Dr Daniel Ginard Vicens is Vice-President of GETECCU and coordinator of its Social Affairs Department. A specialist in gastroenterology, he is coordinator of the Gastroenterology Department at Son Espases University Hospital in Palma de Mallorca, where he has also held various management roles. He combines his clinical and management work with teaching as an associate professor at the University of the Balearic Islands and has an extensive research background, having participated as principal investigator in various national and international studies.
Inflammatory Bowel Disease has seen a sustained increase in incidence in Western countries, and, more specifically, in developing regions. What factors explain this growing epidemiological trend, and what relative weight do genetic factors have compared to environmental factors in this change?
Answer: In recent years, IBD has established itself as one of the most common chronic digestive diseases globally, reflecting changes associated with modern lifestyles. In fact, it is estimated that in Spain there are more than 300,000 people with this condition, and projections indicate that in the coming years it will affect 1% of the population. In Europe and the United States, the figure will exceed seven million people affected.
Given this scenario, we see that genetics is important, but it does not on its own explain the increase we are observing. That is why we now know that environmental and lifestyle factors play a decisive role in this phenomenon.
These likely include the Western diet, the consumption of ultra-processed foods, changes in the gut microbiota, pollution and, in general, changes in many habits associated with the modern environment. Genetics continues to determine a predisposition, but it is environmental factors that appear to act as triggers.
“A few years ago, we treated patients who were very different from one another in a more uniform manner. Today, it is much clearer to us that IBD is not a single disease, but a set of clinical profiles with distinct behaviours”
There is considerable clinical heterogeneity among patients, both in terms of disease progression and response to treatment. To what extent are we moving towards truly personalised medicine in IBD, and what tools allow for better patient stratification?
Answer: We are making progress, although we are probably not yet where we would like to be. A few years ago, we treated patients who were very different from one another in a more uniform manner. Today, it is much clearer to us that IBD is not a single disease, but a set of clinical profiles with different behaviours.
We already use clinical, endoscopic, radiological and laboratory variables to better stratify patients. We also have biomarkers and will increasingly incorporate more tools related to genetics, the microbiota or early prognostic factors.
The role of the gut microbiota has taken centre stage in recent years. Are we closer to effectively intervening therapeutically on the microbiota, or is this still more of a promise than a clinical reality?
Answer.- The microbiota has evolved from being a highly theoretical field into a very solid line of research. The question is how to translate that knowledge into truly effective therapeutic interventions. We still need to better understand which alterations are causes, which are consequences, and how to intervene in a stable and safe manner.
For many years, IBD treatment was adjusted gradually, starting with milder options. Now, in some cases, very potent treatments are chosen from the outset. Why has this approach to treating the disease changed, and what are the benefits of starting with more intensive treatments from the outset in certain patients?
Answer: It has changed because we have learnt that not all patients are at the same risk. Previously, we followed a more stepwise approach, gradually increasing the intensity of treatment.
Today we know that in patients with a more serious prognosis, it may be more effective to use advanced treatments earlier. It is not a question of treating everyone aggressively, but of better identifying who will benefit from a more intensive strategy from the outset.
“Biologics have significantly changed the prognosis for many patients. They have enabled better control of inflammation, induced and maintained deeper remissions, avoided the prolonged or repeated use of corticosteroids and, in many cases, reduced hospitalisations and surgery”
Biological treatments have revolutionised the management of IBD, but they also raise questions regarding safety, cost and patient selection. How has the prognosis of the disease changed since the introduction of biologics, and what limitations remain?
Answer: Biologics have significantly improved the prognosis for many patients. They have enabled better control of inflammation, induced and maintained deeper remissions, avoided the prolonged or repeated use of corticosteroids, and, in many cases, reduced hospitalisations and surgery. Furthermore, they have greatly expanded our ability to personalise treatment.
However, limitations remain, as, as I mentioned earlier, not all patients respond equally to the same treatment.
Specialist IBD units have been shown to improve clinical outcomes and care coordination. What distinguishes a specialist centre of excellence, and how does this excellence impact the patient’s progress?
Answer: What sets a specialist unit of excellence apart is, above all, its ability to provide multidisciplinary and continuous care. It is not just about seeing many patients, but about having a specific organisational structure: specialist gastroenterologists, expert nursing staff, and coordination with surgery, radiology, endoscopy, pharmacy, nutrition, psychology and other relevant specialities.
Rapid response pathways for flare-ups, close monitoring, therapeutic education, systematic evaluation of outcomes, and the ability to incorporate research and continuous updating into clinical practice are also fundamental.
And what does this mean for the patient? A swifter diagnosis, more tailored treatment decisions, better follow-up, less fragmentation of care and, ultimately, better clinical outcomes and a better patient experience.
“Patient associations offer something that no other stakeholder can provide with the same legitimacy: the lived experience of the disease”
Patient associations have gained prominence as active stakeholders in the healthcare system. How do you view the role of organisations such as ACCU Spain in supporting and empowering patients?
Their role is fundamental. Patient associations offer something that no other stakeholder can provide with the same legitimacy: the lived experience of the disease. And that is essential in chronic conditions such as IBD, which affect not only the gut, but also daily life, work, emotional health, personal relationships and one’s outlook on the future.
ACCU Spain in particular, an organisation with which we at GETECCU collaborate very closely, plays a highly valuable role in providing information, support and raising social awareness. Furthermore, it helps patients to better understand their condition and participate more actively in decisions regarding their health.
Access to reliable information is key in complex chronic diseases. What risks does misinformation pose, and how can healthcare professionals and patient organisations work together to improve health education?
Answer: Misinformation can lead to unjustified fear, false expectations, patients abandoning effective treatments, or adhering to therapies with no scientific basis. It can also damage the doctor-patient relationship if the patient receives contradictory or unreliable messages.
In response to this, we professionals must strive to communicate better, with clarity and empathy. In this regard, patient associations can be of great help in translating this knowledge into accessible language that is useful in real life. Furthermore, it is important to use appropriate and validated sources of supplementary information, such as Educainflamatoria
To conclude… Research into IBD is making significant progress in fields such as cell therapy, precision medicine and biomarkers. What do you think will be the most significant advances in the coming years, and which ones could really change clinical practice?
Answer: I believe the most transformative advances will come in three areas. Firstly, better patient stratification, thanks to more precise biomarkers that allow us to anticipate disease progression and therapeutic response. The second is the consolidation of precision medicine, with more personalised decisions from the early stages of the disease. And the third is the development of strategies that go beyond treating inflammation and allow for earlier intervention, even in the very early stages.