Inflammatory Bowel Disease

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

February 5th, 2016 · Leave a Comment

Are Fecal Transplants Effective in Children with IBD?

By kanaazpe kanaazpe

Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea and is increasing in prevalence both in adult and paediatric populations. Moreover, those with inflammatory bowel disease (IBD) are at increased risk of CDI. Fecal microbiota transplantation (FMT) is an effective treatment for recurrent CDI, but little data is available regarding the effectiveness and associated microbiome changes of fecal microbiota transplantation (FMT) for Clostridium difficile infection in children.

In a recent study, researchers investigated C. difficile eradication and microbiome changes with FMT in children with and without IBD. Dr. Mark Bartlett discusses the results, and also provides insight into why IBD patients are susceptible to recurrent CDI. The study is published in Alimentary Pharmacology and Therapeutics.

Read the full study online here.

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

Dr. Bartlett is a gastroenterologist at Mayo Clinic.

Tags: Alimentary Pharmacology Therapeutics, Clostridium difficile infection CDI, fecal microbiome, fecal transplant, IBD, Mark Bartlett

January 27th, 2016 · Leave a Comment

Higher Risk for Pneumococcal Disease in IBD Patients

By kanaazpe kanaazpe

Mayo Clinic gastroenterologist, Dr. William Tremaine discusses a recent study published in The American Journal of Gastroenterology, that aimed to determine the risk of pneumococcal disease in patients with inflammatory bowel disease (IBD), compared with the general population, and how IBD medications may affect this risk, or whether the risk varies before or after IBD diagnosis.

Researchers from Copenhagen, Denmark found that IBD patients had a significantly higher risk for pneumococcal disease compared with controls overall. Dr. Tremaine highlights the importance of this study, especially in terms of disease prevention, and recommendations on routine pneumococcal vaccination.

Read the full study online here.

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

Dr. Tremaine is a gastroenterologist at Mayo Clinic.

Tags: American Journal of Gastroenterology, IBD, pneumococcal disease, vaccinations, William Tremaine

December 29th, 2015 · Leave a Comment

Specific Carbohydrate Diet for Pediatric IBD

By kanaazpe kanaazpe

Dietary intervention such as the specific carbohydrate diet (SCD), initially used to treat celiac disease, has been effective in patients with inflammatory bowel disease (IBD) as well. Dr. Jeanne Tung, M.D., discusses a study, published in the journal Nutrition, where pediatric gastroenterologists at Seattle Children's Hospital looked back at their patients who had tried the specific carbohydrate diet.

In general, the SCD tries to avoid the following foods:

  • Grains, chickpeas
  • Refined sugars or sugar substitutes, molasses, corn syrup, maple syrup
  • Chocolate
  • Processed foods, processed meats and fish
  • Soy products
  • Canned fruits and vegetables
  • Root vegetables
  • Milk, cream, commercial yogurt
  • Nut milk, rice milk, hemp milk

What is allowed?

  • Fresh or frozen vegetables and fruits
  • Most nuts, peas, beans
  • Fresh or frozen meats, turkey, chicken, fish, eggs
  • Some hard cheese, homemade yogurt
  • Honey
  • Juice that is not concentrated

Although the mechanism of action for the SCD is not known, it is hypothesized that the diet decreases intestinal inflammation by changing the fecal microbiome from a proinflammatory state to noninflammatory state.

Read the full study online here.

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

 

Tags: diet, fecal microbiome, IBD, Jeanne Tung, Nutrition, specific carbohydrate diet

December 20th, 2015 · 1 Comment

Pregnancy Concerns in Women With IBD

By kanaazpe kanaazpe

Women with inflammatory bowel disease (IBD) are at increased risk for adverse birth outcomes such as preterm delivery and small for gestational age (SGA) infants, and most recognized cases have underlying placental causes. Dr. Sunanda Kane, M.D., discusses a study, published in Annals of Gastroenterology that examined whether women with IBD have a higher rate of placental inflammation than non-IBD controls.

Researchers compared placental tissue of 26 women who had Crohn's disease or ulcerative colitis, and had delivered healthy children, with the placental tissue of 26 women who gave birth around the same time but didn't have IBD. They found that despite having an autoimmune inflammatory condition, the placenta did not appear to be at any increased risk of inflammation in the group of women who suffered from IBD.

