Supportive Therapy in IBD: What Additional Diagnoses and Conditions Must Be Treated?

Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC-IBD), share three major pathogenetic mechanisms of inflammatory bowel disease (IBD)-gut dysbiosis, gut barrier failure and immune system dysregulation. While clinical differences among them are well known, the underlying mechanisms are less explored. To gain an insight into the IBD pathogenesis and to find a specific biomarker pattern for each of them, we used protein array, ELISA and flow cytometry to analyze serum biomarkers and specific anti-microbial B and T cell responses to the gut commensals. We found that decrease in matrix metalloproteinase (MMP)-9 and increase in MMP-14 are the strongest factors discriminating IBD patients from healthy subjects and that PSC-IBD patients have higher levels of Mannan-binding lectin, tissue inhibitor of metalloproteinases 1 (TIMP-1), CD14 and osteoprotegerin than patients with UC. Moreover, we found that low transforming growth factor-β1 (TGF-β1) is associated with disease relapse and low osteoprotegerin with anti-tumor necrosis factor-alpha (TNF-α) therapy. Patients with CD have significantly decreased antibody and increased T cell response mainly to genera Eubacterium, Faecalibacterium and Bacteroides. These results stress the importance of the gut barrier function and immune response to commensal bacteria and point at the specific differences in pathogenesis of PSC-IBD, UC and CD.

Section: Introductionmentioning

confidence: 99%

Inflammatory Bowel Disease Types Differ in Markers of Inflammation, Gut Barrier and in Specific Anti-Bacterial Response

Coufal

Galanová

Bajer

et al. 2019

Cells

“…In addition, increasing use of medical therapeutics for IBD, in particular biologic agents, creates new opportunities for costs to rapidly incur (Swoger & Binion, 2010; Benchimol et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Bhattacharya

2014

PeerJ

Background. Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD).Aim. To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US).Methods. We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures.Results. Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N = 238), $7,827 (N = 95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N = 276, 372, p < 0.05). Publicly insured patients incurred the highest costs ($18,067) over privately insured ($8,014, p < 0.05) or uninsured patients ($5,129, p < 0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p < 0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI [1.08–4.19]) or no insurance (OR 4.94, CI [1.26–19.47]), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI [0.15–0.95]) and office-based care (OR 0.21, CI [0.07–0.62]).Conclusions. In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

“…6 In addition, increasing use of medical therapeutics for IBD, in particular biologic agents, create new opportunities for costs to rapidly incur. 7,8 Race and socioeconomic factors have long been shown to be associated with unequal healthcare access and utilization, with economic and health implications. 9 As supported by existing literature, we noted a trend for nonwhite, poor, and underinsured patients to utilize less outpatient care and more inpatient care.…”

Section: ) a Mo N G A L L I B D P A T I E N T S I N P A T I E N Tmentioning

confidence: 99%

Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Bhattacharya

2014

Preprint

View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint.Park MD, Bhattacharya J, Park K. 2014. Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting. PeerJ 2:e587 https://doi.org/10.7717/peerj.587Di ff e r e n c e s i n h e a l t h c a r e e x p e n d i t u r e s f o r i n fl a mma t o r y b o we l d i s e a s e b y i n s u r a n c e s t a t u s , i n c o me , a n d c l i n i c a l c a r e s e t t i n g Ba c k g r o u n d : S o c i o e c o n o mi c f a c t o r s a n d i n s u r a n c e s t a t u s h a v e n o t b e e n c o r r e l a t e d wi t h d i ff e r e n t i a l u s e o f h e a l t h c a r e s e r v i c e s i n i n fl a mma t o r y b o we l d i s e a s e ( I B D) . Ai m: T o d e s c r i b e I B D-r e l a t e d e x p e n d i t u r e s b a s e d o n i n s u r a n c e a n d h o u s e h o l d i n c o me wi t h t h e u s e o f i n p a t i e n t , o u t p a t i e n t , e me r g e n c y , a n d o ffi c e -b a s e d s e r v i c e s , a n d p r e s c r i b e d me d i c a t i o n s i n t h e Un i t e d S t a t e s ( US ) . Me t h o d s :We e v a l u a t e d t h e Me d i c a l E x p e n d i t u r e P a n e l S u r v e y f r o m 1 9 9 6 t o 2 0 1 1 o f i n d i v i d u a l s wi t h Cr o h n ' s d i s e a s e ( CD) o r u l c e r a t i v e c o l i t i s ( UC) . Na t i o n a l l ywe i g h t e d me a n s , p r o p o r t i o n s , a n d mu l t i v a r i a t e r e g r e s s i o n mo d e l s e x a mi n e d t h e r e l a t i o n s h i p s b e t we e n i n c o me a n d i n s u r a n c e s t a t u s wi t h e x p e n d i t u r e s . Re s u l t s : A n n u a l p e r c a p i t a me a n e x p e n d i t u r e s f o r CD, UC, a n d a l l I B D we r e $ 1 0 , 3 6 4 ( N= 2 3 8 ) , $ 7 , 8 2 7 ( N= 9 5 ) , a n d $ 9 , 5 2 8 , r e s p e c t i v e l y , s i g n i fi c a n t l y h i g h e r t h a n n o n -I B D ( $ 4 , 3 1 4 , N= 2 7 6 , 3 7 2 , p < 0 . 0 5 ) . P u b l i c l y i n s u r e d p a t i e n t s i n c u r r e d t h e h i g h e s t c o s t s ( $ 1 8 , 0 6 7 ) , o v e r p r i v a t e l y i n s u r e d ( $ 8 , 0 1 4 , p < 0 . 0 5 ) o r u n i n s u r e d p a t i e n t s ( $ 5 , 1 2 9 , p < 0 . 5 ) . A mo n g a l l I B D p a t i e n t s , i n p a t i e n t c a r e c o mp o s e d t h e h i g h e s t p r o p o r t i o n o f c o s t s ( $ 3 , 3 9 2 , p < . 5 ) . I n p a t i e n t c o s t s we r e d i s p r o p o r t i o n a t e l y h i g h e rf o r p u b l i c l y i n s u r e d p a t i e n t s . P u b l i c i n s u r a n c e h a d h i g h e r o d d s o f t o t a l c o s t s t h a n p r i v a t e ( OR 2 . 1 3 , CI 1 . 0 8 -4 . 1 9 ) o r n o i n s u r a n c e ( OR 4 . 9 4 , CI 1 . 2 6 -1 9 . 4 7 ) , wi t h i n c r e a s e d o d d s f o r i n p a t i e n t a n d e me r g e n c y c a r e . P r i v a t e i n s u r a n c e h a d h i g h e r c o s t s a s s o c i a t e d wi t h o u t p a t i e n t c a r e , o ffi c e -b a s e d c a r e , a n d p r e s c r i b e d me d i c i n e s ....