Inflammatory bowel disease on the rise in young people

Cases of inflammatory bowel disease (IBD) have been rising at alarming rates among young Americans. A new study published in the journal Gastroenterology reports that an estimated 100,000 people in the U.S. under the age of 20 have some form of IBD.

IBD is an autoimmune disorder where the immune system attacks healthy bowel cells creating inflammation that causes debilitating diseases like Crohn’s disease and ulcerative colitis.

In the same study, the estimated number of cases of Crohn’s disease rose 22 percent and ulcerative colitis rates were up 29 percent. The highest rates of the disease were among white youth and it was most prevalent in the Northeast.

Falmouth gastroenterologist Wade Billings, MD, has definitely noticed this trend since coming to practice on Cape Cod in July of last year.

“I’ve actually been kind of shocked, especially since coming to the Northeast, how many people have IBD here,” he said. “I’ve only been practicing here a short time, so it’s hard to say if I’ve been seeing a lot more than I used to, but I’ve certainly been seeing a lot of it.”

Possible Causes

No one is exactly sure why IBD is on the rise, especially with young people, but Dr. Billings said there are a few theories.

“There’s some research showing that PFAS can increase the risk of it,” he said.

PFAS are a group of chemicals that can be found in the soil, air, water and food supply, according to the Environmental Protective Agency. They are labeled “forever chemicals” because they break down very slowly and can build up in human bodies, causing health problems that scientists are just beginning to uncover.

The American diet is also implicated in the rise of IBD. It’s probably the biggest contributor, Dr. Billings said. Americans eat a diet of highly processed foods that contain chemicals that quite likely affect our microbiome in damaging ways.

“We do know that, historically, any country that becomes more industrialized starts introducing a more westernized diet with higher fat foods and more sugary foods and then they start having higher rates of IBD. So that’s part of it,” he said.

When it comes to diet, Dr. Billings recommends his IBD patients get as much fiber into their diet as possible. And then try to minimize any processed foods.

Like most autoimmune disorders, IBD has a genetic component that might predispose someone to the condition. The trigger that sets it off is something in the environment, like diet, smoking, a bad infection, psychological stressors and even pregnancy, he said.

IBS and IBD

Many people with IBD also have irritable bowel syndrome (IBS), which is also a common form of dysfunction in the bowel, but with less destructive tendencies. Dr. Billings estimates that anywhere from 10-15% percent of adults in the U.S. have IBS at some point in their lives because of a disruption in their microbiome and the interaction between the brain axis, our biome and our diet.

“In some ways IBS has a lot of similar factors that contribute to it, but IBD is where there is very detectible inflammation and changes in the lining and the wall of the colon or intestines that leads to Crohn’s disease or ulcerative colitis,” he said. “Crohn’s is a deeper inflammation so it can cause other complications where people can get intestinal blockages, abscesses, fistulas or they get an abnormal connection between their intestines and their skin, bladder, vagina or various other places.”

In contrast, ulcerative colitis is more limited to the colon, but it can cause a lot of the same symptoms, like diarrhea, belly pain, blood in the stools and fatigue from all of the inflammation.

Sometimes IBD can be detected with stool tests, CT scans or MRIs, but the only way to formally diagnose it is with a biopsy from a colonoscopy or an endoscopy, Dr. Billings said.

Treatment

There are a lot more treatments for IBD now than there were just 10 or 15 years ago. The old treatments, like steroids or immunomodulators, caused unpleasant side effects, so the rise of biologics has been a blessing. Biologics are usually given by injection or infusion and occasionally orally. But because they are so new, they are extremely expensive and a lot of insurance companies don’t cover them.

Dr. Billings said he is hopeful more insurance companies will see the benefits of covering the drugs, because patients who can’t get proper treatment from medication often end up in the hospital for one or more surgeries, which are much more expensive than the medication and seriously disrupts their quality of life.

The other problem Dr. Billings sees is that once people start to feel better, they stop taking their medication or seeing their gastroenterologist. That is a mistake because they will most likely end up in the hospital a few years down the road.

“It’s a lifelong condition,” he said. “Even when you are doing well, you have to be following up with the GI doctor.”