4 Questions With Dr Alan Moss: Tackling Comorbidities in IBD Patients
In patients with inflammatory bowel disease (IBD), addressing comorbidities is often a crucial component of treatment, according to Alan Moss, MD, FACG, associate professor of medicine at Harvard Medical School in Boston, Massachusetts.
In fact, if comorbidities are not properly addressed, it can negatively impact the efficacy of treatment in these patients.
_______________________________________________________________________________
RELATED CONTENT
C Difficile Infection Risk Higher in Patients With IBD
Older IBD Patients Use Fewer Biologics, More Corticosteroids
_______________________________________________________________________________
Inflammation-associated comorbidities such as arthritis, asthma, and uveitis, as well as cancers of the skin, colon, and liver, are more common in patients with IBD, said Dr Moss. In addition, patients with IBD who have comorbidities such as osteoporosis, diabetes, or psoriasis can experience worsening of their disease as an unwanted side effect.
Consultant360 spoke with Dr Moss, who explained the importance of treating comorbidities in patients with IBD. Dr. Moss recently co-presented “Caring for the patient with multiple co-morbidities” with Millie D. Long, MD, MPH, FACG, of the University of North Carolina at Chapel Hill, at Advances in Inflammatory Bowel Diseases (AIBD) 2017 in Orlando, Florida.
Consultant360: Can comorbidities complicate an IBD diagnosis? What differential diagnoses exist for IBD?
Alan Moss: Some conditions can overlap with IBD, such as irritable bowel syndrome and lactose intolerance. These conditions share many similar symptoms. Additionally, other comorbidities such as arthritis can influence what type of treatments we use for IBD. In the case of arthritis, we would use more systemic treatments vs local treatments. Finally, medications like steroids can worsen co-morbidities such as cancer.
C360: Are comorbidities sometimes overlooked when treating these patients?
AM: Gastrointestinal doctors are usually focused on patients’ gastrointestinal symptoms in clinic visits, so non-gastrointestinal symptoms such as joint pain, fatigue, and rashes tend to receive the least attention. In addition, gastrointestinal doctors may not be comfortable diagnosing and treating conditions such as eczema or psoriasis.
C360: What factors are most important in caring for patients with multiple comorbidities?
AM: The key issue for patients with comorbidities is whether or not their care providers are all on the same page. I work with rheumatologists, dermatologists, and psychiatrists to ensure my patients with complex diagnoses have a team to address the many issues that can arise with complex medical histories and complications. An understanding of medication interactions and side effects is also important for patients who are on a long list of drugs for different conditions.
C360: What do you hope practitioners took away from your presentation?
AM: I hope practitioners who attended our presentation are able to build a team of providers who have an interest (or are willing to develop an interest) in IBD patients and their comorbidities to ensure the entire patient is treated, rather than provide fragmented, uncoordinated care. However, this is easier said than done!
—Christina Vogt
Reference:
Moss A. Caring for the patient with multiple co-morbidities. Presented at: Advances in Inflammatory Bowel Diseases (AIBD) 2017; November 9-11, 2017; Orlando, FL.