Explosion of cases of inflammatory bowel disease

This is a modern Western disease. Modern because of its prevalence This became relevant only 30 years ago.; Western because its appearance seems to be closely related to its environment and diet. We are talking about inflammatory bowel disease (IBD), which, if left untreated, will become one of the main and most pressing health problems given the steady increase in its incidence and which today marks its World Day.

In Spain the figures are alarming: It affects around 400,000 people and 4,000 new cases have now been diagnosed. “We estimate that about 0.8% of the Spanish population is affected. However, this percentage is expected to increase to 1% of the population in the next five years. That is almost half a million people with IBD, which affects both adults and children and adolescents,” warns Iago Rodríguez-Lago, a doctor in the digestive system of the IBD unit at Galdacano Hospital and member of the board of directors of the Spanish Working Group on Crohn’s Disease and Ulcerative Colitis ( Geteccu).

“The prevalence, that is, the number of cases we have in each population, is increasing because it a chronic disease that mainly affects young people and has a very low mortality rate. This forces people to live with it for many years.. As long as the incidence continues to increase slightly, the number of cases we have to deal with in hospitals and that will be seen in the population will continue to increase. This is a major challenge: if we have more patients in the coming years or decades, how to cope with this to ensure quality care for everyone and offer the best treatment to 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 various This fact is influenced by risk factors such as dietary habits, smoking, genetic predisposition, taking certain medications and other lifestyle factors. Its exact cause is unknown.

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

But, What is the reason for this increase? “It is closely related to risk factors, lifestyle… We know that nutrition is an important aspect. The foods we eat, how we store them, how we process them, how we cook them… This affects the intestinal microbiota. Life habits such as exercise, smoking, etc. also have an impact. In fact, genetic predisposition or our genes have not changed that much, but our environment has changed much more than we have changed. Everything around us has changed, and this leads to inflammation in the body when faced with certain irritants, such as infections, certain foods and changes in the microbiota,” continues the expert. These factors include increased consumption of processed foods and smoking.

Chronic and complex

IBD is a chronic disease and includes two pathologies: It can cause inflammation of the colon 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 often include diarrhea, abdominal pain, rectal bleeding, or general symptoms such as fatigue or weight loss. However, they all affect the quality of life of patients and their daily life. Although it can affect people of any age, it most often begins between the ages of 20 and 40.

This is also a complex disease. “In addition to the symptoms it causes, the inflammation associated with the disease and outbreaks of activity cause progressive damage to the intestinal wall,

which causes complications such as stenosis, abscesses or fistulas, which can occur both abdominally and perianally, leading to an even greater decrease in quality of life,” says Dr. Rodriguez-Lago.

The good news is the revolution that is taking place in the field of treatment: From new pharmacological options to innovative biological treatments, they are helping to optimize care for people with IBD. “There is an incredible explosion of treatment options,” says Yamile Zabana, vice president of Geteccu and assistant physician of the digestive system service at Mutua de Terrassa Hospital. A significant fact that supports this point of view is what Rodriguez-Lago points out: “80-90% of the drugs we use today have not been studied in our studies. And I can be considered young. Therefore, it is important to stay informed and communicate information about the disease.

And the fact that incidence continues to rise underscores the urgency of developing therapies that can cure the disease. Although science has not found answers in this sense, it has taken great strides in solving this problem. One of the achievements in the field of research was, as we have already said, the emergence of new drugs and, at the same time, studies that allow us to compare the mechanisms of action of these new molecules.

“With in-depth knowledge of the pathophysiology of IBD new therapeutic targets have been created, we have been able to optimize those that are already available,” says Dr. Zabana. And he adds: “Today situations arise that force bring about a paradigm shift in the treatment of IBD. These paradigms include having an individualized treatment plan that takes into account the benefits of early initiation of appropriate therapy; but also the possibility of combining advanced treatments, performing cyclic treatments and even working towards the ambitious goal of achieving the deepest possible remission.

And the advent of biosimilars, “which will 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 the side effects.” “open the door to hope,” as Zabana points out. Moreover, he continues: ““We understand that blocking IL23 appears to be the answer.”

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

Research of all kinds, since IBD also has strong impact on people’s quality of life, in some cases leading to disability. “Making a decision requires solving problems that go beyond the physical, since it also has a deep impact on the emotional and social spheres,” says Marta Calvo, doctor of the digestive system service of the Hospital Puerta de Hierro Majadahonda and member of the Geteccu directive. “In addition to that, The social stigma associated with the condition can undermine mental health and hinder the social integration of those who suffer from it,” he admits. These people have higher rates of anxiety and depression, and their social and sexual relationships suffer.