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Supplements Importance of Selecting the Appropriate Therapy for Inflammatory Bowel Disease in the Managed Care E

Report: Impact of Inflammatory Bowel Disease

Sheila M. Wilhelm, PharmD, FCCP, BCPS
     IBD is associated with decreased labor force participation. Adults between the ages of 20 and 64 years who have IBD have a higher probability of being out of the workforce, and excess costs associated with their IBD are estimated to be more than $3.6 billion.54


     IBD significantly impacts the physical, emotional, and social lives of the 1.17 million patients who are affected by it. Manifestation in early adulthood often means a lifetime of painful GI symptoms that, for some patients, ultimately results in surgical resection of the bowel. The costs related to managing the physical symptoms of IBD, as well as a patient’s absenteeism or inability to work because of the condition, place an excessive economic burden on the healthcare system and society as a whole.

Author affiliation: Wayne State University, Detroit, MI, and Harper University Hospital, Detroit, MI.
Funding source: This activity is supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc.
Author disclosure: Dr Wilhelm has no relevant financial relation-ships with commercial interests to disclose.
Authorship information: Concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

1. Inflammatory bowel disease (IBD). CDC website. Accessed December 11, 2015.
2. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a com-mercially insured US population. Dig Dis Sci. 2013;58(2):519-525. doi: 10.1007/s10620-012-2371-5.
3. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gut.  2000;46(3):336-343.
4. Loftus CG, Loftus EV Jr, Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940-2000. Inflamm Bowel Dis. 2007;13(3):254-261.
5. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504-1517.
6. Stonnington CM, Phillips SF, Melton LJ 3rd, Zinsmeister AR. Chronic ulcerative colitis: incidence and prevalence in a community. Gut. 1987;28(4):402-409.
7. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785-1794. doi: 10.1053/j.gastro.2011.01.055.
8. Khalili H, Huang ES, Ananthakrishnan AN, et al. Geographical variation and incidence of inflammatory bowel disease among US women. Gut. 2012;61(12):1686-1692. doi: 10.1136/gutjnl-2011-301574.
9. Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104 (2):465-483. doi: 10.1038/ajg.2008.168.
10. Tsianos EV, Katsanos KH, Tsianos VE. Role of genetics in the diagnosis and prognosis of Crohn's disease. World J Gastroenterol. 2012;18(2):105-118. doi: 10.3748/wjg.v18.i2.105.
11. Orholm M, Munkholm P, Langholz E, Nielsen OH, Sorensen TI, Binder V. Familial occurrence of inflammatory bowel disease. N Engl J Med. 1991;324(2):84-88.
12. Roberts SE, Wotton CJ, Williams JG, Griffith M, Goldacre MJ. Perinatal and early life risk factors for inflammatory bowel disease. World J Gastroenterol. 2011;17(6):743-749. doi: 10.3748/wjg.v17.i6.743.
13. Persson PG, Ahlbom A, Hellers G. Inflammatory bowel disease and tobacco smoke--a case-control study. Gut. 1990;31(12):1377-1381.
14. Bridger S, Lee JC, Bjarnason I, Jones JE, Macpherson AJ. In siblings with similar genetic susceptibility for inflammatory bowel disease, smokers tend to develop Crohn’s disease and non-smokers develop ulcerative colitis. Gut. 2002;51(1):21-25.
15. Shaw SY, Blanchard JF, Bernstein CN. Association between the use of antibiotics in the first year of life and pediatric inflam-matory bowel disease. Am J Gastroenterol. 2010;105(12):2687-2692. doi: 10.1038/ajg.2010.398.
16. Card T, Logan RF, Rodrigues LC, Wheeler JG. Antibiotic use and the development of Crohn's disease. Gut. 2004;53(2):246-250
17. Khalili H, Higuchi LM, Ananthakrishnan AN, et al. Oral contra-ceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013;62(8):1153-1159. doi: 10.1136/gutjnl-2012-302362.
18. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med. 2001;344(11):808-814.
19. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy is followed by increased risk of Crohn’s disease. Gastroenterology. 2003;124(1):40-46.
20. Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40(6):754-760.
21. Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospec-tive study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology. 2013;145(5):970-977. doi: 10.1053/j.gastro.2013.07.050.
22. Ananthakrishnan AN, Khalili H, Konijeti GG, et al. Long-term intake of dietary fat and risk of ulcerative colitis and Crohn’s disease. Gut. 2014:63(5):776-784. doi: 10.1136/gutjnl-2013-305304.
23. Jantchou P, Morois S, Clavel-Chapelon F, Boutron-Ruault MC, Carbonnel F. Animal protein intake and risk of inflammatory bowel disease: the E3N prospective study. Am J Gastroenterol. 2010;105(10):2195-2201. doi: 10.1038/ajg.2010.192.
24. Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011;474(7351):307-317. doi: 10.1038/nature10209.
