Inflammatory Bowel Disease

Part
01
of three
Part
01

Inflammatory Bowel Disease Treatments

Anti-inflammatory drugs, immune system suppressors, antibiotics, nutritional support, and surgery are therapies for the treatment of inflammatory bowel disease, carried out to provide and maintain long-term remission, lower the risk of complications, and relieve its symptoms.

OVERVIEW

  • The treatments for inflammatory bowel disease are carried out to reduce the inflammation that leads to the signs and symptoms of the disease. The best possible outcomes of these treatment therapies include long-term remission and a lower risk of complications, accompanied by relief of the symptoms.

ANTI-INFLAMMATORY DRUGS

  • These drugs consist of corticosteroids and aminosalicylates such as "mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal), and olsalazine (Dipentum)."
  • Corticosteroids are applied short-term to reduce the symptoms of inflammatory bowel disease (IBD) quickly. Sometimes, they are also used as a bridge to further long-term treatment for IBD.
  • Aminosalicylates are for mild to moderate IBD cases and can be used to "reduce inflammation in the lining of the intestines, relieving abdominal pain, diarrhea, and other symptoms."
  • Mesalamine, for example, is used to treat ulcerative colitis in the mild to moderate stages by attacking a substance in the body that causes inflammation, diarrhea, and tissue damage.

HOW IT IS APPLIED
METRICS OF SUCCESS
  • Corticosteroids are considered successful if they provide swift relief from IBD symptoms.
ANY GAPS IN THE TREATMENT
  • Since they are only used to treat mild to moderate stages of IBD, anti-inflammatory drugs are likely to be ineffective for severe cases.
  • When using mesalamine for the treatment of IBD, patients are advised to stop usage if the symptoms become severe.

IMMUNE SYSTEM SUPPRESSORS

  • These are drugs taken to suppress the immune system's response to release inflammation-inducing chemicals in the intestinal lining.
  • Some immunosuppressant drugs include "azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune), and methotrexate (Trexall)."
HOW IT IS APPLIED
  • Immunosuppressants are taken orally or via injections. However, the doctor will determine the best treatment regimen for the individual upon examination.
  • These drugs are followed with regular blood tests to determine their effectiveness and to decide whether there should be any dosage changes.
  • Most times, they are prescribed when IBD symptoms are under control after a corticosteroid regimen has been completed.
  • Immunosuppressants are sometimes used with biologic therapies such as the tumor necrosis factor-alpha inhibitors, which neutralize a protein produced by the immune system.
METRICS OF SUCCESS
  • Immunosuppressants are considered successful for the treatment of IBD when they alleviate symptoms of the disease and occasionally help the patient achieve remission by reducing intestinal inflammation.
ANY GAPS IN THE TREATMENT

ANTIBIOTICS

HOW IT IS APPLIED
METRICS OF SUCCESS
  • This procedure is considered successful if it addresses any bacterial infections due to IBD with as little side effects as possible.
ANY GAPS IN THE TREATMENT

NUTRITIONAL SUPPORT

  • Nutritional support for the treatment of IBD involves the recommendation of a special diet to improve the overall nutrition of the body and to rest the bowel. This procedure is used because people with IBD usually have vitamin or mineral deficiencies due to digestive dysfunction, which prevents the body from absorbing essential nutrients.
  • It is a short-term treatment.
HOW IT IS APPLIED
METRICS OF SUCCESS
  • If successful, the bowel should be well-rested, and there would be a short-term reduction in any inflammation to the bowel.
  • For cases with stenosis or stricture in the bowel, a low-residue diet should help to prevent blockage in the bowel.
ANY GAPS IN THE TREATMENT
  • "The high prevalence of micronutrient deficiencies and sarcopenia indicate that patients on a restrictive diet are at risk of further deficiencies and muscle mass loss, especially in catabolic states such as those associated with IBD flares."


SURGERY

  • Surgery is used to treat IBD when "lifestyle changes, drug therapy, or other treatments don't relieve IBD signs and symptoms."
HOW IT IS APPLIED
  • For ulcerative colitis, it may involve the complete removal of the colon and rectum
  • For Chron's disease, the damaged part of the digestive tract is removed, while the remaining portion is reconnected. Surgery may also be used to close fistulas and remove abscesses. Surgery consists of a strictureplasty, resection, colectomy, and proctocolectomy.
METRICS OF SUCCESS
  • Since Chron's disease is lifelong, surgery is considered successful when it alleviates complications of the disease and helps the patient to achieve the best possible quality of life, while preserving as much of the bowel as possible.
ANY GAPS IN THE TREATMENT
  • Surgery for Chron's disease is usually temporary, and there is a high chance of recurrence, which might take place around the reconnected tissue.

