Crohn Disease – An Underwriting Perspective
Crohn disease, an inflammatory bowel disease (IBD) that causes chronic inflammation of the lining of the digestive tract, affects over two million people worldwide and 500,000 in North America. The exact cause of the disease remains unknown, it has no cure and no single treatment works for everyone.
The inflammation associated with Crohn can lead to abdominal pain, diarrhea, weight loss, fever and malnutrition. Symptoms can be mild, or quickly worsen in severity, leading to serious complications including cancer.
People of all ages can be affected, but most are diagnosed between the ages of 15 and 35. We know that ethnicity plays a role, with Caucasians having the highest rates of diagnosis and Jews of Eastern European descent being up to five times more likely to acquire the disease. Genetic and environmental factors could play a role as well.
Diagnosis of Crohn disease is difficult because its symptoms closely resemble ulcerative colitis. Around 10% of individuals with IBD of the colon are diagnosed as having indeterminate colitis because they have features of both Crohn disease and ulcerative colitis.
It means that to obtain a definitive diagnosis, in addition to a complete medical history and physical exam, along with blood work, multiple imaging tests have to be done.
For treatment, anti-inflammatory drugs are often a first step with some patients responding to corticosteroids if that doesn’t work. Surgical intervention is considered for severe Crohn disease when drugs are ineffective or cause severe side effects.
The best underwriting assessment of Crohn disease follows from an evaluation of symptom severity, any extra-intestinal complications, compliance with treatment, age at diagnosis and history of any surgical intervention. Note, the disease could be labeled with a more generic term in clinical notes, such as regional enteritis or IBD.
Gastroenterology records with imaging study results are among of the best resources for risk classification. It’s also worth noting that a colonoscopy and examination of the terminal ileum are invaluable to the underwriting process.
Read my full article for more on risk assessment and Crohn disease.