Transcript
Announcer:
Welcome to CE on ReachMD. This activity is provided by Global Learning Collaborative and is part of our IBD Masterclass curriculum.
Prior to beginning the activity, please be sure to review the faculty and commercial support disclosure statements as well as the learning objectives.
Dr. Iroku:
Hi, I'm Dr. Ugo Iroku. Here with me today is Dr. David Rubin.
Dr. Rubin:
Hi, how are you?
Dr. Iroku:
Most people with IBD are cared for by community gastroenterologists, so what happens in the clinic really determines patients' long-term outcomes and quality of life. In this module, the goal is to develop an understanding of the disease from the inside out, how genetics, environment, the microbiome, and immune pathways interact to create chronic inflammation, and why all that matters. The underlying biology is not just academic; it shapes how we think about risk, diagnosis, monitoring, and long-term management.
Dr. Rubin, in your opinion, why is it important for clinicians to understand the underlying drivers for IBD and not just the symptoms? And how does that knowledge change the way we care for our patients?
Dr. Rubin:
Well, Ugo, I think it's a really important question. Patients who are suffering from GI symptoms and then ultimately have a diagnosis of Crohn's disease or ulcerative colitis naturally want to understand why this happened. And in order to understand why it may have happened, or what we know about the disease process, they need to hear from us our explanation of what we know and frankly and honestly what we don't know so that they understand as well why we treat the way we do.
It's important to remember that most people with inflammatory bowel disease have no family history of this condition, and they feel like it just came out of the blue. They often naturally think that it might have been something they ate that set them off or that they had an infection, or perhaps they were on a vacation with family and everyone got sick but they're the only ones who remained unwell after they got home. So they come up with a different theory or rationale or maybe are living with active disease for quite a while before they finally get diagnosed.
So we need to explain to patients that while we don't understand what actually causes Crohn's disease and ulcerative colitis, we've learned an awful lot about how to treat it. And what we've come to appreciate is that there's a variety of factors contributing to an overactive immune response in their intestinal tract. I explain to patients that the immune system of our intestines has evolved over millions of years to live in harmony with the environment, and that other than our skin, the bowel is exposed to the outside world more than any part of our body, and therefore it's constantly being triggered and activated. If you get food poisoning, it becomes very active, and if you are just eating normally, your food will trigger a mild activity. But people with IBD have whatever triggers that activity either continuing to stimulate it, or they've just lost the off switch, or they've lost the ability to regulate it.
So the research that's gone on has looked at a variety of environmental factors that might be triggering the disease or the environment that's become too clean so our immune system doesn't learn how to regulate properly, combined with some genetic susceptibility, which is not always the case but can certainly be an important factor, and ultimately combined with this immune response.
So I explain to them that rather than thinking that your body is attacking itself, what I actually try to explain is your body thinks it's doing its job to protect you.
And our job in treating this is to turn down that overactive immune system and try to get it back to a resting state. And so our goal when we treat is to remove the inflammation long enough so the body can heal and we can go back to what we call homeostasis. That's the way I incorporate all this.
Now, of course there are some people on the one end of the spectrum with monogenic IBD, a single genetic abnormality that contributes to a significant immune defect that leads to this condition. That's different. Those are usually children under age 6 or 4 or 2 who are diagnosed. And there are others who live with a family history of multiple people who have these conditions. But regardless, it still has the same principle of how we think about it and how we treat it.
And it's very important to explain to a patient that this isn't their fault. It's not something they did to themselves or because they weren't eating well enough, which is often what they think of, or that it was stress necessarily, although it could have been a trigger. They need to understand that this is something we can manage together.
Dr. Iroku:
I agree with that, Dr. Rubin. I also find that in my practice as a community GI doctor, understanding the pathophysiology helps me explain that to the patient. And the more informed they are as to why they have IBD, the more they are informed as to why we need to monitor the levels of inflammation along the course of our therapy. And so when I tell my patients I need that stool sample to check their fecal calprotectin levels, they're more likely to come in if they understand the pathophysiology of why that's relevant. And if I'm telling my patient that although they feel great and perhaps they're on a steroid, they can understand that perhaps with understanding the pathophysiology, it's time to pivot to another medication—that they may feel well, but there are other factors in play that require a change in therapy. And so that's great insight.
Dr. Rubin:
I think it's really important. And also, despite what I said and what I try to explain to patients, everybody has to come to terms with living with a chronic problem, and they often don't know or believe that it is going to be chronic once they go into remission the first time. So this is an important conversation, and it does take time, and it's a journey that you go on with your patient to help them through this.
Dr. Iroku:
Great. It seems like if this conversation tells us anything, it's that being an IBD patient and doctor involves not just an understanding of the latest biologics but also understanding the disease pathophysiology, and that is the foundation of true diagnosis and therapy. Thank you for joining us today.
Announcer:
You have been listening to CE on ReachMD. This activity is provided by Global Learning Collaborative and is part of our IBD Masterclass curriculum.
To receive your free CE credit, or to download this activity, go to ReachMD.com/CME. Thank you for listening.
In support of improving patient care, Global Learning Collaborative (GLC) and Chron’s Colitis Foundation is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. 
Global Learning Collaborative designates this activity for 1.0 contact hour(s)/0.1 CEUs of pharmacy contact hour(s). 
Global Learning Collaborative has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit(s) for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit(s). Approval is valid until 05.01.27. PAs should claim only the credit commensurate with the extent of their participation in the activity. 
