Inflammatory Bowel Disease

Discussing the latest advances in Crohn’s disease and ulcerative colitis

October 31st, 2014 · Leave a Comment

Patient Story: Scott Hennen on Ulcerative Colitis and Mayo Clinic

By Margaret Shepard

Story originally posted on Sharing Mayo Clinic.

Scott Hennen, a radio talk show host from Fargo, ND, had surgery at Mayo Clinic to remove his colon, which had developed several sites with precancerous cells related to his ulcerative colitis, which was first diagnosed in 1997.

Scott had previously described his reasons for being public about his medical condition in this post. In the video below, he offers more background on his medical history and why he came to Mayo Clinic for his operation:

For more information about IBD, visit mayoclinic.org/IBD.

Tags: patient story, Sharing Mayo Clinic, ulcerative colitis

October 24th, 2014 · Leave a Comment

Ann Strom's Patient Story

By Margaret Shepard

Originally posted on Sharing Mayo Clinic.

As a 14-year-old, Ann Strom understandably had knots in her stomach about starting her freshman year of high school.

These knots, however, did not go away.

Following several weeks of abdominal pain, Strom and her parents began to suspect that her upset stomach was more than the result of nervousness or flu.

After a series of tests conducted by her family doctor came back negative, Strom was transferred to a specialist at a University Hospital. Several more rounds of tests, including Strom’s first colonoscopy at the age of 14, ultimately diagnosed her with Crohn’s disease in Oct. 2003.

Throughout high school, Strom alternated between several different medications in an attempt to control her symptoms. At one point, she was taking 14 pills a day. One in particular had terrible side effects, including feeling jittery, shaking, an elevated pulse and a red, puffy face.

“It’s kind of hard to deal with,” said Strom. “High school is a lot about appearances, so sitting there with a puffy, red face isn’t really fun.”

As Strom transitioned out of pediatric care, she began to consider other medical facilities for treatment. “I decided, after my mom had a doctor at Mayo, to switch my care to Mayo,” said Strom.

Upon arriving at Mayo, Strom met Dr. David Bruining, who recommended an aggressive re-assessment of her diagnosis. This time her testing was felt to be most suggestive of ulcerative colitis, not Crohn’s disease, as the cause of Strom’s condition.

“For patients like Ann, it is important to seek out help as they are not alone in their struggles,” said Dr. Bruining. “There are many treatment options available for patients with IBD.”

Though hopeful that this diagnosis was the correct one, towards the end of her freshman year of college Strom was still plagued by fatigue and abdominal pain.

“I was kind of at the end of the line when it came to medication options,” said Strom. “I could go back on high dosages of medication that caused really bad side effects that I hated in high school, or another option would be to have surgery.”

After much deliberation, Strom chose surgery. She completed a series of three surgeries, with a final take-down procedure in Oct. 2009.

Since then, Strom is back to her “new normal.”

“I’ve been feeling the best I’ve felt since I was 14 years old,” said Strom.

For more information about IBD, visit mayoclinic.org/IBD.

October 15th, 2014 · Leave a Comment

Proactive Monitoring

By Margaret Shepard

Edward Loftus Jr., M. D., discusses a recently published article in Inflammatory Bowel Diseases that looks at proactive Infliximab drug monitoring in patients. Infliximab treats Crohn's diseases and more recently, ulcerative colitis.

The recently published paper looks at proactive monitoring, instead of reactive monitoring which physicians have been doing. A physician at Bethel Decan Medical Center in Boston looked at 48 patients starting in 2009. The patients' blood levels were proactively checked regardless of the patients' condition. A control group of 78 patients either had a reactive approach or no drug monitoring at all.

A vast majority of patients did receive some adjustment in therapy. This resulted in patients staying on Infliximab for a longer period of time. 10% of the patients in the proactive arm resulted in less discontinuing Infliximab.

Read the full article online here.

For more information about IBD, visit mayoclinic.org/ibd.

Dr. Loftus is a gastroenterologist at Mayo Clinic.

