“Antibiotic use should be avoided whenever possible” – Dr. Raphael Kellman MD
“You could probably go to the healthfood store and cure every disease there is” – Dr. Paul Capobianco, D.O. – Medical Doctor and Crohn’s Patient
“The world won’t be destroyed by those who do evil but by those who watch without doing anything” – Albert Einstein
“Drugs don’t make healthy microbiomes” – Dr. Michelle V D.O.
- Global Gut Health is decreasing at an alarming rate
“IBD is a modern epidemic. The best estimates of incidence of Inflammatory Bowel Disease in US at the turn of the century in 1900 was about 1 in 10:000 individuals. Today it’s one in 250” – Dr. David Brady ND, DC
- 31 Billion Dollars: The annual financial burden of IBD in the United States
- 1.6 million: American’s diagnosed with Inflammatory Bowel Disease(IBD)
- 200,000: America children diagnosed with IBD
- 1.4 Million: American adults diagnosed with IBD
- Under 35: The age of most Americans diagnosed with IBD
“25% Increase In Inflammatory Bowel Disease in the last 15 years” – Dr. Michael Ash, BSc DO ND F.DipION
- 800,000: Americans diagnosed with Crohn’s Disease(CD)
- 800,000: American’s diagnosed with Ulcerative Colitis(UC)
- 1 in 200: American’s suffering from IBD
- 12%: The yearly growth rate of IBD patients in America
- 200,000: The number of new IBD diagnoses each year
- 3 Million: The number of IBD cases in Europe
- 235,000: The number of IBD cases in Canada
- 75,000: The number of IBD cases in Australia
- 75%: The percentage of patients diagnosed with Primary Sclerosing Cholangitis (PSC) who have IBD
“Once a child receives a diagnosis of Celiac Disease, they have a 40% increased risk of committing suicide compared to a non-celiac child” – Dr. Tom O’Bryan
- 30x: The multiplier used to determine the number of IBS cases vs. IBD cases
- Woman: Twice as likely to experience IBS symptoms than Men
- 32-48 Million: The number of Americans suffering with IBS*
- 16- 23 Million: The number of Americans diagnosed with IBS*
- 90 Million: The number of IBS cases in Europe
- 7 Million: The number of IBS cases in Canada
- 2 Million: The number of IBS cases in Australia
“It’s almost reached epidemic proportions,” – Dr Daniel Gaya, a specialist in Inflammatory Bowel Disease (IBD) at Glasgow Royal Infirmary, Scotland
- 384,000, or 48%: The number of UC patients in remission
- 30%: The percentage of UC patients in remission who will have a flare the following year
- 416,000, or 52%: The number of UC patients not in remission
- 30% of these patients have mild-disease activity, 20% moderate, 2% severe
- 50%: The percentage of CD patients who will be in remission in next five years
- 50%: The percentage of CD patients who will have mild-disease over the next five years
- 20%: The percentage of CD patients in remission who will have a recurrence in 1 year
- 40%: The percentage of CD patients in remission who will have a recurrence in 2 years
- 67%: The percentage of CD patients in remission who will have a recurrence in 5 years
- 76%: The percentage of CD patients in remission who will have a recurrence in 10 years
- 70%: The percentage of CD patients who will require surgery
- 30%: The percentage of post-surgery CD patients who will have a recurrence in 3 years
- 60%: The percentage of post-surgery CD patients who will have a recurrence in 10 years
- 33%: The percentage of UC patients who will require surgery after 30 years
- 32%: The percentage of American babies delivered by C-section, and growing *
- 1875: The year UC was first described by two English physicians, Wilks and Moxon
- 1932: The year CD was described by three doctors—Burrill Crohn, Leon Ginzberg, and Gordon D. Oppenheimer
- 50,000: The number of estimated deaths in the US and Europe due to antibiotic resistance
- 700,000: The estimated number of deaths , globally, due to antibiotic resitance
There are 5 million people in 36 countries living with Crohn’s Disease or Ulcerative Colitis with no known cause or cure. We won’t stop until we’ve found cures
In addition to signs and surgery, the following complications may develop and require urgent medical care:
Complications of ulcerative colitis include:
- Heavy, persistent diarrhea, rectal bleeding, and pain
- Perforated bowel—chronic inflammation of the intestine may weaken the intestinal wall to such an extent that a hole develops
- Toxic megacolon—severe inflammation that leads to rapid enlargement of the colon
- Complications of Crohn’s disease include:
• Fistula—ulcers on the wall of the intestine that extend and cause a tunnel (fistula) to another part of the intestine, the skin or another organ.
