Inflammatory bowel disease (IBD) occurs most frequently in late teens to early 20s and 30s. It tends to emerge during the period when individuals are completing their studies and preparing to enter society, and because it is still difficult to cure, early detection and active treatment are important.
Professor Hwang Seong-wook of the Inflammatory Bowel Disease Center at Asan Medical Center in Seoul noted on 2nd at the hospital that "the number of inflammatory bowel disease patients in Korea is rapidly increasing." Professor Hwang graduated from Seoul National University College of Medicine and has served as an intern and resident at Seoul National University Hospital, an assistant professor at Seoul National University Hospital, and as a visiting professor at the University of Michigan, and is currently a professor in the Department of Gastroenterology at Asan Medical Center.
Inflammatory bowel disease is a condition characterized by chronic inflammation occurring repeatedly in the gastrointestinal tract. Crohn's disease, where inflammation occurs in various parts of the small and large intestines, and ulcerative colitis, where inflammation occurs continuously from the anus to the colon, are typical examples. According to the Health Insurance Review & Assessment Service (HIRA), the number of inflammatory bowel disease patients in Korea increased by 30.8% from 70,814 in 2019 to 92,665 in 2023. In particular, those in their 20s and 30s account for 25.8%.
Patients often initially misinterpret inflammatory bowel disease as a simple stomach upset, but the causes and treatments differ from a common stomach upset or gastroenteritis. Inflammatory bowel disease is fundamentally an autoimmune disease where the body's immune system attacks its own intestines instead of external pathogens.
In the past, genetic factors and immune system abnormalities were considered the main reasons, but recent studies suggest that acquired factors such asWesternized dietary habits, changes in gut microbiota, infections, and environmental stressors contribute to an overactive immune response that triggers the disease.
Professor Hwang noted that "over 300 genes related to immune response and protection of the intestinal mucosa have been reported so far," adding, "It should be understood that it is not a single gene that determines the onset of the disease, but that multiple genes interact with environmental factors and immune abnormalities to cause the disease."
He highlighted environmental factors such as the preference for greasy and spicy foods, as well as the increased use of alcohol, smoking, and anti-inflammatory pain relievers, as the background for the recent surge in domestic patients. Inflammatory bowel disease can lead to complications such as intestinal stricture and perforation if left untreated, making early detection and active treatment vital.
Ulcerative colitis presents symptoms like blood in stool and diarrhea more quickly than Crohn's disease, making it relatively easier to diagnose. In contrast, Crohn's disease can develop irregularly in various segments of the small and large intestines and often has long asymptomatic periods, leading to late diagnosis.
Professor Hwang explained, "In its early stages, Crohn's disease often only presents vague abdominal pain and diarrhea, which leads to delays in diagnosis and treatment," adding, "Due to late diagnosis, about 40% of Crohn's disease patients already have complications like fistulas at the time of diagnosis."
A fistula occurs when pus accumulates in the anal glands, resulting in the formation of a hole. He stated, "If abdominal pain, diarrhea, or blood in stool persists for more than a month, or if there is unexplained weight loss, an endoscopic examination is strongly advised," emphasizing that, "Particularly if there is a family history, careful monitoring is essential."
Inflammatory bowel disease is diagnosed through a combination of colonoscopy, biopsy, blood tests, and imaging studies. When Crohn's disease is suspected, small bowel computed tomography (CT) or magnetic resonance imaging (MRI) is performed. Although there is still no complete cure, advancements in diagnostic techniques and treatments have significantly changed the treatment environment and prognosis for inflammatory bowel disease compared to ten years ago.
Professor Hwang remarked, "In the past, treatment began only after symptoms had worsened, but recently, managing the condition during asymptomatic periods or early detection has become a global trend," adding, "With the introduction of molecular diagnostic methods and genetic analyses, we can predict the type of disease and prognosis for patients more accurately now."
The development of various autoimmune disease treatments has significantly improved patients' quality of life. Professor Hwang explained, "In the past, only anti-inflammatory drugs and immunosuppressants were available, but they didn't work well. Now, many targeted therapies, including biological products and small molecules, are available; currently, there are five targeted therapies for Crohn's disease and nine for ulcerative colitis."
He stated that the treatment goal is to enable patients to lead normal daily lives with "maintenance of remission." Remission is a different concept from a cure. A cure means that all symptoms have disappeared, and no further medications or treatments are needed, while remission refers to a state where health is maintained and symptoms do not appear with appropriate treatment or medication.
He noted, "Using the right medication at the appropriate time for each patient can suppress and control inflammation, leading to a state of remission," adding, "If remission is maintained, patients can live almost like the general population." Most importantly, advancements in diagnostic methods have also increased treatment possibilities.
Professor Hwang has recently focused on the advantages of intestinal ultrasound in the diagnosis of inflammatory bowel disease. Since last year, he has traveled abroad to Australia and Japan to learn about the examination methods. He is the first medical professional in Korea to receive dual certifications from the international intestinal ultrasound accreditation systems IBUS (International Bowel Ultrasound Group) and GENIUS (Gastrointestinal Network for Ultrasound).
He remarked, "Intestinal ultrasound can be performed at much shorter intervals than colonoscopy or small bowel CT and MRI, and the patient's inflammatory status or drug response can also be quickly assessed," adding, "We can more closely monitor patient conditions by conducting intermediate checks with ultrasound and regular checks with colonoscopy, etc."
Inflammatory bowel disease is challenging to diagnose early or completely cure. Hence, it is essential to maintain a healthy state to avoid worsening the disease while preserving daily life. Professor Hwang stated that once a patient is met, they inevitably continue to be monitored for a long time.
"Medical professionals accompany patients through significant life journeys, including graduation, employment, marriage, childbirth, and parenting. We will continue to engage in research to solve new challenges, such as personalized treatment and preemptive screening and prevention methods, to enhance patients' quality of life."