The effect bowel disease can have on morbidity and mortality is often underestimated. Gail Arkless outlines the most common disorders and reveals how underwriters view them
There are three common bowel disorders that you are likely to see disclosed on a proposal form. Irritable bowel syndrome (IBS), ulcerative colitis and Crohn's disease. Approximately three in 1,000 people suffer from some form of inflammatory bowel disease and 15% state they have or have had IBS at some time, so this is frequently seen. Outlined below is a description of each problem and the current treatments in use.
The aim of the digestive tract is to break down food, absorb the nutrients out of it and then get rid of the waste at the other end. It is a complex process with many stages, starting at the mouth and ending with the waste product. If you want to see this amazing set of organs in action have a look at www. medtropolis.com/vbody and take a look at the guided tour of the digestive tract. Here, we are only concerned with the later stages which take place in the small intestine and colon. This section measures an amazing 25-27 feet long, the same length as a stretch limousine, so it is hardly surprising that things sometimes do go wrong.
Irritable bowel syndrome
IBS differs from ulcerative colitis and Crohn's disease in that there is no inflammation of the bowel or intestinal tract. The symptoms tend to be much more mild, chronic and relapsing than in inflammatory bowel disease. It is often found in people with mental health disorders such as stress, depression, and anxiety. Some patients are helped with a change in diet or anti-depressant treatment.
Ulcerative colitus
There are two major forms of inflammatory bowel disease, ulcerative colitis and Crohn's disease. There are some similarities between the two diseases and this is why it is sometimes difficult to accurately diagnose. However, there are also significant differences between the two especially when it comes to the degree of disability they cause, the increased mortality risk and the way in that they are managed and treated.
Ulcerative colitis affects about eight in every 100,000 people and it is most prevalent in the US and Northern Europe. It usually occurs in 20-30 year olds and is more common in Caucasians than people of African origin. Slightly more males than females suffer from it.
It affects only the inner layer of the colon, or large bowel. It always starts in the rectum and may extend as a continuous inflammation from there into the rest of the colon. It can also affect the joints, liver, skin and eyes. Symptoms can include diarrhoea, bleeding, urgency and pain and it can be exacerbated by stress. A severe attack can be life threatening, with megacolon ' abnormally enlarged colon ' and perforation of the bowel having a particularly high fatality rate. Patients who suffer from ulcerative colitis for more than ten years and whose entire colon is affected also have an increased risk of colon cancer.
In active disease, steroids are used to reduce inflammation and control symptoms. Once control is gained sulphasalazine or similar products are used to keep the patient stable. There is a four-fold reduction in relapse when such maintenance therapies are used. Bizarrely enough smoking seems to keep the symptoms of this disease under check and many new cases of ulcerative colitis are in people who have given up smoking in the previous year. However, this is in no way a suggestion that you should take up or not stop smoking. We are all well aware of the other, highly dangerous aspects of smoking and that is why smokers automatically attract higher premiums. However, there is current research taking place into the use of nicotine patches and gum for non-smokers to see if they can have a long-term impact on symptoms.
The disease can be completely eliminated by surgically removing the colon, but afterward, waste material may have to be stored and expelled through an external appliance, for example, ileostomy.
Crohn's disease
Crohn's disease affects less people, around two in every 100,000 and has mainly two ages of onset, between 20 and 30 and 65 to 75. It is slightly more common in woman and smokers than ulcerative colitis. The incidence of Crohn's doubled between the 1960s and 1980s but has now reached a plateau. The cause is unknown but it is believed that both genetics and environmental factors play a part. Childhood onset is becoming increasingly common.
Crohn's can affect any area of the gastro-intestinal tract from the mouth to the anus and it affects the full thickness of the intestinal wall. The joints, liver, eyes and gallbladder can also be affected. Symptoms include abdominal pain, diarrhoea, weight loss and anaemia. Fistulae can also occur. These are passages that open up between two contacting organs, such as between the intestines and bladder, with obvious unpleasant consequences. Scar tissue may also form, resulting in narrowing of the intestines, which may cause pain as the passage of food is blocked. If the blockage is total, a stricture, then surgery may be required to remove it.
For smokers, giving up is as beneficial as any of the current medications available. Acute attacks can be treated with diet and steroids. Surgery can also be used but recurrence can be as high as 75% as obviously the whole alimentary tract cannot be removed.
While there are many similarities between ulcerative colitis and Crohn's disease the eventual outcome as regards treatment, cure and subsequently underwriting can differ greatly. They are common diseases but often underestimated in their ability to effect mortality and morbidity.
Gail Arkless is a life and disability underwriter at Scottish Equitable Protect