• Stricture—a narrowing of a section of intestine caused by scarring, which can lead to an intestinal blockage
• Abscess—a collection of pus, which can develop in the abdomen, pelvis, or around the anal area
• Perforated bowel—chronic inflammation of the intestine may weaken the wall to such an extent that a hole develops
• Malabsorption and malnutrition, including deficiency of vitamins and minerals.
- Complications Outside the GI Tract:
Not all complications of IBD are confined to the GI tract. Some people develop symptoms that are related to the disease but affect other parts of the body. The most common of these complications affect the skin and bones.These extraintestinal complications may be evident in the:• eyes (redness, pain, and itchiness)
• mouth (sores)
• joints (swelling and pain)
• skin (tender bumps, painful ulcerations, and other sores/rashes)
• bones (osteoporosis)
• kidney (stones)
• liver (primary sclerosing cholangitis, hepatitis, and cirrhosis)—occurs rarelyMortality
Death due specifically to Crohn’s disease or its complications is uncommon. However, people with Crohn’s disease have a slightly higher overall mortality rate than the general healthy population. The increase in deaths is largely due to conditions such as cancer (particularly lung cancer), chronic obstructive pulmonary disease, gastrointestinal diseases, (both including and excluding Crohn’s disease), and diseases of the genital and urinary tracts.
Death due to ulcerative colitis or its complications is also uncommon. Most people with ulcerative colitis do not have a higher risk of dying from any particular disease than the general population. However, those with extensive inflammation in the colon are at higher risk than the general population for dying from gastrointestinal and lung diseases (although not lung cancer).Genetics
Scientific evidence clearly points to the role of heredity in IBD. Studies have shown that 5% to 20% of affected individuals have a first-degree relative (parent, child, or sibling) with one of the diseases. Children of parents with IBD are at greater risk than the general population for developing IBD. The risk is greater with Crohn’s disease than with ulcerative colitis. The risk is also substantially higher when both parents have IBD. One study found that 36% of people with both parents affected developed IBD.Racial and Ethnic Impacts
IBD can affect people of any racial or ethnic group. At this time, there is limited data describing the incidence and prevalence of IBD among minority patients. One small study of IBD patients in California looked at interracial variations in disease characteristics. It included Caucasian, African American, Hispanic, and Asian subjects. For example, Asians were diagnosed with IBD at older ages than Caucasians and African Americans, and Hispanics were diagnosed at older ages than Caucasians. A higher proportion of Caucasians had a family history of IBD than African Americans or Asians. Other research shows that people of various ethnic groups who have immigrated to the United States from countries with low incidences of ulcerative colitis have higher rates of developing the disease once living in this country. This suggests that race and ethnicity alone are probably not the sole determining factors, and that unexplained environmental influences are at work.
Data from the Multicenter African American IBD Study and the National Institute of Diabetes and Digestive and Kidney Diseases IBD Genetics Consortium suggest that there are differences in symptoms and location of disease among racial and ethnic groups. African Americans with Crohn’s disease are more likely than Caucasians to have disease in the colon or upper GI tract (esophagus, stomach, and first section of the small intestine).16 They are also less likely to have disease in the last section of the small intestine (terminal ileum).
African Americans are also more likely to have certain extraintestinal complications, such as uveitis (swelling/ irritation of the eye). Hispanics have a higher prevalence of a skin disorder called erythema nodosum (tender, red nodules beneath the skin).
