Projet GEM et Maladies Chroniques

Introduction

• Presentation of inflammatory bowel diseases (IBD)
• Learning unit 5
• Theoretical capsule
• Prepared by UA 5 team A24

Presentation of IBD

• Crohn's disease
• Ulcerative colitis
• Inflammatory and obstructive disorders
• Celiac disease
• Irritable bowel syndrome (IBS)
• Diverticulosis and diverticulitis

Treatments for IBD

• Medical treatments for IBD
• Medical cannabis and IBD
• Impact of IBD
• Coping strategies for individuals with IBD
• Protein, carbohydrate, and lipid digestion
• Total parenteral nutrition (TPN)

Incidence of IBD

• In Canada (2023)
• High prevalence rate internationally
• Higher incidence than in 2018
• 322,600 Canadians affected in 2023 compared to 270,000 in 2018
• 0.8% of the population, which is equivalent to 8 people out of 1000
• More than 11,000 new cases diagnosed per year

Crohn's Disease and Ulcerative Colitis

• Abnormal immune system response
• Crohn's disease: deep inflammation and ulcers affecting all layers of the GI tract (from anus to mouth); abscess, fistulas; usually affects colon and ileum (distal part of the small intestine)
• Ulcerative colitis: inflammation and ulceration affecting the inner layer of the intestinal wall (superficial mucosa); limited to the rectum and colon

Other IBDs

• Celiac disease: autoimmune disease characterised by inflammation and damage to the small intestine lining due to gluten ingestion.
• Irritable bowel syndrome (IBS): recurring and intermittent abdominal pain; likely connected to disrupted intestinal motility and inflammation.
• Diverticulosis and diverticulitis: the formation of diverticula (small pouches) in the digestive tract. More common in the sigmoid and descending colon. 15-25% of diverticulosis cases lead to inflammation.

Treatment Objectives for IBD

• Allow bowel rest
• Control inflammation
• Combat infection
• Correct malnutrition
• Reduce stress
• Relieve symptoms
• Improve quality of life

Medication Classes for IBD

• Corticosteroids (prednisone, methylprednisolone)
• Immunosuppressants (e.g., azathioprine)
• Biological responses modifiers (e.g., infliximab)
• Other medications: aminosalicylic acid (mesalamine), antimicrobials, antidiarrheals, hematinics, and vitamins

Surgical Treatments for IBD

• Crohn's disease: stricturoplasty (widening narrowed intestinal segments), bowel resection and anastomosis, temporary or permanent stoma, bowel transplantation (last resort)
• Ulcerative colitis: total colectomy with ileoanal reservoir or ileostomy, proctocolectomy with permanent ileostomy, or the Kock pouch.
• Celiac disease and IBS: no required surgery
• Diverticulosis and diverticulitis: possible resection of affected colon area and temporary stoma.

Other treatments for IBD

• Fecal transplant - microbiome alteration
• Specific diet (carbohydrates)—microbiome alteration
• Enteral nutrition in children (liquid diets)
• Aloe vera juice
• Acupuncture

Medical Cannabis and IBD

• Several studies since legalization
• Positive effects on symptoms and inflammatory processes
• Improved results for nausea and abdominal pain
• No effect on intestinal membrane healing
• Similar results as placebo

IBD Costs

• Estimated at 5.38 billion Canadian dollars annually in 2023
• Breakdown of costs across different treatment categories

Impact of IBD

• Reduced quality of life for patients and their support networks
• Medical issues
• Financial burdens due to expensive treatments
• Employment challenges
• Difficulty planning for the future (careers, travel, etc.)
• Potential lack of social support

Quality of Life and Health

• Severity of IBD remains the primary predictor of physical and mental health.
• IBD patients have a lower quality of life compared to the general population.
• Higher rates of stress, anxiety, insomnia and panic attacks in IBD patients, especially those whose illness is active.
• Study confirming fatigue and depression in IBD patients

Quality of Life and Treatment

• Effective treatments improve quality of life by reducing symptoms, complications, and providing a sense of empowerment in managing the disease.
• Diet and lifestyle changes
• Medication (Lewis et al., 2024, Tome 3, p.213−tableau 55.26)
• Surgery

Quality of Life and Productivity

• Connection between quality of life and productivity
• Unemployment, disability and sick leave related to low quality of life
• Improved quality of life for employed IBD patients
• Higher employment rates in IBD patients who are in remission

Challenges for IBD Patients

• Low awareness regarding IBD.
• Stigma, lack of access to public restrooms, and
• Diagnostic delays
• Unequal access to treatments.
• Geographical limitations and access to specialists.
• Employment worries
• Limited social support

Coping Strategies

• Information and support systems for themselves and their families
• Adjustment to the illness
• Maintain daily activities (exercise, sports, and daily routines)
• Planning trips and appointments
• Emotional support
• Acknowledging anxiety and fears (e.g., surgical interventions)
• Maintaining a positive outlook
• Avoiding isolation

Research Project on IBD

• Canadian research team discovered differences in gut bacteria that might predict Crohn's disease years before noticeable symptoms.
• Study monitored 5000 individuals and their family members with Crohn's disease to examine potential patterns, in an attempt to develop treatments or preventive measures.

Video on Ulcerative Colitis

• Youtube channel on living with ulcerative colitis

Digestion (proteins, carbohydrates, and lipids)

• Components, functions, phases, and specific enzymes involved.

Nutritional Deficiencies and IBD

• Impacts of deficiencies, including loss of fluids, electrolytes, and vital nutrients due to the effects and severity of IBD symptoms on absorption of nutrients, and strategies to address them.

Total Parenteral Nutrition (TPN) and IBD

• Overview of TPN, its composition, its uses for patients who are unable to absorb nutrients, administration methods, related complications (in detail), and patient education components
• Related medical examination questions (NCLEX-RN, 2019)

Additional information

• Presentations and relevant tables, figures and other data are included.