25. Cahill RJ, Foltz CJ, Fox JG, Dangler CA, Powrie F, Schauer DB. Inflammatory bowel disease: an immunity-mediated condi-tion triggered by bacterial infection with Helicobacter hepaticus. Infect Immun. 1997;65(8):3126-3131.
26. Breese E, Braegger CP, Corrigan CJ, Walker-Smith JA, MacDonald TT. Interleukin-2- and interferon-gamma-secreting T cells in normal and diseased human intestinal mucosa. Immunology. 1993;78(1):127-131.
27. Fuss IJ, Neurath M, Boirivant M, et al. Disparate CD4+ lamina propria (LP) lymphokine secretion profiles in inflammatory bowel disease. Crohn's disease LP cells manifest increased secretion of IFN-gamma, whereas ulcerative colitis LP cells manifest increased secretion of IL-5. J Immunol. 1996;157(3):1261-1270.
28. Onuma EK, Amenta PS, Ramaswamy K, Lin JJ, Das KM. Autoimmunity in ulcerative colitis (UC): a predominant colonic mucosal B cell response against human tropomyosin isoform 5. Clin Exp Immunol. 2000;121(3):466-471.
29. Chaudhari S, Desai JS, Adam A, Mishra P. Inflammatory bowel disease: an idiopathic disease and its treatment. IJPRR. 2014;3(4):106-114.
30. Kornbluth A, Sachar DB; Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis prac-tice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501-523. doi: 10.1038/ajg.2009.727.
31. Hendrickson BA, Gokhale R, Cho JH. Clinical aspects and pathophysiology of inflammatory bowel disease. Clin Microbiol Rev. 2002;15(1):79-94.
32. Langholz E, Munkholm P, Davidsen M, Binder V. Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology. 1994;107(1):3-11.
33. Boyapati R, Satsangi J, Ho GT. Pathogenesis of Crohn’s disease. F1000Prime Rep. 2015;7:44. doi: 10.12703/P7-44.
34. Munkholm P, Langholz E, Davidsen M, Binder V. Disease activity courses in a regional cohort of Crohn’s disease patients. Scand J Gastroenterol. 1995;30(7):699-706.
35. Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 2001;49(6):777-782.
36. Vester-Andersen MK, Prosberg MV, Jess T, et al. Disease course and surgery rates in inflammatory bowel disease: a population-based, 7-year follow-up study in the era of immuno-modulating therapy. Am J Gastroenterol. 2014;109(5):705-714. doi: 10.1038/ajg.2014.45.
37. Epidemiology of the IBD. CDC website. Accessed December 11, 2015.
38. Langan RC, Gotsch PB, Krafczyk MA, Skillinge DD. Ulcerative colitis: diagnosis and treatment. Am Fam Physician. 2007;76(9):1323-1330.
39. Crohn’s disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Accessed September 11, 2015.
40. The facts about inflammatory bowel diseases. Crohn’s & Colitis Foundation of America website. Published November 2014. Accessed December 11, 2015.
41. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231(1):38-45.
42. Sakatani A, Fujiya M, Ito T, et al. Infliximab extends the duration until the first surgery in patients with Crohn’s disease. BioMed Res Int. 2013;2013:879491. doi: 10.1155/2013/879491.
43. Winther KV, Jess T, Langholz E, Munkholm P, Binder V. Survival and cause-specific mortality in ulcerative colitis: follow-up of a population-based cohort in Copenhagen County.
44. Bewtra M, Kaiser LM, TenHave T, Lewis JD. Crohn’s disease and ulcerative colitis are associated with elevated standard-ized mortality ratios: a meta-analysis. Inflamm Bowel Dis. 2013;19(3):599-613. doi: 10.1097/MIB.0b013e31827f27ae.
45. Canavan C, Abrams KR, Mayberry JF. Meta-analysis: mortal-ity in Crohn's disease. Aliment Pharmacol Ther. 2007;25(8):861-870.
46. Umanskiy K, Fichera A. Health related quality of life in inflam-matory bowel disease: the impact of surgical therapy. World J Gastroenterol. 2010;16(40):5024-5034.
47. Casellas F, Arenas JI, Baudet JS, et al. Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study. Inflamm Bowel Dis. 2005;11(5):488-496.
48. Bernklev T, Jahnsen J, Lygren I, Henriksen M, Vatn M, Moum B. Health-related quality of life in patients with inflammatory bowel disease measured with the short form-36: psychometric assessments and a comparison with general population norms. Inflamm Bowel Dis. 2005;11(10):909-918.
49. Kalafateli M, Triantos C, Theocharis G, et al. Health-related quality of life in patients with inflammatory bowel disease: a single-center experience. Ann Gastroenterol. 2013;26(3):243-248.
50. Jones MP, Wessinger S, Crowell MD. Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(4):474-481.
51. Graff LA, Walker JR, Lix L, et al. The relationship of inflamma-tory bowel disease type and activity to psychological functioning and quality of life. Clin Gastroenterol Hepatol. 2006;4(12):1491-1501.
52. Becker HM, Grigat D, Ghosh S, et al. Living with inflamma-tory bowel disease: A Crohn’s and Colitis Canada survey. Can J Gastroenterol Hepatol. 2015;29(2):77-84.
53. Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135(6):1907-1913. doi: 10.1053/j.gastro.2008.09.012.
54. Longobardi T, Jacobs P, Bernstein CN. Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey. Am J Gastroenterol. 2003;98(5):1064-1072.

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