RESEARCH STRATEGY
We found the details for the requested treatment methods from medical sites such as WebMD, Mayo Clinic, and Healthline, among others. However, for one of the sources, we attached the link to a Google Doc because there was no way to attach it directly. To provide the metrics of success for the treatment methods, we leveraged the reason for their prescription as the ultimate metric for success.
Part
02
of three
Part
02

Inflammatory Bowel Disease Solutions

While dieting and not smoking represent two treatment approaches to inflammatory bowel disease (IBD) that have been reasonably substantiated by empirical research, coping with stress and other alternative medicines are less validated as clinically effective therapies for managing IBD.

Dieting

  • Dietary therapy for IBD occurs either in the form of a formula-based exclusive enteral nutrition (EEN) diet or a food-based exclusion diet.
  • In either instance, the dietary treatment for IBD is applied by carefully and consistently excluding specific types of foods from a patient's diet.
  • Notably, modifying diets as a treatment for IBD has been validated by both epidemiological studies as well as intervention studies.
  • For example, a study using EEN in pediatric Crohn’s disease patients demonstrated high rates of IBD remission (85%) and superior mucosal healing as compared with more traditional drug-based treatments, while a randomized-controlled trial in adults with Crohn’s disease demonstrated similarly high rates of remission (56.8%) as compared with those on infliximab (44.4%).
  • However, such dietary therapy has many gaps or challenges, including the lack of clear, consistent designs for these diet programs, remaining questions about how diet actually impacts IBD pathogenesis on a scientific level as well as larger issues in designing and implementing clinical trials to test such treatment protocols.

Not Smoking

  • Tobacco smoking is one of if not the most well-established risk factors for IBD conditions including Crohn’s disease and, as such, a logical treatment option for the condition is to reduce or cease smoking behavior.
  • Specifically, smoking has been shown to penetrate the GI tract barrier and thereby cause IBD, through the creation of oxidative stress, DNA damage and immune responses.
  • As such, the application of not smoking is used as a disease-modifying intervention for IBD.
  • Additionally, the relationship between IBD and the cessation of smoking has been robustly validated across many epidemiological studies.
  • For example, a recent research study found that reducing or stopping smoking behavior modified the association between 64 SNPs and IBD.
  • However, as with dietary treatments, a major gap or challenge with not smoking as a therapy for IBD is the lack of a clear, scientific understanding of how smoking and not smoking may impact gene-immune system-microbiota interactions.
  • Additionally, it appears that smoking and the cessation of smoking have meaningfully different impacts on different types of IBD, such as Crohn’s disease and ulcerative colitis.

Coping with Stress

  • Methods for coping with psychosocial stress are used to treat IBD based on evidence that such stressors, particularly the perception of stress, may impact the interactions between the brain and gut microbiome, such as intestinal permeability, the immune system and microbial gene expression and virulence.
  • The application of this method for treating IBD can include a variety of therapies or behavior modifications, including acceptance and commitment therapy (ACT).
  • Such therapies have been demonstrated to improve stress, although the impact on IBD as the result of these treatments is often assumed rather than clinically measured.
  • For example, a randomized controlled trial that deployed eight weeks of ACT therapy to patients with IBD showed improved stress levels (39%) and other indices of psychological health, but no significant, quantitative measurements of IBD impacts.
  • As such, perhaps the most significant challenge or gap in treating IBD with stress management is that, while it is believed that psychological stress exacerbates IBD, there is a lack of knowledge about the brain-gut connection and how this both measurable and scientifically impacts IBD.

Alternative Medicine

  • The range of currently available alternative medical treatments for IBD is broad, and includes everything from the application of herbal therapies, cannabis, vitamins, mineral and probiotics, to the introduction of different sleep practices, hypnotherapy and acupuncture.
  • In all of these diverse treatments, the application of IBD therapy is composed of the consistent and monitored introduction of one or more of these alternative therapies, either separately or in combination with more standard forms of prescription treatment.
  • However, evidence to support the efficacy of these treatments is generally lacking, representing a significant gap or challenge in strategically administering such therapies.
  • Additionally, as with several of the other treatment methodologies discussed above, many of these treatment approaches lack the accompanying scientific understanding of how they impact underlying psychological and physiological interactions with the gut.
  • Ultimately, such alternative medicines are generally viewed as a matter of ongoing research, rather than as credible treatment schemes with clear, measurable success metrics.