Children Most people with IBD are diagnosed after age 15. IBD can be diagnosed at a younger age, although it is rare in children younger than eight years of age. Previous studies estimate that approximately 5% of all IBD cases in the US are of pediatric age (<20 years).17 Extrapolating from this data to current IBD trends, there may be as many as 80,000 children in the US with IBD. In children, Crohn’s disease occurs twice as frequently as ulcerative colitis. Slightly more boys than girls develop IBD (especially Crohn’s disease) in childhood.18 When IBD is diagnosed in childhood it may be more extensive and follow a more severe course than when it is diagnosed in adulthood.19 Some children with IBD experience delayed puberty and some fail to grow at a normal rate (growth failure).20 In approximately one third of children with Crohn’s disease and one-tenth of children with ulcerative colitis, their final adult height is less than expected because of their IBD.
IBD can affect men and women of all ages. For certain populations of IBD patients—such as children, women of childbearing age, and older adults—there are special considerations regarding these diseases.
For women of childbearing age with IBD, there are considerations related to fertility and pregnancy. During times when the disease is in remission, women with Crohn’s disease or ulcerative colitis have normal fertility rates. When the disease is active, conceiving a child may be more difficult and fertility may be affect – ed, at least temporarily. Some people with ulcerative colitis may need to have surgery to remove the colon and rectum.
Studies show that in women who have ileoanal J-pouch surgery, fertility rates are reduced to about one-third of normal. This is thought to be due to scarring and/or blockage of the fallopian tubes from inflammation and/or post – operative surgical scarring. Ideally, women with IBD should be in remission for six months before becoming pregnant. For women in remission or with mild disease at the time of conception, the birth will almost always be normal. The risk for complications, such as miscarriage, stillbirth, and developmental defects, is increased when the disease is active at the time of conception and during pregnancy. Most women with Crohn’s disease can deliver vaginally, but cesarean(C-section) delivery may be preferred for patients with anorectal abscesses and fistulas. Babies born during a C-section are at an increased risk for immune and metabolic disorders. Slathering your baby with vaginal fluid may partially restore your babies microbiota.
An estimated 8% to 16% of cases of IBD are diagnosed in people 60 years of age and older. For the most part, the symptoms and features of the diseases when diagnosed in the elderly are the same as when diagnosed at a younger age. However, symptoms of diarrhea and bleeding are more likely to be present at diagnosis in older adults compared with younger IBD patients. In addition, the diagnosis of IBD is more likely to be missed or delayed in older adults compared with younger adults. IBD patients older than 60 years experience twice as many drug-related adverse events, but the risk of steroid-associated complications is similar to those younger than age 65.2
Risk of Other Diseases
IBD patients are at a slightly greater risk for some other diseases, including colon cancer, blood clots, and a liver disease called primary sclerosing cholangitis (PSC).
Risk for Cancer
People with Crohn’s disease of the colon or ulcerative colitis have a higher risk for colorectal cancer than the general population. Colorectal cancer rarely occurs in the first eight to ten years after initial diagnosis of IBD. The risk increases the longer a person lives with the disease. An analysis of all published studies found that as many as 18% of people with IBD may develop colorectal cancer by the time they have had IBD for 30 years. The degree of increased risk is also related to the length of colon involved and the severity of disease. Because of this increased risk, people with IBD are advised to undergo more frequent colonoscopies than the general population (every one to two years after eight years of disease). The use of certain medications for IBD may increase the risk for lymphoma (blood cancer that originates in the lymphatic system). Two studies found a three to four times increased rate of lymphoma in IBD patients taking medications that suppress the immune system, such as immunomodulators or biologic therapies. Although this may seem alarming, the overall risk is very low; less than one percent of IBD patients taking these medications will ever develop lymphoma.
Risk for Blood Clots
People with IBD have about a three times greater risk than the general population for developing deep vein thrombosis (a blood clot that forms in a vein deep in the body) or pulmonary embolism (a blood clot causing a sudden blockage in a lung artery).28 Hospitalized IBD patients appear to be at even greater risk. Treatment with blood thinners while in the hospital can reduce the risk of blood clots.
Risk for Primary Sclerosing Cholangitis (PSC)
PSC is a form of severe inflammation and scarring that develops in the bile ducts. About three-quarters of all PSC patients have IBD. PSC occurs more frequently in people with ulcerative colitis than in those with Crohn’s disease and affects men more than women. Symptoms include jaundice, nausea, weight loss, and itching. About five percent of patients with ulcerative colitis (those with extensive disease) and one percent of patients with Crohn’s disease develop this condition. The cause is not known and there is no effective medication for PSC. A liver transplant may ultimately be required.
