IBD is the common name for inflammatory bowel diseases such as ulcerative colitis (UC) or Crohn's disease (CD). Frequent, chronic diarrhea means that patients have to go to the toilet up to 20 times a day. In Poland, about 50,000 suffer from inflammatory bowel disease. people, every fourth of them is underage. Until now, despite many studies, inflammatory bowel diseases do not have a specific cause, and therefore there is no way to treat them effectively. However, there are drugs that can significantly improve the quality of life of patients. What do you need to know about NZJ?

IBD(IBD) is characterized by chronic lesions and ulcerations in the gastrointestinal walls. The group of inflammatory bowel diseases includes ulcerative colitis and Crohn's disease.

Inflammatory bowel diseases are chronic, incurable diseases, and contrary to appearances - quite common. Statistics show that the incidence of them is still growing - in Poland currently suffer from 30,000 to 50,000 people. patients, but not all become seriously ill, and not all require specialized treatment. Inflammatory bowel disease can be mild, but also severe. Typical for these diseases are remissions and relapses.

IBD most often affects people between 15 and 35 who are fully professionally active, as well as children, which is why the disease complicates their lives a lot - it makes it difficult or even impossible to continue their education and implement their professional plans.

Inflammatory bowel disease - causes

The cause of inflammatory bowel diseases is not known, but it is believed that:

  • genetic factors
  • disorders of the immune system
  • environmental factors, including :
    • so-called "Western" diet
    • effect of chemicals in food
    • increase in environmental pollution
    • smoking
    • chronic stress

IBD symptoms

IBD has the following symptoms:

  • severe abdominal pain
  • diarrhea- sometimes with an admixture of blood and mucus
  • fever

Patients often suffer from loss of appetite, nausea, vomiting, flatulence, deterioration of physical efficiency and weight loss. IBD may result in the inability to continue education or work, or the need to interrupt them due to the course of the disease.

Depending on which IBD is involved, other symptoms may appear. For example, ulcerative colitis is often accompanied byextraintestinal symptoms :

  • uveitis
  • joint pain
  • erythema nodosum
  • alopecia
  • liver disease
  • thrombosis
  • anemia

IBD difficult to treat

Characteristic of inflammatory bowel diseases arerelapses and sudden exacerbations , which exclude the patient from normal functioning. There are patients who have only one exacerbation of the disease in their life, but there are also those who struggle with the severe course of their ailments for years. When the disease is diagnosed, the doctor is not able to predict its course or whether the patient will respond to a given therapy and what treatment will be the most optimal for him.

Unfortunately, the treatment of IBD is difficult and complicated as some patients do not respond to treatment (data show that this problem affects 2/3 of IBD patients), and standard treatment is associated with many side effects for them . This is a bad prognosis, especially for young people who have to take into account the necessity of treatment for many more years.

In a situation where the patient has been given various therapy options, and yet there is no positive response to treatment, it may be necessary to surgically intervene, excise a fragment of the large intestine and create a stoma, which is a new way to defecate abdominal wall.

Such a procedure is dangerous and significantly reduces the quality of life of patients. And it is worth remembering that - according to statistics - the highest incidence of inflammatory bowel disease concerns people in the 2nd and 3rd decade of their lives, i.e. when they finish their education, look for a job, a partner, are socially and socially active.

Drugs used in the treatment of IBD

Treatment of inflammatory bowel disease is based on the use of drugs from several groups, because each stage of the disease and each patient requires an individual approach - as indicated by the guidelines of the Polish Society of Gastroenterology .

In the treatment of mild disease -both ulcerative colitis and Crohn's disease - useaminosalicylic acid preparations .

In severe relapses, glucocorticosteroids and immunosuppressants are administered.

Unfortunately, it happens that patients with a severe course of the disease do not respond to treatment with steroids (steroid resistance) or immunosuppressive drugs.

In addition, therapy with steroids has disadvantages in the form of side effects, as well as the phenomenon of steroid dependence, which means that in some patients discontinuation of drugs causes an immediate relapse of the disease.

Therefore, the current goal of treating IBD patients isachieving and maintaining remission without the use of glucocorticoids . What is more, it is crucial to leave the freedom to doctors in making decisions about stopping or continuing treatment, taking into account the well-being and individual condition of the patient. In the current situation, it is the time (12 or 24 months) that determines the decision to discontinue treatment instead of clinicians.

Biological treatment - rescue for the most severe cases of NJZ

A breakthrough in the treatment of IBD was the introduction of the so-called biological medicines used in patients with the most severe course of IBD and in those who do not respond to immunosuppressive or steroid therapy. Biological drugs are mainly TNF-α inhibitors (infliximab and adalimumab), which are effective in both remission and maintenance of the disease - in many cases they stop the disease, allowing patients to function normally.

Biological treatment is safe and effectivebut unfortunately quite expensive. Currently, in Poland, biological treatment is possible thanks to a program that reimburses treatment, but only for a short time. In patients with UC, the therapy is reimbursed for 12 months, and in patients with CD - 24 months. After this time, patients cannot continue the biological treatment reimbursed. They can be re-enrolled in the program only when their condition worsens and the disease recurs - for them, this means repeating the story and starting another battle for their he alth. Worldwide, biological drug therapy has no time limit and is continued for as long as needed and effective. The decision on its duration is at the discretion of the physician and does not result from an administratively imposed time frame.

Our problem is not only the short reimbursement period, but also too strict eligibility criteria for the drug program and too late introduction of biological therapy, which affects the deterioration of he alth.

Programsdrugs for patients with inflammatory bowel disease

It should be emphasized here that not all patients are eligible for the drug program that allows the use of biological drugs, but only those with a severe course of IBD - these drugs are intended for 10-15% of patients. sick. But for this group of several thousand people, they are necessary, and their reimbursement for a year or 2 is definitely too short. Taking these preparations from patients after the period set by the program often means relapse or exacerbation of the disease.

Therefore, according to specialists, you need to calculate the real costs of this therapy or its lack. Thanks to biological medicines, patients with inflammatory bowel diseases can function normally, study and work, which translates into the state's finances.

The cost of treatment is high, but the obtainedremission is a value in itself : patients are productive because they work and earn money, they do not take sick leave, so they do not benefit from benefits. The fear of losing access to medications is not only a great stress, but also the risk of complications that may result in the removal of the intestines (colectomy) and stoma surgery.

Category:

Gastrology