GIs should wear ‘internal medicine hats’ to care for IBD across all ages
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I remember being flummoxed as a first-year gastroenterology fellow when we had an elderly patient on service with abdominal pain and weight loss who ended up diagnosed with ileocolonic Crohn’s disease. Our “IBD antennae” are often finely tuned when we see a patient in their late teens or 20s with such symptoms, but maybe not so much in an octogenarian. Indeed, in a recent update of the inception cohorts of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, we had noted that two-thirds of Crohn’s disease patients and about 60% of ulcerative colitis patients were diagnosed under the age of 40 years. However, flipping this around, this means that one-third of patients with Crohn’s disease and 40% of patients with UC are diagnosed in their fifth decade of life or later.
This month’s cover story reviews the impact of IBD across the whole gamut, from early life environmental influences that may impact the risk of developing IBD, to special considerations such nutritional therapy in kids with IBD, the delicate transition from pediatric to adult gastroenterology care, the impact of IBD on women of childbearing age, and finally the management of seniors with IBD.
While nutrition is important in patients of all ages, it is particularly crucial in pediatric patients, because there is a window of opportunity to maximize growth in these patients, and enteral therapies can play an important role. One of the keys to transitioning a patient from pediatric to adult care is to provide the patient and their parents plenty of notice and explanation for what is being done, and to help negotiate and expedite that transition from parental care to self-care. A healthy dose of patience on the part of the adult provider is needed — while we would all like to see our patients navigate immediately to self-care, we know this is an uneven process (I still have the occasional 40- or 50-year-old come in with a parent!).
Many of our later-onset IBD patients (i.e., those diagnosed in their 50s or 60s or older) have relatively mild disease, although there are, of course, notable exceptions. In contrast, many patients diagnosed at a younger age will continue to have active/refractory IBD later in life, and these patients can pose many challenges, including medication selections, safety of surgical solutions, etc.
The range of IBD across the ages highlights the importance of wearing our internal medicine hats when caring for these patients. It can be challenging but ultimately very rewarding!
- Reference:
- Shivashankar R, et al. Clin Gastroenterol Hepatol. 2017;doi:10.1016/j.cgh.2016.10.039.
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