Is IBD an unrecognized health problem in minority groups? – Harvard Health Blog


As many people know, inflammatory bowel disease (IBD) is a complex condition that affects the gut, which is the part of the digestive tract that helps digest food and eliminate water, salt and waste.

But you may not know it: in recent years, in the United States, IBD has been diagnosed more often among blacks, Hispanics / Latinos, East and Southeast Asians, or other minority groups than in decades past.

Is it a real increase in cases? Is IBD unknown in minority populations? Although we do not yet have all the answers, exploring the health disparities of IBD and explaining its symptoms can encourage more people to receive the health care they need.

What is IBD?

IBD is a chronic inflammatory condition in the gut that can progress steadily or appear repeatedly (relapse) and calm down (remit).

The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease (DC):

  • Ulcerative colitis affects the rectum and colon alone.
  • Crohn’s disease can affect any portion of the intestinal tract from the mouth to the anus and can cause complications such as abscesses, stenosis, and fistulas.
  • Both conditions often affect organs outside the gastrointestinal tract, such as the joints, skin, and eyes.

What do we know about IBD among minority groups?

Traditionally, IBD has been considered a disease that greatly affects white people. For every 100,000 individuals, IBD occurs in approximately 10 Hispanic / Latino individuals, 25 black individuals, and 70 non-Hispanic white individuals, according to estimates published in 2014. However, more recently we have seen an increase in IBD among other ethnic and racial groups in the U.S. and around the world.

Is inflammatory bowel disease not recognized in minority groups?

Some experts believe that IBD may not be recognized or underestimated in minority populations, which could lead to delays in diagnoses. A delayed diagnosis can mean longer periods of untreated inflammation, which also increases the risk of complications, such as

  • stenosis (areas where the intestine narrows due to scars)
  • fistulas (a passage between nearby organs or tissues that is not normally present)
  • abscesses (an infection that can cause a fistula if left untreated)
  • surgery
  • bowel cancer.

One study examined people receiving health care two symptoms suggesting IBD: iron deficiency anemia (a low red blood count) and diarrhea. The researchers found that certain groups were less likely to receive adequate training to find out why they had these particular symptoms. Those who were black or with public insurance were less likely to get the right job, compared to those who had private or white insurance. These findings further support the hypothesis that the recognition of IBD in minority populations may be unknown.

What do we currently know about health disparities in IBD?

Avoidable differences – so-called health disparities – in health and well-being are seen among people with inflammatory bowel disease. These disparities may be due to a number of factors affecting certain groups, including inequalities in social determinants of health, unconscious biases of medical providers, barriers to care, and differences in complex genetic and environmental driving forces. of IBD that have not been sufficiently studied.

Black patients with IBD experience higher rates of use of the emergency service – and, in a to study, higher hospitalization rates, possibly because they are less likely to receive regular care from a gastroenterologist. In addition, although the hospitalization rate in white patients with IBD has decreased, it remains unchanged for black patients.

Additional research shows that black patients with Crohn’s disease are less likely to be in remission, are more likely to be operated on, and experience complications after surgery. Socioeconomic status also matters: lower incomes are related to a higher risk of suffering serious illness, IBD-related hospitalizations, ICU stays, and death. Another study reports this approximately 14% of Americans with IBD have food insecurity. In addition, it links food insecurity to the inability to take prescribed medications due to the cost and difficulty of paying medical bills.

What symptoms may be signs of inflammatory bowel disease?

A variety of symptoms can be signs of inflammatory bowel disease:

  • Blood in the stool and urgency and increased frequency of bowel movements may be signs of ulcerative colitis.
  • Abdominal pain, nausea, vomiting, blood in the stool, and diarrhea may be signs of Crohn’s disease.

If you experience any of these symptoms, especially if you notice blood in your stools, talk to your doctor. After a medical history and examination, the following steps may be a subsequent evaluation with a colonoscopy to look at the bowel and / or a superior endoscopy to look at the upper digestive system. Image studies may also be required. This evaluation will help your doctor diagnose IBD or another health problem that is causing similar symptoms.

Getting an effective treatment makes all the difference

Fortunately, ulcerative colitis and Crohn’s disease are treatable conditions. Our goal in the treatment of IBD is stable remission to stop or relieve symptoms and ensure a high quality of life. Everyone with IBD can achieve this with great care. Treatment may include oral medications or those given as infusions. dietary changes, surgery or a combination of these. It is important to find the right treatment and control plan for each person at the beginning of the illness.

I assure my patients with IBD that we will work together to find the best and safest treatment options for them. IBD care requires a team approach, which may include a primary care physician, gastroenterologist, pharmacist, surgeon, dietitian, and other health care providers. If you have IBD, you are the central member and captain of the team; as suppliers we are just coaches. It is important that you feel heard, understood, and empowered as you navigate life with IBD.

Follow me on Twitter @AdjoaGIMD

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