Inflammatory Bowel Disease, an autoimmune disease mainly affect intestine. It needs early attention to not let it becomes fatal. Dr Piyush Ranjan, Senior Consultant, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Delhi, explains various aspects of the disease, symptoms, precautions, and treatment measures, in an exclusive interview with Harshal Desai of Elets News Network (ENN).
Q You have years of experience tackling IBD patients at topmost hospitals. Tell us what exactly is IBD and how is it affecting Indians.
IBD basically stands for Inflammatory Bowel Disease. It comprises malfunction in the digestive system involving intestine. There are the two major types-the most common being, Ulcerative Colitis and Crohn’s disease. Ulcerative colitis involves the large intestine while Crohn’s disease occurs in both–large and small intestine. Then there are indeterminate colitis and microscopic colitis- these are the sub type of IBD.
Q How’s this trend different from the other trend we have in India. How is this different from the growing global trend?
Yes, the global trend is the same. Initially people used to believe that Crohn’s disease does not exist in India or it has low prevalence in India. Moreover, due to different presentations, it was confused with Intestinal Tuberculosis. Now with better diagnostic test, we are finding that Crohn’s is being diagnosed more and more. In addition, people who were previously treated for Intestinal Tuberculosis later turned out to be Crohn’s Disease. Crohn’s disease relevance has been increasing in India mainly because of better diagnostic tests and better awareness among the doctors.
Q Brief us about the reasons why it happens? Does our routine life like working under stress, long office hours are some of the reasons for IDP?
There are many, but the exact reason of this disease is not known. Mainly these diseases are autoimmune in nature. Autoimmune disease means those diseases which occur because of the damage in the body by its own immune system. In this case, own immune system recognize a particular organ as foreign origin. Because this is it matter of speculation. Some genetic disposition has been found but one to one correlation has not been seen yet. It oscillates about the triggering event. An industrial bacterium is one of the postulates. But in a sense, it is because of the damage of intestine by a person’s own immune system.
Q Does it mean that you need to have a strong immune system to fight of this disease?
No, actually a strong immune system damages you; so it is a misbalance. It is a failed recognition of the self-tissue. It’s not like these people are not susceptible to other infection. It’s just that there immune cells start damaging any tissue–it may be liver or in case of ulcerative disease it is intestine.
Q What is the diagnosis process and what are the possible treatments in the country right now?
Diagnostic process starts from the symptoms. Whenever someone has blood mixed diarrhea, it is most likely that person is suffering from ulcerative colitis. The diagnosis test for this type of diseases is the colonoscopy. Endoscopy is done from the oral route; colonoscopy is done from the rectal route. Endoscope is passed through the rectum and large intestine is examined directly. The appearance of ulcerative colitis is very characteristic but still to confirm it a biopsy is taken though this is nothing to do with malignancy. People get scared too much when they are told about that biopsy has been undertaken. Ulcerative colitis diagnosis process involves colonoscopy and taking the intestinal biopsy. This is very simple for ulcerative colitis. For Crohn’s disease, we may examine small intestine with the help of a Capsule Endoscopy. There are other ancillary tests but they are not as credible as this to establish the diagnosis
This disease requires life-long treatment, the most important thing which has to be understood. There are many drugs available. The choice of drugs depends upon the location– where the disease is in the intestine exactly. Then the severity of disease is another factor. According to the severity of the disease, various drugs are prescribed–like the oldest drugs which are five amino salicylate. Then there are oral steroids, other immune suppressive drugs like azathioprine methotrexate and newer drugs which are known as biological drugs- -anti TNF Alpha drugs,
So, which drug one would choose depends on the severity of the disease. For active disease, stronger medicine is required to first bring disease into control and once the disease has been brought under control then a different group of drug is required to maintain that state–that is ignored remission.
The most common cause of a person having uncontrolled disease recurrent is over compliance to the treatment. People often stop their treatment and start taking alternative options which leads to loss of control of disease.
Q What are the challenges you face while diagnosing IBD diseases?
One of the most common challenges is when a person is having bleeding. Doctor very often misdiagnosed as having hemorrhoid–that is piles. They undergo surgery because they do not undergo a colonoscopy, so any person having bleeding, sigmoidoscopy or colonoscopy at the onset is the bare minimum which is required.
So one needs to understand that this is a possibility and unless and until a test is done it will not be possible to diagnose this. Patients have to be counseled for depression that is a major challenge. These drugs have some side effects too, so monitoring is very necessary.
In this COVID time, people have stopped coming for checkups. This may lead to relapse– that the disease coming back more strongly. One particular problem in our country is proclivity for alternative medicines like Ayurvedic and Homeopathic. People fall in that trap often. When they are promised that they’ll be given some medicines which will not have any side effects, they go for it. These are some of the challenges.
Q Do we have cure in Ayurveda and Homeopathy for this disease?
They claim but you must have read that patanjali has found the cure for coronavirus but anything that is claimed has to be proved by a scientific mean. As a scientist you cannot say no to anything. They may have a cure but you need scientific proof which they don’t have.
Q Due to lockdown, IBD may have taken toll on lots of IBD patients. What is your take?
A: Absolutely any person with long standing chronic disease need to visit doctor on regular interval but due to lockdown they are averse to visit doctors. They are scared to come to the hospital due to fear of catching infection. So not only Ulcerative, people with many different diseases, non COVID diseases are facing a lot of problem because of their reluctance to come to the hospital to seek help.
Q Recently I read a report that people with inflammatory bowel disease are at the high risk of dementia, do you think so?
As I told you these medicines decrease the immunity level. So there are groups of medicines among medicines which are being used for treatment of IBD which might put a person to higher risk for developing COVID. But the fact is again continuation or discontinuation. There are very clear cut guidelines for that and you actually need to take guidance of a Gastroenterologist to decide–depending on the activity of the disease, the past behavior of the disease, and the current needle that is their control.
Q What message would you like to give to people who are suffering from IBD?
Get yourself diagnosed early if you’re having such symptoms. Discuss with the doctor. Accept that you are having a problem and accept the fact is this disease requires a life-long treatment, this is the most important thing. You need regular follow up to look at the activity of disease and monitor the side effects of the drugs. If you do this, nearly 90% people will have a very good course. 80 to 90% will have a very good and smooth course–there will be intermittent some bumps on the way but most of the people can have the normal productive active life.