Subject : A Survey Among Gastroenterologists to Understand Management of Inflammatory Bowel Disorder (IBD) in India with Focus on Therapy with Biologicals (REASSURANCE Study)
Inflammatory bowel disease (IBD) encompasses two chronic inflammatory disease entities, Ulcerative colitis (UC) and Crohn’s disease (CD). The diagnosis is essentially based on classical symptomatology, endoscopy and radiological and histological findings. In 10-15% of cases, it is difficult to distinguish between the two, referred to as unclassified IBD and when diagnosis is not possible even in a resected bowel specimen, this is referred to as indeterminate colitis.
IBD is a major health problem around the world. Earlier, it was reported in high proportions from Northern and Western Europe, North America and Australia however, it now has a considerably wider geographic distribution, with an increasing prevalence even in countries that were initially considered as low risk areas. In addition, there is an increase in IBD burden amongst children and adults in developing nations.
The first prevalence figure of 42.8/100,000 patients for UC from Haryana were reported in 1986 by Khosla et al. Subsequently, Sood et al., in 2003, reported a similar prevalence of 44.3/100,000 while screening 51,910 people from Punjab.
A multicentric hospital-based study from the northern and eastern states of the Indian subcontinent reported a fourfold increase in referrals for CD from the late 1990s onwards and also a higher frequency from the southern States of India.
Overall, hospital-based studies in the recent past have reported an increasing number of IBD cases in India. This may be the result of increasing awareness amongst physicians, improved diagnostic techniques and enhanced access to specialized healthcare systems.
Urbanization together with changes in dietary pattern i.e., westernization of Indian diet, environmental conditions and the underlying genetic predisposition are likely factors responsible for an increase in UC burden.
The prevalence of extraintestinal manifestation (EIM) in India was similar to that reported from the West as per questionnaire-based study; 38% had at least one, whereas 20% had multiple EIMs. The most frequent EIM was peripheral arthritis in 33% followed by ankylosing spondylitis in 18% and ocular symptoms in 13%. Mucocutaneous manifestations, aphthous stomatitis and pyoderma gangrenosum constituted 9%.
Recently published guidelines by American Gastroenterology Associationi, European Crohn’s and Colitis Organization, British Society of Gastroenterology and Japanese Guidelines recommend biologicals and JAK inhibitors for the management of moderately to severely active UC and CD.
Biological anti-TNF agents have been considered as a viable therapeutic option for individuals with moderate-to-severe inflammatory bowel disease (IBD). Among these agents, with clinical trials proving the efficacy and safety in IBD management adalimumab has established itself as a prominent 2018 biosimilars were approved and launched in other countries including India.
The purpose of this survey is to understand the disease profile and management of IBD with biologicals with emphasis on high concentration adalimumab by gastroenterologists across India.
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