Treating inflammatory bowel disease in India a challenge

IBD can affect any age group, the youngest can be of one-year, and the oldest 70-years.
Image used for representational purpose only.
Image used for representational purpose only.

It is important to distinguish between Inflammatory Bowel Disease (IBD) – particularly Crohn’s disease – and tuberculosis as the symptoms of intestinal TB and small bowel Crohn’s disease are almost the same. Starting treatment early and ensuring patients continue with it is necessary, says Dr T S Chandrasekar, chairman and chief gastroenterologist, MedIndia Hospitals, Chennai, in an interview with Sinduja Jane. Edited excerpts:

What is IBD?

IBD is a chronic autoimmune disease of the large intestine and small intestine. The term inflammatory bowel disease refers to Crohn’s disease and ulcerative colitis. Ulcerative Colitis predominantly affects the large bowel. Sometimes it affects the eyes, joints and the skin which is called extra intestinal manifestation.

IBD can affect any age group, the youngest can be of one-year, and the oldest 70-years. It affects both men and women. Crohn’s disease affects predominantly the young age group and ulcerative colitis affects the middle age group.

What are the causes of IBD?

There is no single cause for IBD. It is an autoimmune disorder in which the body’s immune system attacks healthy tissues. Consumption of refined food, lower fibre diet, family history and hereditary factors are other suspected causes.

What are the symptoms to look out for?

In Crohn’s disease, symptoms would be diarrhoea, malaise, weakness, tiredness, loss of energy and increased bowel movements. Usually there is no bleeding in rectum. If the large intestine is affected then the symptoms would be increased bowel frequency, blood in stool, severe anaemia, nutritional deficiency and others.

How is IBD diagnosed?

Inflammatory Bowel Disease is diagnosed with CT and MRI scans of the intestine. It is also done with endoscopy where a flexible tube with a camera (enteroscopy) is passed from mouth to the intestine and biopsy of the small intestine can clinch the diagnosis.

Colonoscopy is the most important test where in an endoscope is passed through the anus to look into the entire large intestine. Colonic mucosal biopsy will reveal the evidence of ulcerative colitis. Blood tests and others are also needed to diagnose extra intestinal manifestation of IBD.

What are the treatment options available?

Treatment for Crohn’s disease and ulcerative colitis are different. But in both, nutritional deprivation, albumin and proteins, and vitamin deficiencies are tested. There are two types of treatment – step up treatment and top down therapy. In step up treatment, medication is started step-by-step as per needs, from anti-inflammatory and immunosuppressive drugs to steroids.

In top down therapy, the strategy involves early, aggressive therapy with biologics and immunomodulators. The aim is to prevent severe complications and induce remission.

During treatment, the family and patient should be given psychological counselling  and should be explained about the treatment and its outcome.

As Crohn’s disease sometimes presents with strictures – block and obstruction in the small intestine – it needs surgical intervention. Some of the complications of Crohn’s disease are internal and external fistula, formation of abscess which may require antibiotics and surgical intervention.

IBD should be treated with steroids, anti- inflammatory, immunosuppressants and monoclonal antibodies. Some patients may not tolerate milk, egg, and gluten in wheat products which need to be avoided as per the advice of the treating doctor.

What are the challenges in treating IBD in India?

In India diagnosing and treating IBD early is a challenging task as Crohn’s disease mimics tuberculosis.

It is very important to differentiate between the two. In western countries, as TB is not an issue, diagnosing Crohn’s is easy.

As IBD affects both rich and poor, and literate and illiterate equally, creating awareness on IBD is important. Also, treatment should be continued for years, in some cases lifelong. Some patients discontinue the treatment if their symptoms are better. They might relapse.

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