Research Strategy

Please note, for the purpose of this analysis, a compilation of research and associated findings published within the Journal of Crohn's and Colitis was used to provide details related to the many forms of alternative medicine used to treat IBD. Although this compilation of research was conducted by the European Crohn’s and Colitis Organization (ECCO), only those findings that were either sourced from US-based research and/or were determined to be relevant to the US IBD market were included in this analysis. Considering the comprehensive nature of this summary report, as well as the availability of findings that were specifically relevant to the US IBD market, it was deemed reasonable and appropriate to use this resource for the purpose of this analysis.
Part
03
of three
Part
03

Inflammatory Bowel Disease Opportunities

Some opportunities that drive the growth for the Inflammatory Bowel Disease (IBD) treatments in the US include the high cost of treatment and increased hospitalizations that are associated with the disease. Moreover, the increased number of IBD patients and limited community-based support are other opportunities that drive the growth of the IBD solutions market in the United States.

High Cost of Treatment

  • A study in the United States revealed that people who suffer from Inflammatory Bowel Diseases incur more than three times the annual cost of living of non-IBD patients.
  • Therefore, the need to ensure that the IBD treatment solutions get cheaper is expected to drive the growth of the IBD treatment market in the US.

Increasing Number of Patients

  • A study conducted in 2018 pointed out the rising number of IBD patients in the United States.
  • The study indicated that between 3.1% to 14.6% in 100,000 people in the US suffer from IBD every year.
  • The increasing number of IBD patients in the United States is an opportunity that is driving towards the growth of the IBD treatment market in the US.

High Hospitalization Rates

  • The hospitalizations provide an opportunity for the growth of IBD treatments in specific centers to help IBD patients.

Limited Community-Based Support

  • Young children are among the people getting diagnosed with IBD, and with the prolonged symptoms, there is a need for support to get through the condition and social stigma that comes with it.
  • However, there is limited access to counselors and community-based support for IBD patients.
  • The need to provide more accessible support to IBD patients is an opportunity that drives the growth of IBD treatment in the US.

Research Strategy

To provide an overview of the opportunities that are driving the expected growth for the IBD treatments market in the United States (US), we looked through reports and surveys conducted about the subject in the US. The available research reports and statistics pointed out some factors that drive the growth of the IBD treatments market in the United States. Also, some trusted news releases available online provided insights on the subject.
Sources
Sources

From Part 03
Quotes
  • "“The results of this study confirm what we suspected – having IBD places an enormous financial burden on patients and their families. We must work together as a community to tackle the costs to ensure that patients have access to the treatments they need, when they need it.” "
Quotes
  • "Crohn’s disease and ulcerative colitis are two major types of IBDs. Crohn’s disease was the largest segment in 2018 due to increasing prevalence of the condition. According to an article published in the Jobson Medical Information LLC, in 2018, the incidence of CD was found to be around 3.1 to 14.6 cases per 100,000 person every year and the prevalence was approximately 201 cases per 100,000 adults in U.S."
Quotes
  • "In response, the hospitalization rate has risen in America, generating opportunities in the market for the therapy of inflammatory bowel diseases. Besides this, the recent product approvals by the European Medicines Agency and other similar organizations have enabled the market gain significant momentum."
Quotes
  • "In 2015, an estimated 1.3% of US adults (3 million) reported being diagnosed with IBD (either Crohn’s disease or ulcerative colitis).1 This was a large increase from 1999 (0.9% or 2 million adults).2"
Quotes
  • "Once IBD has been diagnosed, the symptoms can often be effectively managed. However, Crohn’s disease and ulcerative colitis are chronic illnesses, and changes are likely to occur over time. Symptoms may recur at times and complications may develop."
Quotes
  • "Other initiatives are focusing on the development of learning health systems including ImproveCareNow and IBD Qorus; these are virtual platforms and networked practices which allow for sharing of data and best practices, along with QI training for IBD centers and practices, predominantly in the United States."