Tags: Edward Loftus, IBD, monitoring

October 9th, 2014 · Leave a Comment

Crohn’s Disease and Remission with Vedolizumab

By Margaret Shepard

Edward Loftus Jr., M. D., discusses a recent article published in Gastroenterology looking at how well vedolizumab works with Crohn’s disease patients who have already been on an anti-TNF agent.

 

The study specifically examined the question of how well vedolizumab in patients with Crohn's disease who have already been on a different type of anti-TNF agent. The trial enrolled over 400 patients and 3/4 of the patients had to have previously failed one anti-TNF agent. About half of the patients enrolled failed two anti-TNF agents and a small percentage failed all three anti-TNF agents. The primary end point of the clinical trial was looking at the clinical remission rate at week six. Clinical remission was defined as a Crohn's disease activity index of 150 or less.

The patients in the trial received the drug at weeks 0, 2, and 6, and were followed until week 10.

The primary end point of the clinical trial was not met. About 15% of patients receiving vedolizumab and 12% receiving the placebo met the primary end point, and the results weren't significantly significant. However, at week 10, the remission rates were significantly different; the placebo rate stayed the same and the vedolizumab remission rate went up significantly.

The message from this study is that vedolizumab does work in patients that have failed other anti-TNF agents with significant difference showing up after week 10.

Read the full study online here.

For more information about IBD, visit mayoclinic.org/ibd.

Dr. Loftus is a gastroenterologist at Mayo Clinic.

Tags: Crohn's disease, Edward Loftus, Gastroenterology, Vedolizumab

October 3rd, 2014 · Leave a Comment

Fecal Transplants and Inflammatory Bowel Disease

By Margaret Shepard

Darrell Pardi M. D., a gastroenterologist at Mayo Clinic, discusses the role of fecal transplants in the management of inflammatory bowel disease (IBD).

Fecal transplant involves taking healthy bacteria from normal patients and putting it in the colon of patients with diseases like IBD. There's good evidence that fecal transplant treats C. difficile with high efficacy of a 90% or so response rate with very little toxicity. Researchers are hoping to extend this response rate to patients with IBD. Until now, there have been small case studies and reports saying fecal transplant might work but some saying it doesn't work so well.

At this year's Digestive Diseases Week, there was a studying looking at fecal transplants for patients with ulcerative colitis. The study had about 60 patients. Half of the patients were randomized to fecal transplant and the other half to enemas. The patients received treatment once a week for six weeks. The results showed there wasn't a noticeable difference in response rate between the two treatments. At this dose and frequency, fecal transplants don't help patients with ulcerative colitis.

There are ongoing studies at multiple centers looking at ulcerative colitis in adults and children. At this point, fecal transplants are not indicated as a treatment option for patients with ulcerative colitis outside of clinical trials.

For more information about IBD, visit mayoclinic.org/ibd.

Dr. Pardi is a gastroenterologist at Mayo Clinic.

Tags: Darrell Pardi, fecal transplants, IBD, ulcerative colitis

September 25th, 2014 · Leave a Comment

Patient Story: Crohn's Disease and Pregnancy

By Margaret Shepard

When I walked into Dr. Sunanda Kane’s office at Mayo Clinic, I was crying. I had been diagnosed with Crohn’s Disease not long before, and I was devastated by the news. I know some people who have Crohn’s, and they were not doing well. I had one baby and knew I wanted to have another, and I thought the diagnosis was basically a death sentence.

Before learning I had Crohn’s, I’d had 12 to 14 years of ups and downs with gastrointestinal issues. Doctors offered different diagnoses like irritable bowel syndrome and anxiety. It wasn’t until I had more intensive testing through Mayo’s Gastroenterology and Hepatology I Department that the Crohn’s was discovered.

I am fortunate to be an employee at Mayo. I’ve worked here for 10 years in secretarial and phone receptionist roles, and recently became a Registered Nurse. When I was working on the phones, I’d hear people’s opinions about the care and expertise at Mayo – how it was world-class. I feel very fortunate to have Mayo’s resources close to home.

One of my Mayo secretary friends recommended Dr. Kane to me. Dr. Kane focuses on pregnant women with Crohn’s. She has a great manner and personality and has been absolutely fantastic. She sat down with me and explained things like the different severities of the disease, which made me feel calm and more in control. Dr. Kane told me, “I promise you will not die from this disease.”

