Primary Care Physicians Can Play a Critical Role in Caring for Patients With Gastrointestinal Disorders

This month, 50,000 people worldwide will gather at the World Congress of Gastroenterology to discuss ways to improve care for gastrointestinal disorders. While these efforts within the GI community are undeniably important, it's also critical that we educate the broader medical community about the growing challenge that these disorders present for today's doctors.

Up to 16 million patients in the United States suffer from irritable bowel syndrome with diarrhea, a disorder that mainly affects the bowel and is characterized by abdominal pain and diarrhea.

Constipation is the most common and bothersome gastrointestinal side effect reported by patients taking opioids, and there are over 200 million opioid prescriptions written each year.

Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease usually involve severe diarrhea, abdominal pain, fatigue and weight loss. In 1999, there were 1.8 million cases of IBD in the United States. As of 2016, there were 3.1 million.

[See: 10 Lessons From Empowered Patients.]

When the liver is unable to remove toxins from the blood, it can cause loss of brain function known as hepatic encephalopathy. The yearly inpatient incidence of HE increased from 20,918 in 2005 to 22,931 in 2009, comprising approximately 0.33 percent of all hospitalizations in the U.S.

Not only do these GI diseases and conditions affect an overwhelmingly large part of our population, they have also become a burden on the national health care system. In 2013, direct costs of IBS had ranged from $1,562 to $7,547 per patient per year. The total national charges related to HE also increased from $4.6 billion in 2005 to $7.2 billion in 2009.

The next logical question is: Are these patients receiving proper treatment? Let's take a closer look at IBS, since it's the most common functional gut disorder. Research published in the American Journal of Gastroenterology in June 2017 revealed that there is a greater than 40 percent chance that individuals who visit their family doctor for symptoms of IBS won't receive the proper diagnosis. On average, it takes patients with IBS four years to be diagnosed.

It's no surprise that some GI specialists would appreciate if primary care physicians and nurse practitioners would handle the most common cases. But that may not happen until the broader medical community becomes more familiar with diagnosing the disorders.

[See: How Often Should I Poop, and Other Toilet Topics.]

For the population of IBS sufferers who go undiagnosed, many resort to searching the Internet repeatedly, followed by one attempt at self-cure after another. A survey by the Pew Internet & American Life Project found that 80 percent of Internet users have searched for a health-related topic online -- most frequently, for information about a specific disease or medical problem. A Google search for "IBS," for example, yields around 50 million hits. Add direct-to-consumer advertising to the mix, and the clutter of information can be overwhelming to both patients and physicians.

Much of the information available to anyone with an internet connection is evidence-based, but much is specious and unfounded. Evaluating the information in an effort to self-diagnose may be dangerous. What we need is a strategy to help individuals and physicians cut through the clutter and make that information work for them in mutually positive ways.

We at Salix are pledging investing multimillions to increase awareness of GI disorders. In fact, later this year, we're launching a national educational program at the primary care level that takes these physicians on an educational voyage deep inside a high-definition, virtual lumen of the small intestine. Through the lens of a virtual reality tool, physicians peruse a swarm of microbiota and assorted bacteria floating through the undulating, glistening layers of pinkish gut as a narrator explains how these life forms can potentially create a life of abdominal pain, diarrhea and all-around visceral misery for their unhappy landlord. This immersive animation is part of our strategy to engage and educate the broader medical community on several leading theories about IBS, including the role gut microbiota may play in creating IBS symptoms for patients.

GI specialists are already familiar with the inside of the small intestine, but many primary care physicians and the broader medical community may not be. And that is where we can make a difference: by educating the broader medical community about these common digestive disorders, because they are the first and sometimes only line of defense for patients against these debilitating conditions. If these physicians, physician assistants and nurse practitioners aren't acutely aware of the constellation of symptoms and potential etiologies that would point a GI specialist to the appropriate therapy, their patient may continue to suffer for several years before finding an appropriate therapy.

[See: 10 Questions Doctors Wish Their Patients Would Ask.]

The ultimate goal for us is to eliminate any barriers to GI patient care for the undiagnosed and untreated patient population. If health care practitioners can diagnose patients earlier, those barriers to care may come down.

Mark McKenna is the Senior Vice President and General Manager of Salix Pharmaceuticals. Salix Pharmaceuticals is a leading specialty biopharmaceutical company committed to offering innovative treatments in gastroenterology, hepatology, endocrinology and other conditions. Mr. McKenna was appointed by the Board of Directors and CEO to lead Salix following the acquisition in late 2015. Since taking the helm, Mr. McKenna has significantly improved results and positioned the business for long-term growth through several strategic initiatives. Prior to leading Salix Pharmaceuticals, Mr. McKenna spent over a decade with Bausch + Lomb, most recently as the SVP and GM of their US Vision Care business. Mark holds a B.S. in marketing from Arizona State University and an MBA from Azusa Pacific University. In addition, Mark is also a Fellow with the University of Pennsylvania, Wharton School of Business.