Advances in Inflammatory Bowel Disease
MADISON - If you're among the one to two million people in the United States with inflammatory bowel disease, you've probably heard it all.
Maybe you'd feel better if you weren't so
Advances in Inflammatory Bowel Disease
MADISON - If you're among the one to two million people in the United States with inflammatory bowel disease, you've probably heard it all.
Maybe you'd feel better if you weren't so stressed out… if you switched jobs… got more sleep… ate more sensibly.
And then there's the biggest misconception - It's all in your head.
In fact, Crohn's disease and ulcerative colitis - the two conditions that together are known as inflammatory bowel disease (IBD) - are systemic diseases, meaning that they can affect a person's entire body.
Characterized by chronic intestinal inflammation, or abnormality in the lining of the intestines, IBD is often confused with irritable bowel syndrome (IBS), which involves a constellation of bowel-related symptoms not caused by inflammation or tissue abnormalities.
At the seminar, UW Health gastroenterologists Mark Reichelderfer, MD
and Robert Judd, MD served on a panel of experts, along with University of Chicago School of Medicine associate professor of medicine Sunanda Kane, MD.
Addressing a group of IBD patients and their loved ones, Dr. Kane described some cases of IBS as the type of "butterflies in the stomach" that might cause an athlete to have diarrhea or nausea before a big game. But while IBS may be fleeting, inflammatory bowel disease is a chronic, lifelong disease for which there is no medical cure.
"That sounds pretty horrible, but you can say the same thing about diabetes, high blood pressure and asthma," says Dr. Kane. She added that though there's no known cure for Crohn's disease and ulcerative colitis, they are treatable conditions.
In fact, the outlook is improving for people with IBD. In the last decade, several medical and pharmaceutical advances have helped improve the quality of life for patients, and burgeoning research could lead to more breakthroughs. Several new drugs are on the cusp of FDA approval.
"There are many possibilities and options available today that were unheard of 25 years ago," said Jane Present, co-founder and executive director of the Foundation for Clinical Research in Inflammatory Bowel Disease.
Crohn's disease can affect any part of the digestive tract, from the mouth to the anus. It most frequently affects the lower part of the small intestine, called the ileum.
With Crohn's, the body mistakes normal bacteria in the intestines for foreign or invading substances, and the immune system launches an attack. The abnormal response causes symptoms that can dramatically change a Crohn's sufferer's life - from persistent diarrhea and abdominal cramps to fever and even rectal bleeding.
While Crohn's can strike anywhere in the digestive tract, ulcerative colitis only affects the colon. Symptoms differ depending on how much of the colon is inflamed, but may include urgency to evacuate and loss of appetite and weight. Because IBD is a systemic disease, symptoms may also include joint pain and swelling, eye inflammation and skin lesions.
The Spectrum of IBD Treatment
Crohn's disease and ulcerative colitis can broadly range in severity. Some patients may experience minimal symptoms every few years; others may have almost nonstop, severe symptoms.
Generally, the treatment approach is to start with mild medications to treat mild disease. With more severe disease cases, stronger medications are generally necessary, but they also tend to have more side effects.
Only a few types of medications were available prior to 1990 to treat Crohn's disease and ulcerative colitis. Since then, a dramatic increase both in the scope of research and medication development has opened up more treatment options than ever before for IBD patients.
With advances in both drug and surgical therapy, most people with IBD live normal, productive lives. But gastroenterology experts stress that it's important for patients to adhere to their drug therapies and maintenance medications, regardless of whether they believe their disease is in remission.
"You don't take insulin away from a diabetic just because their blood sugars are all under good control," says Dr. Kane. "It's the same thing for ulcerative colitis and Crohn's - if you're well, it's because you have been on medicine."
Treatment of inflammatory bowel disease involves a wide range of medications, as well as surgical options, nutrition therapy and emotional support. Goals include:
- Relieving symptoms; and achieving and maintaining remission (the absence of symptoms)
- Treating inflammation and complications
- Detecting cancer in early stages, including subtle "pre-cancer" warnings called dysplasia, which indicate that cancer is likely to develop
- Improving patients' daily functioning
- Replenishing nutritional deficits
IBD Drug Therapies
To achieve these goals, a range of drug therapies ar