Punch to the gut
VERY often, people who are experiencing stomach cramps, fatigue and fever may brush off the whole ordeal and assume the cause for such symptoms to be a mere stomach bug.
However, when the intense pain persists and other symptoms include watery or bloody stools, reduced appetite and weight loss, there is a possibility that you have inflammatory bowel disease (IBD).
IBD was the focus of last week’s World Digestive Health Day, an annual initiative by the World Gastroenterology Organisation (WGO) to increase the general awareness of specific digestive disorders, including their related research, prevention and therapy. This year’s campaign was aimed at providing gastroenterologists, patients, healthcare providers and the general public with the relevant basic and clinical knowledge surrounding IBD. A crucial factor about IBD is that there is still a lack of understanding or information about the disease’s manner of development inside the human body within the medical fraternity. Scientists and doctors have yet to pinpoint the definite causes of IBD and the medications currently ribed to IBD patients are herapies to dampen the nt immune response or ess the inflammation. e good news is that the ber of IBD cases remains ively low in Malaysia and e are therapies available. owever, this does not an that Malaysians should e the disease lightly as it reatly impede daily life using water and salt anaemia, dehydration, e weight loss and bly life-threatening lications in the long run.
Understanding the threat
The good news is that the number of IBD cases remains relatively low in Malaysia and there are therapies available.
an be separated into two sease categories – disease (CD) that affects and ulcerative colitis can affect any part of the ystem.
Both conditions have overlapping and distinct clinical and pathological features that are a result of an abnormal immunological response whereby the patient's white blood cells and other inflammatory cells attack the gastrointestinal tract, leading to prolonged, uncontrolled inflammation and ulceration.
“In severe case is particularly debili an greatly restricts one lyl sa s Prof Dr Lee Yeong Yeh, professor of medicine and consultant of gastroenterology at Universiti Sains Malaysia.
“Although the symptoms in milder cases may subside, they can recur and progress to become more severe if left untreated.
“Severe cases may require specialised treatment in the form of biologics managed by a gastroenterologist. Those of higher severity may need surgery.”
Prof Lee, who also holds the position of science leadership chair of the Academy of Sciences Malaysa’s Young Scientist Network, says the common symptoms include abdominal pain, watery or bloody stools, fever, weight loss and feeling easily tired while less common ones include joint and skin problems.
World Digestive Health Day 2017 chair Dr Charles Bernstein wrote in his introduction of IBD on WGO’s website: “The pathogenesis of IBD is incompletely understood. As IBD is increasingly a worldwide disease, one challenge will be to determine if the therapies proven to be effective in one population will be comparably effective in another.
“Another challenge will be to facilitate access to novel expensive therapies in lesser privileged countries.”
Though the cause of IBD is unknown, genetic and environmental factors are believed to play a role in triggering the disease.
According to a 2015 article titled Management of IBD in Malaysia published in the IBD Research journal, the prevalence of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD) in the country was at 9.24, 6.67 and 2.17 per 100,000 persons respectively.
Hence, the estimated number of people with IBD in Malaysia is between 2,000 and 3,000, with a larger number of cases among the Indian ethnic community and the majority of all patients falling below the age of 30.
While it is good that many people do not live with IBD in Malaysia, this in itself can be discouraging for patients.
The journal article states that there is a lack of experience in the use of biologics to treat IBD, leading to the overuse of steroids.
In addition, it claims that surgical expertise is limited as there are few colorectal surgeons with specific IBD training or experience.
Worse still is when patients of IBD require surgery but exhibit side effects of long-term steroid use and nutritional deficiencies, further compromising surgical success.
These findings mirror another 2015 article, Chronic attacks on the bowel, which states that due to the infrequent number of IBD cases in the country, some diagnoses were delayed by doctors or, worse, mistaken for other conditions such as irritable bowel syndrome, haemorrhoids or even cancer due to the overlapping symptoms.
Prof Lee agrees that awareness of the disease is generally low among healthcare providers and IBD can be difficult to distinguish from cancers based on symptoms alone.
However, he adds, “Subsequent investigations including colonoscopy should be able to differentiate between IBD and cancer, and if there is suspicion of either condition, it is best to refer to a gastroenterologist or specialist in bowel disorders.”
Defusing the situation
In the United Kingdom where the prevalence of IBD is much
Fifteen per cent of patients with UC in the United Kingdom were unable to work after five to 10 years living with the disease while patients with moderate to severe UC faced a 30% increased risk of work impairment compared to those without.
hig – people or 400 patients per 100,000 of the population – the IBD Standards Group (a UK group made up of various digestive, paediatric and gastroenterology associations and societies) reported that up to 85% of IBD patients required hospitalisation and up to 70% of patients with CD required surgery within five years of diagnosis.
Fifteen per cent of patients with UC in the UK were unable to work after five to 10 years living with the disease while patients with moderate to severe UC faced a 30% increased risk of work impairment compared to those wit .
One would be forgiven for wondering if Malaysia too will face such a dire situation, given the rising number of IBD cases locally and how the situation can take a toll on an already stressed national healthcare system.
Fortunately, Malaysia’s IBD numbers are still among the lowest globally. In addition, Prof Lee believes that Malaysia has the right therapies in place, whether through biologics or surgery. However, patients need to have the right diagnosis early. While the awareness of IBD may still be low in Malaysia, the Malaysian medical field is starting to pay more attention to understanding the disease.
The establishment of an IBD interest group, Persatuan Crohn dan Kolitis Malaysia, as well as collaborations with international agencies such as the European Crohn’s and Colitis Organisation and Asian Organization for Crohn’s & Colitis are steps in the right direction, but the medical fraternity also needs to ensure Malaysia continues to have a control of the situation.