Individualizing IBD Care Beyond the Bowel, With David T. Rubin, MD

Improving quality of life for patients with inflammatory bowel disease (IBD) starts with a simple but often-skipped step: asking the right questions.

"If you don't ask, you won't know," David T. Rubin, MD, professor of medicine at the University of Chicago and director of the Inflammatory Bowel Disease Center said in an interview with HCPLive.

According to Rubin, clinicians can become so focused on bowel symptoms, bleeding, or anemia that they miss the bigger picture affecting a patient's daily life.

Screening Questions to Identify IBD's Impact on Quality of Life

Rubin suggested 2 direct questions clinicians can use to uncover functional limitations that might otherwise go unspoken: "What does having this disease prevent you from doing that you would want to do?" and "What are you unable to eat that you would like to enjoy?"

"You start to learn more about somebody's limitations from the disease that you can develop a treatment plan that will address them," Rubin said.

Using Validated Screening Tools for Anxiety and Depression in IBD

Beyond open-ended questions, Rubin pointed to validated screening tools, such as a generalized anxiety scoring system and the Patient Health Questionnaire-9 (PHQ-9), as a way to catch what clinical impression alone often misses.

"If you screen for it, you will find it," Rubin said. He pushed back on the idea that experienced clinicians can simply tell when a patient is struggling. "I think that there's a lot of people who are depressed that you would never be able to tell in a limited clinical encounter."

Barriers to Comprehensive IBD Care in Clinical Practice

Rubin was candid about why these conversations don't happen more often, even when clinicians know they should. Referral infrastructure is thin. "Very few centers like ours have a GI psychologist or psychogastroenterologist... that I can refer them to," he said, adding that most clinicians were never trained to ask about sexual health in the first place.

Time is the other constraint. In a 15- to 20-minute visit already covering new therapies, upcoming scopes, insurance coverage, and lab follow-up, Rubin said, there's rarely room left for "tell me about your sex life, or fill out this survey and tell me if you're anxious or depressed."

"There's some very big system issues that are preventing us from providing the care that people need," Rubin said, arguing that the field needs a different care model, not just better awareness, to give clinicians the time and resources to manage these issues properly.

Selecting IBD Therapy Based on Extraintestinal Manifestations

Rubin said knowing about a patient's coexisting conditions can directly shape treatment selection. Patients with inflammatory joint problems alongside their IBD may be better served by an anti-tumor necrosis factor (TNF) therapy or a Janus kinase (JAK) inhibitor, both of which can address joint inflammation as well as bowel disease. Patients with coexisting skin conditions, such as psoriasis, erythema nodosum, or pyoderma, may benefit more from an interleukin-23 (IL-23) inhibitor, which Rubin said is effective for both skin and bowel.

"You can pick therapies based on knowing about some of these other challenges and problems," Rubin said. "The patient with IBD deserves care that tries to address these issues."

References

1. Hinnant L, Rios Villacorta N, Chen E, et al. Consensus statement on managing anxiety and depression in individuals with inflammatory bowel disease. Inflamm Bowel Dis. 2025;31(5):1248-1255.

2. Holmer AK, Chang S, Malter L. Selecting therapies in moderate to severe inflammatory bowel disease: key factors in decision making. GI and Hepatology News. November 1, 2023.