Inflammatory Bowel Disease

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

July 11th, 2015 · Leave a Comment

Surveillance Colonoscopy May Reduce Colorectal Cancer Risk in Ulcerative Colitis

By Kanaaz Pereira

John Kisiel, M.D., a gastroenterologist at Mayo Clinic, helps us understand the benefits of surveillance colonoscopy for patients with ulcerative colitis (UC), which can reduce the risk of colorectal cancer. In this study, published in the American Journal of Gastroenterology, researchers report data from the St Mark’s Hospital UC surveillance program, one of the largest and longest-running programs in the world.

https://www.youtube.com/watch?v=PWN4uZSWZ9U

The study includes the following significant findings:

There is a higher risk of colorectal cancer in patients with ulcerative colitis. Regular surveillance colonoscopy helps in the detection of cancer at an earlier stage, allowing patients to retain their colon for longer, as well as increasing the survival rate.

Two types of colonoscopy have been performed in the last decade: chromoendoscopy, where dyes are instilled into the gastrointestinal tract, and white light colonoscopy. The rate of detection of pre-cancerous changes is significantly higher with chromoendoscopy, and it is important to note that subsequently the need for colectomy has decreased. However, the risk of interval cancer was about the same for those who got chromoendoscopy, as opposed to white light endoscopy. Thus, for patients and providers who may not have access to chromoendoscopy, high definition white light endoscopy is an effective option.

Approximately 50% of patients with high grade dysplasia had a synchronous colon cancer, and routine colonoscopy and removal of the high grade lesions alone is not sufficient.

Read the full story online here.

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

Dr. Kisiel is a gastroenterologist at Mayo Clinic.

Tags: American Journal of Gastroenterology, chromoendoscopy, colorectal cancer, dysplasia, high definition white light endoscopy, IBD, John Kisiel, ulcerative colitis

July 3rd, 2015 · Leave a Comment

Genome Sequencing Plays Increasing Role in Pediatric IBD

By Kanaaz Pereira

Over the past two decades, researchers have been better able to understand the role of genetics in patients with inflammatory bowel disease (IBD). At Mayo Clinic, a unique collaboration between pediatric gastroenterology and the Center for Individualized Medicine (CIM) offers young patients the opportunity for deep sequencing of DNA, and in most cases exome sequencing to try to identify the genetic basis of their symptoms as well as a therapeutic strategy to treat them.

Dr. Michael C. Stephens, M.D., a pediatric gastroenterologist at Mayo Clinic has  been actively involved in an international effort to identify better ways to stratify patients with IBD, with a focus on factors that predict more-severe disease. "One of our goals is to use the integration across pediatric and adult GI as well as the CIM to provide a comprehensive multidisciplinary program for families with multiple affected members. The family could come to Mayo and have adult and pediatric specialists collaboratively build a treatment strategy," says Dr. Stephens.

Read more in the Digestive Diseases Update.

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

Dr. Stephens is a pediatric gastroenterologist at Mayo Clinic.

Content originally posted in the Digestive Diseases Update.

 

Tags: Center for Individualized Medicine, Digestive Diseases Update, genetics, IBD, Michael C Stephens

June 29th, 2015 · Leave a Comment

IBD Patients May Need More Vaccination Counseling

By Kanaaz Pereira

Jeanne Tung, M.D., talks about why optimizing vaccinations in patients with inflammatory bowel disease seems to be a challenging issue, and emphasizes the benefits of counseling from gastroenterologists and primary care providers.

A recent study published in the Journal of Crohn's and Colitis found that concerns about side effects and vaccine safety were the most common reasons patients gave for not being vaccinated. Dr. Tung addresses these issues in the following steps:

  • Safety: Inactivated vaccines are generally safe. These include the annual influenza shot, meningococcal, tetanus, pneumococcal, and HPV vaccines. However, it is very important that patients receiving prednisone or immunosuppressants should avoid live vaccines, which include varicella, nasal influenza, and yellow fever vaccines. The MMR and rotavirus vaccines are also contraindicated  in children  with IBD.
  • Evaluation of an IBD patient for vaccination should be individualized, based on age and previously administered vaccinations. The best time to do that is at the time of initial diagnosis.
  • Care Coordination: A majority of patients in the study reported that the primary responsibility to ensure vaccine completion lies with the patient and the family physician. Effective and consistent communication between gastroenterologists and primary care physicians is key to developing a feasible strategy to educate IBD patients on vaccinations.

