need to focus on patient metrics which are based on patients continuing their lives without hindrances caused by the condition. Through a holistic, multidisciplinary approach we have witnessed success in IBD treatment. However, to successfully ensure patient treatment and care is improving at large, our vision should have the best-practice treatment for IBD.”
Break the silence
In a virtual round table held by Pzifer to ‘break the silence’ on World IBD day by raising awareness, renowned specialists spoke about the impact of the condition. “Considering the implication of gut health on the brain, linked as they are through a complex system of nerves and biochemical signals, it is not only the social implications of the disease that impact mental well-being. In recognition of this fact, we want to encourage patients to break the silence, speak with their doctors and ask them for their support. By asking for help, doctors can connect patients with advocacy and patient support groups, which are an ideal forum for sharing experiences and helping patients alleviate the psychological burden of IBD and reducing feelings of isolation. These can be vital to the creation of a roadmap to get back a sense of emotional well-being after suffering from a chronic disease such as IBD,” says Dr. Cecilio R. Azar, Clinical Associate, Division of Gastroenterology, Clemenceau Medical Center (CMC), Consultant Gastroenterology and Hepatology, Middle East Institute of Health (M.E.I.H), Lebanon.
“As a chronic disease impacting both physical and psychological well-being, patients with IBD can face a lifetime of challenges impacting both work productivity and relationships if not properly managed. The invisibility of the disease can make it particularly challenging for patients to communicate the negative impact that IBD can have on their day-to-day lives,” comments Yasser El Dershaby, Vice President of Pfizer and Medical Affairs Lead for Africa and Middle East Region.
Future of IBD patient care in the UAE
Sheikh Shakhbout Medical City, one of the UAE’s largest hospitals for serious and complex care, and a joint-venture partnership between Abu Dhabi Health Services Company (SEHA) and Mayo Clinic, launched a comprehensive centre for inflammatory bowel disease in Abu Dhabi. The centre would offer dedicated, multidisciplinary services inclusive of biological medicines, minimally invasive robotic surgery, and as part of its set of services the SSMC IBD Center has onboarded a new dedicated, multidisciplinary team of experts that will be delivering surgical, endoscopic, nutritional, radiological, pharmaceutical, and eventually behavioural health services, amongst others.
“The close cooperation between gastroenterology and colorectal surgery specialists is an essential aspect of the comprehensive and patient centred care. IBD is a unique and challenging disease. Patients benefit the most when they are seen and managed by a collaborative team of specialists from the outset to select the most appropriate treatment plan for every individual patient,” says Dr. Faek El Jamali, division chair of Colorectal Surgery, SSMC.
“IBD patients are at significantly greater risk of pre-cancerous lesions of the colon which are typically difficult to see and remove. Therefore, employing advanced methods of detection such as chromoendscopy (both digital and blue dye) and the removal of these through endoscopes as opposed to surgery,” adds Dr. Michael Wallace, Gastroenterology and Hepatology consultant and division chair, SSMC.
Chromo colonoscopy, or chromoendoscopy, is an adjunctive procedure which refers to the application of topical dying or digital optical filters during an endoscopy in order to identify otherwise difficult to see abnormalities. A rare procedure at UAE facilities, it is being offered by SSMC IBD Centre.
To further improve understanding and publish sound epidemiological data for IBD in the UAE, SSMC is actively seeking to create the first IBD consortium in Abu Dhabi. “This registry will encompass every IBD patient in the emirate and will enable us to conduct robust observational research and put into place a clinical trials infrastructure that directly aims to address the needs of our local IBD patients,” concludes Dr Malik.