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'Korea should wake up to seriousness of inflammatory bowel disease'
  • By Lee Han-soo
  • Published 2020.01.30 14:08
  • Updated 2020.01.31 11:01
  • comments 0

Inflammatory bowel disease (IBD) is on the rise in Asia and has been met with additional research needs in the region.

In the case of the two most common IBD -- ulcerative colitis (UC) and Crohn's disease (CD) -- intestinal inflammation makes conditions both improve and aggravate repeatedly, causing severe abdominal pain and diarrhea in the process, making daily life all but impossible.

Until now, IBD has been more common in the Western hemisphere. With the advent of the Western lifestyle, the incidence and prevalence of IBD have been sharply increasing in Asia over the past few years.

Despite such a rise in patient numbers, the region lacks long-term epidemiologic data for IBD. To resolve this problem, a Korean research team, led by Professor Yang Suk-kyun of the Inflammatory Bowel Disease Center at Asan Medical Center, conducted a 30-year long long-term epidemiologic survey in Songpa-gu and Gangdong-gu, southeastern Seoul.

According to the team, the IBD cohort study is significant because it examined epidemiologic trends of ulcerative colitis and Crohn's disease in Korea through a 30-year study.

Korea Biomedical Review met exclusively with Professor Ye Byong-duk to get a better grasp of and insight into the research.

Professor Ye Byong-duk at Asan Medical Center explains the importance of treating inflammatory bowel disease from the onset of the illness, during an interview with Korea Biomedical Review at the hospital in Songpa-gu, Seoul, on Monday.

Question: What is IBD? What are the causes and symptoms of the disease and the current status of patients in Korea?

Answer: The number of people with IBD in Korea had increased steadily to about 66,000 registered patients as of 2018.

The pathogenesis of IBD is not yet clear. Still, it is thought that the onset of the immune response to intestinal microorganisms persists in individuals with a genetic predisposition, and environmental factors, such as food and smoking, are involved in the pathogenesis.

Representative IBD includes ulcerative colitis (UC), Crohn's disease (CD) and Bechet's enterocolitis.

The main symptom of UC includes thin stools or diarrhea containing blood and mucus, and in severe cases, can cause abdominal pain, dehydration, loss of appetite and anemia. In the case of Crohn's disease, the main symptoms include diarrhea, abdominal pain, and weight loss, and perianal pus and anal fistula.

Q: How is the diagnosis and treatment of IBD done?

A: There is no single gold standard for diagnosing IBD. Therefore, diagnosis is not easy, and it may take a long time for doctors to confirm the symptoms. IBD should be diagnosed by combining clinical features, endoscopic and histopathological findings, blood tests, and imaging tests.

In some cases, the diagnosis is not clear at first, which may require time to observe changes in clinical features.

The basis of treatment for IBD is the improvement of symptoms through inflammation control, prevention of complications and disease progression, and ultimately maintaining the quality of life of the patient.

In the past, IBD treatment was aimed at improving symptoms, but the paradigm has changed recently.

In recent years, many patients have found that symptom improvement alone cannot prevent progressive bowel damage and intestinal complications. Recently, there is a tendency to actively treat the disease from the onset to improve mucosal healing as well as improve symptoms.

Also, the importance of a multi-departmental approach, involving departments such as gastroenterology, surgery, radiology, pathology, nutritionist, and professional nurses, is emphasized.

It is also important to note that considering the characteristics of IBD usually occurs at a young age and lasts for a long time, optimized care, and life management according to the life cycle is essential.

Q: What is more dangerous for people suffering from IBD when compared to the general population? Are there any accompanying diseases, and what are the other risks?

A: If inflammation is poorly controlled, stricturing or penetrating complications and massive bleeding can occur. Infectious complications are also common, and in severe cases, sepsis may occur.

Uncontrolled and prolonged inflammation also increases the risk of colon and small intestine cancer. At the same time, IBD can cause inflammation not only in the intestines, but also in joints, skin, eyes, and biliary tracts.

