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Un-promoted issues in inflammatory bowel disease: opportunities to optimize care
J M Andrews1, R E Mountifield, D R Van Langenberg
1Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, and School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia. jane.andrews@health.sa.gov.au
Insights
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, require attention beyond acute flares. This review highlights crucial "un-promoted issues" impacting patient quality of life and long-term management.
Area of Science:
- Gastroenterology and Internal Medicine
- Chronic Disease Management
- Patient-Reported Outcomes
Background:
- Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions causing significant morbidity and reduced quality of life (QoL).
- Current medical management predominantly focuses on acute disease flares, with a trend towards prioritizing intensive therapies for severe cases.
- This focus on acute care and newer therapies, driven by clinical trial requirements, risks neglecting essential non-acute aspects of IBD management.
Purpose of the Study:
- To identify and review critical 'un-promoted issues' in the management of IBD that receive insufficient attention.
- To emphasize the importance of addressing psychosocial burden, comorbidities, maintenance, and lifestyle factors in IBD care.
- To advocate for a more comprehensive approach to IBD management that includes these often-overlooked aspects.
Main Methods:
- Literature review focusing on 'un-promoted issues' in IBD management.
- Analysis of the current IBD treatment landscape, highlighting imbalances in research and clinical focus.
- Synthesis of information on the importance and treatment strategies for psychosocial factors, comorbidities, maintenance therapy, smoking, reproductive health, and nutritional deficiencies.
Main Results:
- Key 'un-promoted issues' identified include psychosocial burden, QoL, psychological comorbidities, functional gastrointestinal disorders (FGIDs), maintenance therapy, compliance, smoking (CD), sexuality, fertility, family planning, pregnancy, iron deficiency, and anemia.
- These issues significantly impact patient morbidity and QoL but are often under-addressed in clinical practice and research.
- Existing literature and management guidelines show a disproportionate emphasis on acute care and novel therapeutics.
Conclusions:
- A significant gap exists in IBD management, with critical 'un-promoted issues' requiring greater clinical and research attention.
- Addressing these neglected aspects is essential for improving the overall QoL and long-term well-being of individuals with IBD.
- A balanced approach integrating acute care with comprehensive management of chronic, non-acute issues is crucial for optimal IBD patient outcomes.
Abstract:
Inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gut, which lead to significant morbidity and impaired quality of life (QoL) in sufferers, without generally affecting mortality. Despite CD and UC being chronic, life-long illnesses, most medical management is directed at acute flares of disease. Moreover, with more intensive medical therapy and the development of biological therapy, there is a risk that management will become even more narrowly focused on acute care, and be directed only at those with more severe disease, rather than encompassing all sufferers and addressing important non-acute issues. This imbalance of concentration of medical attention on 'high-end' care is in part driven by the need to perform and publish randomized clinical trials of newer therapies to obtain registration and licensing for these agents, which thus occupy a large proportion of the recent IBD treatment literature. This leads to less attention on relatively 'low-technology' issues including: (i) the psychosocial burden of chronic disease, QoL and specific psychological comorbidities; (ii) comorbidity with functional gastrointestinal disorders (FGIDs); (iii) maintenance therapy, monitoring and compliance; (iv) smoking (with regard to CD); (v) sexuality, fertility, family planning and pregnancy; and (vi) iron deficiency and anaemia. We propose these to be the 'Un-promoted Issues' in IBD and review the importance and treatment of each of these in the current management of IBD.
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