As many people know, inflammatory bowel disease (IBD) is a complex disease that affects the intestines. This is the part of the digestive tract that helps digest food and remove water, salt, and waste.
But you may not know this: In recent years, IBD has been diagnosed more often in the United States in people who are Black, Hispanic / Latin American, East and Southeast Asian, or are from other minorities than in previous decades.
Is this a real increase in cases? Is IBD not recognized in minorities? While we don't have all the answers yet, studying the health differences in IBD and explaining the symptoms can help more people get the health care they need.
What is IBD
IBD is a chronic inflammatory disease of the bowel that can progress steadily or repeatedly flare up (relapse) and calm down (abandonment).
The two main types of IBD are ulcerative colitis (UC) and Crohn's disease (CD):
- Ulcerative colitis only affects the rectum and colon.
- Crohn's disease can affect any part of the intestinal tract from the mouth to the anus, causing complications such as abscesses, strictures, and fistulas.
- Both diseases often affect organs outside of the gastrointestinal tract such as the joints, skin, and eyes.
What do we know about minority IBD?
Traditionally, IBD has been viewed as a disease that primarily affects white people. According to estimates published in 2014, IBD occurs in approximately 10 Hispanic / Latin American people, 25 black people, and 70 non-Hispanic white people per 100,000 people. More recently, however, we have seen increases in IBD among other races and other ethnic groups in the US and around the world.
Is inflammatory bowel disease not recognized in minority groups?
Some experts believe that IBD may not be or poorly recognized in minority populations, which can lead to delays in diagnosis. Delayed diagnosis can mean longer periods of untreated inflammation, which also increases the risk of complications such as:
- Strictures (areas where the bowel narrows due to scarring)
- Fistula (a passageway between organs or nearby tissues that usually doesn't exist)
- Abscesses (an infection which, if left untreated, can lead to a fistula)
- Colon cancer.
One study looked at people who received medical care and had two symptoms that suggest IBD: iron deficiency anemia (low red blood counts) and diarrhea. The researchers found that certain groups were less likely to receive an adequate work-up to figure out why they had these particular symptoms. Those who had black or public insurance were less likely to receive the relevant processing than those who were white or privately insured. These results also support the hypothesis that IBD may not be recognized in minority populations.
What do we currently know about health differences in IBD?
People with inflammatory bowel disease experience avoidable differences in health and wellbeing known as health inequalities. These differences may be due to a number of factors affecting specific groups, including inequalities in social determinants of health, unconscious biases about health care providers, barriers to care, and differences in the complex genetic and environmental drivers of IBD that have not been seen before have occurred sufficiently investigated.
Black patients with IBD have a higher rate of emergency admissions – and a higher rate of hospitalizations in one study, possibly because they are less likely to be treated regularly by a gastroenterologist. While the hospitalization rate has decreased in white patients with IBD, it remains unchanged for black patients.
Additional research shows that black patients with Crohn's disease are less likely to be in remission, have more surgery, and have more complications after surgery. Socioeconomic status also plays a role: lower income is associated with a higher risk of serious illness, hospitalizations related to IBD, stays in the intensive care unit, and death. Another study reports that approximately 14% of Americans with IBD are food unsafe. In addition, it associates food insecurity with an inability to take prescribed medication due to costs and difficulty paying medical bills.
What symptoms can be signs of inflammatory bowel disease?
A variety of symptoms can indicate inflammatory bowel disease:
- Blood in your stool and urgency and frequency of bowel movements may be signs of ulcerative colitis.
- Abdominal pain, nausea, vomiting, blood in your stool, and diarrhea can all be signs of Crohn's disease.
If you have any of these symptoms, especially if you notice blood in your stool, talk to your doctor. After taking a medical history and exam, the next steps may be further assessment with a colonoscopy to examine the bowel and / or an upper endoscopy to examine the upper part of the digestive system. Imaging tests may also be needed. This assessment will help your doctor diagnose IBD or any other health problem that is causing similar symptoms.
Effective treatment makes a difference
Fortunately, ulcerative colitis and Crohn's disease are treatable conditions. Our goal in treating IBD is stable remission to stop or alleviate symptoms and ensure a high quality of life. Anyone with IBD can do this with good care. Treatment may include drugs taken orally or given as infusions, diet changes, surgery, or a combination thereof. It is important to find the right treatment and monitoring plan for each person early in the disease process.
I assure my IBD patients that we will work together to find the best and safest treatment options for them. IBD care requires a team approach that may include a family doctor, gastroenterologist, pharmacist, surgeon, nutritionist, and other health care provider. If you have IBD, you are the central member and the captain of the team. As a provider, we are only trainers. It is important that you feel heard, understood, and empowered as you navigate life with IBD.
Follow me on Twitter @AdjoaGIMD