The two main Inflammatory Bowel Diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, progressive idiopathic inflammatory disorders of the gastrointestinal (GI) tract. CD can affect any part of the GI tract, whereas UC affects the colon only.
A study using data from 2003-2004 estimated that approximately 436,000 Americans have CD and 512,000 have UC 1. The prevalence of CD was estimated at 151 per 100,000, while UC prevalence was estimated 178 per 100,000 1. A subsequent study using 2009 data estimated that 1,171,000 Americans have IBD (565,000 CD and 593,000 UC) 2. The protracted nature of these diseases exerts a major toll on patients in terms of need for chronic medical therapies, hospitalizations, surgery, health-related quality of life, economic productivity and social functioning. CD is responsible for $3.48 billion in total costs in the United States 3
Management of IBD is a complex, multidisciplinary process, made all the more difficult by the clinical heterogeneity of IBD and the lack of comparative effectiveness studies. Numerous studies have demonstrated practice variation, for example in the use of anti-inflammatory therapies, vaccinations and surgery. A recent study found significant variation among seven major US referral centers in the treatment of CD with immunomodulators 4. The practice variation points to areas of potential improvement in the quality of IBD care.
- Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1424-9.
- Kappelman MD, Moore KR, Allen JK, Cook SF. Recent Trends in the Prevalence of Crohn’s Disease and Ulcerative Colitis in a Commercially Insured US Population. Dig Dis Sci. 2013; 58(2): 519–525.
- Ganz ML, Sugarman R, Wang R, Hansen BB, Håkan-Bloch J. The Economic and Health-related Impact of Crohn's Disease in the United States: Evidence from a Nationally Representative Survey. Inflamm Bowel Dis. 2016 May;22(5):1032-41.
- Ananthakrishnan AN, Kwon J, Raffals L, Sands B, Stenson WF, McGovern D, Kwon JH, Rheaume RL, Sandler RS. Variation in treatment of patients with inflammatory bowel diseases at major referral centers in the United States. Clin Gastroenterol Hepatol. 2015 Jun;13(6):1197-200.