Burdens of IBD
The annual financial burden of IBD in the United States may be more than $31 billion
Impact on Patients
Patients with Crohn’s disease and ulcerative colitis can, and do, lead full and productive lives. However, when these diseases are active they can have significant impact on the quality of life for patients due to flare-ups and complications. Complications can occur inside or outside the GI tract. In Crohn’s disease, a recent review of studies showed that complications inside the GI tract (such as strictures) occurred in:
• up to 33% of patients at the time of diagnosis
• approximately 50% of patients within 20 years of diagnosis In ulcerative colitis:
• 50% of patients have mild disease at the time of diagnosis
• up to 19% of patients have severe disease at the time of diagnosis
• 90% of patients have at least one relapse of active symptoms within 25 years of diagnosis
Use of the Healthcare System
People with IBD most often receive care in physicians’ offices or other outpatient sites. Hospitalization is required for severe disease, to treat certain complications, and for surgery.
• In 2004, there were 1.1 million ambulatory care visits (the number of specific disease-related visits made annually to office-based health care providers, hospital outpatient clinics, and emergency departments) for Crohn’s disease.
• In 2004, there were 1.8 million prescriptions written for medications to treat Crohn’s disease.
• In 2010, there were 187,000 hospitalizations specifically for Crohn’s disease.
• In 2004, there were 716,000 ambulatory care visits for ulcerative colitis.
• In 2004, there were 2.1 million prescriptions written for medications to treat ulcerative colitis.
• In 2010, there were 107,000 hospitalizations specifically for ulcerative colitis.
Having a chronic illness such as IBD can be emotionally burdensome. Symptoms of IBD can flare up unexpectedly and can be painful, uncomfortable, inconvenient, and embarrassing. IBD patients may experience a wide range of emotions in response to having these conditions.
Some IBD patients react to the unpredictable and sometimes severe nature of IBD symptoms with feelings of anger, anxiety, or fear. They may also have elevated stress levels. In addition, stressful situations (even those unrelated to the disease itself) may lead to flare-ups of symptoms. Depression is a serious disorder that can affect some people with IBD. However, depression is treatable with psychological counseling and/or antidepressant drugs. Mental health counseling and support groups can be extremely helpful in dealing with the psychological impact of IBD.
There are both direct and indirect costs associated with IBD. Direct medical costs include expenses for hospitalizations, physician services, prescription drugs, over-the-counter drugs, skilled nursing care, diagnostic procedures, and other healthcare services. Indirect costs are the value of lost earnings or productivity. Indirect costs also include the value of leisure time lost.
• Studies have estimated the annual direct cost of Crohn’s disease to be from $8,265 per patient (based on 2003-2004 US insurance claims data)32 to $18,963 per patient (based on 1999-2005 MarketScan database data).
• Studies have estimated the annual direct cost of ulcerative colitis to be from $5,066 per patient (based on 2003-2004 US insurance claims data)32 to $15,020 per patient (based on 1999-2005 MarketScan database data)
• Extrapolating from the study data listed above to the current prevalence estimates of IBD (780,000 cases of Crohn’s disease and 907,000 cases of ulcerative colitis), the total annual direct costs for all patients with IBD (both Crohn’s disease and ulcerative colitis) in the United States is estimated to be between $11 billion to $28 billion.
• Based on a national health survey in 1999, nearly 32% of symptomatic IBD patients reported being out of the workforce in a one-year period, incurring an indirect cost of an estimated $5,228 per patient, bringing the total indirect cost of IBD in 1999 to $3.6 billion.
Using the data listed above, the total annual financial burden (adding direct and indirect costs) of IBD in the US is an estimated $14.6 billion to $31.6 billion.References:
American College Of Gastroenterology: Irritable Bowel Syndrome FAQs
CCFA Updated Fact Book – 2014
Nature – Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer
Arstechnica – Birth Of A Microbiome Researchers Smear Babies With Vaginal Fluid
Smithsonian Magazine – Does Having a C-Section Alter Babys First Microbiome?
CDC Fasts Stats Births Methods Of Delivery
NIH – Is delivery by cesarean section a risk factor for food allergy?
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