Inflammatory bowel disease (IBD)
Inflammatory bowel diseases (IBD), which combine two nosological forms – Crohn's disease (CD) and ulcerative colitis (UC), are chronic progressive immuno-mediated diseases of unknown etiology. IBD is one of the most serious and unresolved problems in modern gastroenterology, which is due to the high and constantly growing incidence rate, poorly studied etiopathogenesis, unpredictable clinical outcomes and difficulties in choosing treatment tactics. According to European publications, the incidence of IBD in Western Europe is twice as high as in Eastern Europe (Crohn's disease: 6.5 cases per 100,000 population compared to 3.3, ulcerative colitis: 9.8 cases per 100,000 population compared to 4.6). However, according to the regional registers of the Russian Federation, the prevalence of IBD is much higher and is 5-12 cases per 100,000 population in regions where there are no IBD centers, and more than 40 cases in regions where an IBD center operates.
Given the fact that the majority of patients who are diagnosed with ulcerative colitis or Crohn's disease are younger than 40 years old (the onset of the disease occurs in 20-35 years), these diseases not only worsen the quality of life of patients and their immediate environment, but also cause them serious economic damage, significantly limiting the ability to work and, accordingly, limiting the income of the active working population.
Due to the progressive nature of the course and the drug incurable nature of IBD, patients should receive therapy for life and undergo regular lifelong monitoring of the activity of inflammation, i.e. assessment of the response to therapy. In this regard, the creation of regional and urban centers of IBD – associations of specialists and health resources on the basis of medical institutions, including gastroenterologists, coloproctologists, endoscopists, morphologists, ultrasound and radiology specialists who are familiar with the problems of IBD, is of particular relevance. A multidisciplinary approach to the treatment of patients with IBD will allow you to choose an individual effective treatment strategy at an early stage, stop the progression of the disease and improve the quality of life of patients.
Extra-intestinal manifestations are a sign of activity and a risk factor for the progressive course of IBD. For these patients, it is especially important to involve a rheumatologist for joint observation within a multidisciplinary team.
IBD also negatively affects the psychoemotional component. According to research data, up to 68.2% of patients have a depressed mood, 5.6% of patients experience depression, 23.8% have sexual disorders, 56% have a disease that negatively affected their career, and 17% have it led to the end of personal relationships. Therefore, it seems necessary to involve a psychologist in a multidisciplinary team for the joint management and treatment of patients with IBD.
In children, compared with adults, the course of IBD is characterized by greater severity, especially at an early age, it can occur against the background of immunodeficiency conditions. Treatment of children with IBD requires the participation of highly qualified doctors of various profiles: pediatricians-gastroenterologists, surgeons-coloproctologists, endoscopists, resuscitators, radiologists. It should be carried out jointly by a multidisciplinary team with experience in the treatment of patients of this profile.
High anxiety gradually becomes a personality trait and leads to the appearance of a tendency of patients to depression, subsequently-to a violation of their social adaptation.
Poor quality, and more often the lack of psychological care for patients with IBD is one of the serious problems that reduces the effectiveness of even high-quality medical care and adherence to treatment.
It is unlikely that it will be possible to achieve a reduction in morbidity, since the increase in morbidity is a global trend, but these measures will certainly allow us to improve and speed up diagnosis, reduce the number of complications, hospitalizations, operations, and start timely and adequate treatment. Thousands (tens of thousands) of young people who are now "outside" the attention of medical and social structures would return to work and social life.
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