Abstract
Ulcerative colitis and Crohn disease are relatively common inflammatory diseases of the gastrointestinal tract that have unknown causes. A combination of abnormalities in genetics, the immune system, and the microbiome of the gut may cause inflammatory bowel disease (IBD). The majority of patients with IBD are in their late teens or early twenties. Most present to their primary care physician for a diagnosis. Although gastroenterologists and surgeons do most of the endoscopy and management of IBD, these patients require a great deal of health maintenance that many never receive. Osteopathic primary care physicians can play a pivotal role in the care of patients with IBD by understanding what areas of the body are affected by the disease and what screening and monitoring are needed to keep patients healthy with the highest quality of life possible.
Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn disease (CD) and affects a large portion of the US population. The majority of patients with IBD have either UC or CD, are in their late teens or early twenties, and have a family history of IBD. The incidence and prevalence of UC are 2.2 to 19.2 per 100,000 person-years and 238 per 100,000 population, respectively, and of CD are 3.1 to 20.2 per 100,000 person-years and 201 per 100,000 population, respectively.
1(p1941) Idiopathic IBD comprises conditions characterized by chronic or relapsing immune activation and inflammation within the gastrointestinal tract.
The cause of UC and CD is unknown, but current evidence
2 indicates that there are probably abnormalities in 3 body systems involved in the pathogenesis of IBD: genetics, immune system, and the microbial milieu of the colon. First, there are now more than 100 genes linked to CD, UC, or both.
2 Second, perturbations of both the innate and adaptive immune system help to induce a continuous inflammatory process in the gut that causes most of the intestinal damage seen in patients with IBD. Most of the current medications used to treat patients with IBD are aimed at halting the abnormal immune function in the gut. Third, the microbiome in the gut of the individual affected with IBD plays an important role in the pathogenesis of IBD. By providing antigens that cross the epithelial barrier in the gut and initiate the inflammatory process in an individual with the genetic and immune abnormalities already mentioned, the bacterial population in the colon plays a major role in the etiologic process of IBD.
For the most part, UC affects only the mucosal layer of the colon, but CD is transmural and can be found anywhere from the mouth to the anus. This characteristic explains why patients with CD may develop fistulas and abscesses and patients with UC do not.
1(pp1948-1949)
A 2008 study
3 reported that patients with IBD receive less primary care, fewer screening tests, and less maintenance care than patients without IBD. According to a survey-based study by Sinclair et al,
4 gastroenterologists and family physicians believed that vaccines in patients with IBD were the responsibility of the other physician and not themselves. A similar survey by Kane
5 indicated the same attitude in regards to osteoporosis. Gastroenterologists and surgeons do most of the endoscopic diagnosis and management of IBD, but osteopathic primary care physicians can play a major role in the care of patients with IBD by monitoring several areas of their patients' well-being in addition to their bowel function. Areas of concern include anemia, cancer screening, vaccinations, bone health, smoking cessation, and depression.
In the present article, I review the health care issues that osteopathic primary care physicians need to be aware of and address how they can offer the highest quality of care to their patients with IBD.
High quality care of patients with IBD involves a number of specialists. One of the most important physicians is the one who takes care of health maintenance in several different areas. These areas include diagnosis and management of anemia, cancer screening, vaccinations, management of osteoporosis, smoking cessation, and depression screening. Osteopathic primary care physicians are well trained in these areas and should work with gastroenterologists and surgeons to ensure all of their patients with IBD are receiving the best care possible.