Inflammatory bowel disease (IBD) is widely regarded as a systemic disorder not limited to the gastrointestinal tract. That's because many patients develop extra-intestinal symptoms, says Remo Panaccione, professor of medicine and director of the inflammatory bowel disease unit at the University of Calgary.
"Extra-intestinal – or outside the intestine – manifestations of these diseases are very common. About half the patients with IBD experience the symptoms of at least one of these extra-intestinal manifestations, and 20 per cent have more than one. For many patients, these issues affect their quality of life to a large degree," he says. "And in a quarter of patients, symptoms outside the gut precede their IBD diagnosis."
While some extra-intestinal manifestations are closely linked to the inflammation in the bowel and tend to flare up at the same time, others are more independent, Dr. Panaccione explains. "Some of the most common issues associated with IBD are problems of the joints – either in the elbows, knees or fingers – and lower back pain," he says. "Other issues include ocular problems with red or painful eyes or blurred vision and various skin conditions."
Less frequent manifestations can affect the liver, kidney, lungs, pancreas or the even the vascular system.
"It is important for patients to understand that many symptoms they may experience outside the gut can be linked to their inflammatory bowel disease," he says. In many cases, patients will see multiple specialists, for example ophthalmologists for eye problems, rheumatologists for back pain, dermatologists for skin conditions, in addition to their gastroenterologist. "Everyone has to be aware of that connection to IBD, and all specialists have to work together as a cohesive team to ensure the chosen therapy takes all the different manifestations into account," says Dr. Panaccione.
Certain medications such as anti-TNF therapies, a type of drug used to treat inflammatory conditions, may be effective for addressing Crohn's disease and ulcerative colitis, the main forms of IBD, as well as eye, joint and skin conditions, he says. "This gives us a nice umbrella to treat not only the intestinal disease but also the majority of extra-intestinal manifestations."
Dr. Panaccione adds that any switch to a different medication needs to be considered in light of the whole sum of conditions, rather than one aspect in isolation.
The overriding concept is to ensure a thoughtful and whole-patient approach to care and therapy, says Dr. Panaccione, who believes the ability to work as a team can ensure the best outcomes for the patient.
To get involved, learn more about the No Forced Switch campaign and send a letter to your MPP, MLA or provincial minister of health visit action.crohnsandcolitis.ca.
To see your province or territory’s grade in the IBD Report Card and learn what you can do locally to help your voice be heard, visit badgut.org.
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