Read the full study online here.

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

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Tags: IBD, immunosuppressants, Jeanne Tung, Journal of Crohn's and Colitis, vaccinations

June 19th, 2015 · Leave a Comment

The Safety of Therapeutic Drugs in Male IBD Patients Wishing to Conceive

By Kanaaz Pereira

Sunanda Kane, M.D., discusses a recent study in Alimentary Pharmacology & Therapeutics about how male infertility can be impacted  with therapeutic drugs used to treat inflammatory bowel disease. Specifically, Dr. Kane focuses on the effects of azathioprine, sulfasalazine, and methotrexate.

Azathioprine is used to induce remission in patients with chronic IBD. Follow-up data to a pilot study, conducted over 10 years ago, suggests that there is little risk associated with the use of  azathioprine and sperm count and motility.

Sulfasalazine, which has been used for over 60 years, has been shown to cause qualitative and quantitative abnormalities of sperm. However, mesalamine products such as Lialda, Asacol or Aprizo do not carry as much risk, and it is therefore recommended that IBD patients who are on sulfasalazine be switched over to mesalamine.

There is some data to suggest that methotrexate can be toxic to sperm, but other studies report that it does not appear to affect testicular function.

The use of steroids or antibiotics over a long period can also cause a decrease in sperm concentration and motility.

Read the full study online here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

Tags: Azathioprine, IBD, male infertility, methotrexate, sulfasalazine, Sunanda Kane

June 4th, 2015 · Leave a Comment

Pros and Cons of Imaging Modalities for Pediatric IBD

By Margaret Shepard

Article appears in June's Digestive Diseases Update.

Inflammatory bowel disease (IBD) is one of the most serious gastrointestinal diseases affecting children in the Western world. It has a complex and variable course, and diagnosis not only includes endoscopy but also small bowel imaging to assess mucosal alterations and transmural involvement as well as response to treatment. As a result, patients are likely to have multiple imaging studies over a lifetime.

Jeanne Tung, M.D., recommends small bowel follow-through (SBFT) for children younger than 10.

"Most young children aren't capable of being in a room by themselves with a big, scary machine," she says. "With small bowel follow-through, they are in the presence of a provider and a reassuring parent for the duration of the study. There is some radiation exposure — in the pediatric population, the effective dose is about 1.2 to 1.5 millisieverts."

Read more about pediatric imaging for IBD in this month's Digestive Diseases Update.

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

Dr. Tung is a gastroenterologist specializing in the evaluation of children with IBD at Mayo Clinic.

May 29th, 2015 · Leave a Comment

Infliximab Quantitation with Reflex to Antibodies to Infliximab

By Margaret Shepard

From Mayo Medical Laboratories

The new Infliximab Quantitation with Reflex to Antibodies to Infliximab, Serum, test is now available to the Mayo Clinic practice and Mayo Medical Laboratories clients. This test should be ordered to assess a trough level quantitation for evaluation of patients with loss of response to infliximab.

Maria Willrich, Ph.D. gives a video overview of the test on Mayo Medical Laboratories website.

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

Tags: IBD, infliximab, Mayo Medical Labs

May 14th, 2015 · Leave a Comment

IBD and Increased Risk of Melanoma

By Margaret Shepard

Siddharth Singh, M.B.B.S., discusses the patient takeaways from a Mayo Clinic study that found patients with inflammatory bowel disease are at higher risk for melanoma, a type of skin cancer.

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

Siddharth Singh, M.B.B.S. is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Tags: digestive diseases, IBD, Melanoma, Siddharth Singh, skin cancer

May 8th, 2015 · Leave a Comment

IBD and Stool Testing

By Margaret Shepard

Sunanda Kane, M.D., discusses stool tests for pediatric and adult patients with inflammatory bowel disease. Specially, Dr. Kane focuses on two proteins that may help identify active inflammation.

Read the full study online here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

Tags: IBD, protein, stool testing, Sunanda Kane

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