I was able to get pregnant, and I didn’t have any problems. My husband and I just had our baby boy, and we’re so excited! Although I was on Crohn’s medications before becoming pregnant, I didn’t need any during my pregnancy. Dr. Kane explained that some Crohn’s medications are safe to take if needed, which is very reassuring.

I can’t say enough good things about Dr. Kane. I hope to continue to stay healthy, and I plan on having more children in the future. Dr. Kane took me from being devastated to having hope and for that, I am very grateful.

Originally posted on Sharing Mayo Clinic.

Tags: Crohn's disease, patient story, Pregnancy, Sharing Mayo Clinic, Sunanda Kane

September 19th, 2014 · Leave a Comment

New or Recurrent Cancer in IBD Patients

By Margaret Shepard

John Kisiel, M.D., discusses a recently published article in Gut about risk of cancer in patients with Crohn’s disease and ulcerative colitis and a previous history of cancer on immunosuppressive therapy.

Researchers know that patients on immunosuppressants do have an increased risk of developing cancer. This risk appears to be quite high in patients who have received a solid organ transplant. Researchers have also seen an increased risk in certain types of cancers like lymphomas and nonmelanoma skin cancers. Immunosuppressants are very effective for IBD, particularly when combined with Humira, Cimzia, and Remicade.

The aim of the study was to see if patients with a prior history of cancer were more like to develop new or recurrent cancers if treated with immunosuppressants. A group of about 700 gastroenterologist across the country of France enrolled all their patients into the study for a full year, which was nearly 20,000 patients. The sample included about 400 patients with a prior history of cancer. If patients had a prior history of cancer, they were twice as likely to develop a new cancer. Other risk factors for developing cancer include age. If patients were taking an immunosuppressant, they were not anymore likely to develop a new cancer. Patients with prior cancers treated with immunosuppressants  appeared to have the same risk factor as patients with prior cancer history not taking immunosuppressants.

This is a very important finding and good news for patients. Patients with prior history of cancer can be treated aggressively for their ulcerative colitis or Crohn's disease using modern, combination immunosuppressant therapies.

If a patient has a history of melanoma or lymphoma skin cancer, there still should be caution about using immunosuppressants.

Read the full study online here.

For more information about IBD, visit mayoclinic.org/ibd.

Dr. Kisiel is a gastroenterologist at Mayo Clinic.

Tags: Crohn's disease, GUT, IBD, John Kisiel, ulcerative colitis

September 12th, 2014 · Leave a Comment

Pediatric IBD Prevalence

By Margaret Shepard

Jeanne Tung, M.D., discusses a recently published article in the Journal of Pediatric Gastroenterology and Nutrition about the prevalence of pediatric inflammatory bowel disease (IBD).

 

The researchers from Manitoba, Canada were interested in seeing if more children were developing IBD over time. In Manitoba, all children with IBD are seen at the children's hospital in Winnipeg. Adult and pediatric gastroenterologists created an IBD database of Manitoba residents and looked at records from 1978 - 2000. The researchers identified 397 children diagnosed with IBD over 30 years. The average age of diagnosis was 13, 1/5 were diagnosed before they were 10, and the youngest patient was 2 years old.

All together in Manitoba, approximately 6.3 children out of 100,000 were diagnosed with IBD each year. The proportion of patients diagnosed with Chron's disease compared to ulcerative colitis shifted from about 70% in the 1980s to 58% in the 1990s and 2000s. Throughout the 30 years of the study, people diagnosed with IBD were more likely to live in an urban setting compared to a rural setting.

Why does IBD seem to be increasing? There have been several studies focusing on environmental changes over time. Researchers have seen that as more countries become more Westernized, IBD increased. There hasn't been an identification about what in lifestyle or environmental changes is the exact cause.

In the general population, patients should avoid overusing antibiotics and try to eat a healthier diet, but this won't prevent IBD or change what happens when you have IBD.

Read the full study online here.

For more information on IBD, visit mayoclinic.org/IBD.

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Tags: IBD, Jeanne Tung, Pediatrics

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