Q: You've recently presented a 30-year-long epidemiologic survey for IBD in Seoul’s Songpa-gu and Gangdong-gu area. What is the background of your research?

A: As I said, the incidence and prevalence of IBD in Asia are increasing, but there is no long-term epidemiologic data, so the long-term epidemiologic trends and clinical courses are unknown.

Understanding the epidemiologic characteristics and long-term prognosis is a necessary study as it gives us the most basic data for establishing the treatment strategy for IBD. Besides, various Korean studies have been reported that Korean patients with IBD have different genetic and clinical characteristics and progression than those of the West.

Q: What was the result?

A: In this study, the team found that the incidence of IBD in Songpa-gu and Gangdong-gu has been increasing continuously for the last 30 years.

In 1986, the incidence rate of UC per 100,000 people was 0.33, and Crohn's disease was 0.00, whereas in 2015, UC per 100,000 people was 6.58, and Crohn's disease was 2.42.

In terms of demographics, the age-specific distribution of UC and Crohn's disease was high in the 10s and 20s, while males in their 60s had the highest UC incidence rate among all age and sex groups.

Regarding gender distribution, there were 1.2 times more male patients with UC and 3.3 times in Crohn's disease compared to female patients.

The difference between local and Western patients was also confirmed.

While more male patients had Crohn's disease in Korea, in the West, there was a higher ratio of female patients or a similar ratio between the two sexes in the Western countries.

Also, compared with Western patients, Korean Crohn's disease patients were more common to suffer from ileal involvement and perianal abscess and fistula.

For UC, local patients had a higher proportion of proctitis than in Western patients.

Q: We heard Asan Medical Center is running an Inflammatory Bowel Disease Center to treat the disease better and raise awareness. Can you give us a brief introduction of what the center does?

A: Asan Medical Center's Inflammatory Bowel Disease Center opened in 2012 with Professor Yang Suk-Kyun, a pioneer in the field of IBD in Korea, as the head of the center

The center is composed of various departments, including gastroenterology, pediatrics, colorectal surgery, radiology, pathology, diagnostic laboratory, rheumatology, dermatology, ophthalmology, mental health, biochemistry and molecular biology, nutrition team, and nurses specializing in IBD.

Currently, the center treats the most IBD patients in Korea, with about 7,000 patients with UC and Crohn's disease are registered at the center.

The center conducts holistic care from accurate diagnosis of IBD to classification, prognostication, individualized care according to patients' characteristics, close monitoring, and optimized care and life cycle.

Q: What is the future goal of the center?

A: The center is recognized both locally and internationally, and actively participates in lectures and international collaborative research at international conferences and educational programs.

However, we plan to do more by trying to establish ourselves as a leading center for IBD research in Asia and around the world.

Also, while the level of care in the local IBD treatment has improved to an unprecedented scale, we plan to increase our potential further and focus on education to provide quality care not only in large hospitals but also anywhere in the country.

The center also plans to help other neighboring countries combat IBD. In Southeast Asia, the incidence of IBD has begun to increase, but due to the lack of awareness of the disease, proper diagnosis and treatment are often not achieved.

The center has been working to improve the understanding of the IBD through local lectures and inviting medical staff from the Southeast Asia region.

Q: Are there any additional comments you would like to make to IBD patients and medical staff treating the disease?

A: With the development and introduction of new therapies such as biologic agents and small molecules, the application of close monitoring and personalized care has now become a reality. IBD has now become a disease that is manageable if treated appropriately and can allow patients to live their daily lives similar to that of an average person.

To this end, I would like to emphasize that the patient should have a good understanding of the disease, receive constant treatment with or without symptoms, and focus on life management.

Treating IBD is also rapidly developing, so I would like to ask the medical staff for continuous attention, acquisition of up-to-date knowledge, and application to clinical care.


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