A New Method for Assessing Disease Severity in IBD Patients

Whether it is doctors, hospitals, or healthcare fund managers, they need to stratify risks (assessing the risks of disease progression, complications, and adverse outcomes) and make treatment decisions (deciding whether to use biologics) based on the disease severity of IBD patients.

In addition, clinical guidelines also recommend making treatment decisions based on disease severity (mild to moderate, moderate to severe), providing best clinical practice recommendations to better help and support patients.

For example, doctors can assess the relative risk of complex complications in IBD patients and the benefits of early effective treatment to adopt a more aggressive treatment plan.

So the key question is, how to accurately and objectively assess the disease severity of IBD patients? Is disease severity sufficient to predict the risk of adverse outcomes in IBD? Should patients’ perspectives be included in the severity criteria?

Currently, there is a push for the development of high-quality IBD care, which requires measuring the quality of IBD care and the reasonableness of treatment cost reimbursement.

Treatment goals are not limited to symptom relief and mucosal healing but also depend on whether IBD patients’ intestinal function can be restored and quality of life improved.

Therefore, there is a need to reconsider the metrics for measuring IBD disease severity, incorporating non-clinical factors related to disease progression, complications, treatment costs, and quality of life.

Thus, it is necessary to assess patients’ health-related social factors, normal life disruptions, and mental health issues.

Previous studies have shown that about 15% of IBD patients consume 50% of healthcare resources, not only due to higher disease severity in some patients but also influenced by social and psychological issues (chronic pain, substance abuse, depression, low social support).

Identifying these reasons for consuming IBD healthcare resources and intervening could potentially improve treatment outcomes and healthcare costs for patients.

Therefore, researchers have proposed a method for measuring the disease severity of IBD patients: the Disease Severity Index (DSI), which includes two main aspects: mucosal healing and emotional relief.

The Disease Severity Index (DSI) considers the restoration of objective structure and function of the intestine while assessing improvements in patients’ social function and mental health, linking clinical and functional outcomes.

Furthermore, multidisciplinary research teams have used DSI to assess the physical symptoms and physiological functions (including emotional functions) of IBD patients, providing more comprehensive support for clinicians’ risk stratification of patients, and successfully predicting the risk of complications based on baseline patient conditions.

Additionally, researchers have observed that the development of psychological symptoms in IBD patients can also be considered an adverse outcome or disease complication, indicating the necessity of pre-treatment psychological assessments.

Since DSI is a prospective assessment, it can also reflect the cumulative impact of disease burden over time on patients and how it leads to negative disease outcomes and risks.

For patients with high severity scores on the DSI, ongoing assessments of biological disease progression and changes can be conducted, as well as evaluations of the emotional burden caused by disease progression (such as loss of hope, isolation, and helplessness).

It is essential to emphasize that when assessing IBD severity, doctors should pay attention to whether there are factors interfering with patients’ self-management of their disease (treatment confidence, adherence, acceptance, and self-regulation).

Some patients may experience changes in symptom perception and emotions, which should be included as part of the overall disease severity.

To achieve truly individualized treatment for IBD, these emotional, psychological, and social functional factors cannot be separated from other clinical indicators.

Of course, at least from the perspectives of patients and doctors, the most valuable method for assessing IBD severity is to ask patients how they cope with the disease in their lives and how the disease affects them.

This process is not achieved through simple standardized questionnaires but requires establishing a trusting relationship between the doctor and patient through open and honest dialogue.

(This article is for personal learning only)