While this is reassuring data, Dr. Kane explains that it does not change the recommendation for continuing anti-inflammatory drugs during pregnancy in women with IBD. Understanding what affects poor birth outcomes in IBD women is crucial to develop efficient and targeted therapeutics to improve births.

Read the full study online here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

Tags: Annals of Gastroenterology, Crohn's Disease, IBD, placental inflammation, pregnancy, Sunanda Kane, ulcerative colitis

December 13th, 2015 · Leave a Comment

New Gene Variants May Contribute to Very Early Onset IBD

By kanaazpe kanaazpe

Major advances in understanding the genetic contribution to the development of inflammatory bowel diseases (IBD) have been achieved in the last decade. However, these studies were performed primarily in adults and in children 10 years of age and older, and did not include children with very early-onset IBD (VEO-IBD), diagnosed at younger than 5 years of age. Dr. Konstantino Papadakis, M.D., discusses a study published in Gastroenterology, which investigated whether patients with VEO-IBD carry rare or new variants in genes that might contribute to disease development.

This study is critical as it provides a method to identify some of the underlying genetic defects as well as the pathways that contribute to the disease process in VEO-IBD patients. Moreover, these findings highlight the fact that clinicians can begin to individualize treatment to the specific patient, and may allow for targeted therapy in these children.

Read the full study online here.

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

Dr. Papadakis is a gastroenterologist at Mayo Clinic.

Tags: Gastroenterology, genome-wide association studies, IBD, Konstantinos Papdakis, VEO-IBD

December 4th, 2015 · Leave a Comment

Faecal Testing and IBD

By kanaazpe kanaazpe

Inflammatory bowel disease (IBD), mainly consisting of Crohn’s disease and ulcerative colitis, are lifelong intestinal disorders, and disease flares are often unpredictable and significantly affect the patient’s quality of life. Sunanda Kane, M.D., discusses stool tests for pediatric and adult patients with inflammatory bowel disease, focusing  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

December 3rd, 2015 · Leave a Comment

Symptoms and Diagnosis of IBD

By kanaazpe kanaazpe

How is inflammatory bowel disease (IBD) diagnosed? What are the symptoms? William Faubion, M.D., discusses these questions.

 

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

Dr. Faubion is a gastroenterologist at Mayo Clinic specializing in pediatric and adult inflammatory bowel disease (IBD).

Tags: diagnosis, IBD, symptoms, William Faubion

December 1st, 2015 · Leave a Comment

CCFA Awareness Week: Dec.1-7, 2015

By kanaazpe kanaazpe

Living with inflammatory bowel disease (IBD) can be difficult, but the right resources and support can make day to day living much easier. The Crohn's & Colitis Foundation of America (CCFA) is a non-profit, volunteer-driven organization dedicated to finding the cures for Crohn's Disease and ulcerative colitis.

In an effort to raise awareness and support for patients and families battling Crohn's Disease and ulcerative colitis, Dr. Jeanne Tung, M.D., highlights some of the research and activities, and invites you to join the conversation during CCFA's Awareness week.

The week of December 1-7, 2015 is reserved to encourage all Americans to help find cures for inflammatory bowel diseases and raise support for the now 1.6 million Americans battling Crohn’s and ulcerative colitis through awareness and advocacy.

To learn more about Crohn's & Colitis Foundation of America, visit ccfa.org

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Tags: Crohn's Disease, IBD, Jeanne Tung, ulcerative colitis

November 21st, 2015 · Leave a Comment

Interval Colorectal Cancer Low with Surveillance Colonoscopy

By kanaazpe kanaazpe

Surveillance is recommended for patients with chronic inflammatory bowel disease (IBD), as they have an increased risk of colorectal cancer (CRC). According to recent study data, published in Clinical Gastroenterology and Hepatology, the incidence of interval colorectal cancers, (cancers occurring between scheduled surveillance colonoscopies), is low in patients undergoing regular surveillance colonoscopy. Dr. John Kisiel, M.D., explains how current surveillance guidelines may impact interval CRC.

Dr. Kisiel underscores two important facts:

  • Surveillance guidelines practiced in the United States are appropriate, and, "although they are conservative, we are catching more cancers."
  • The authors of the study found that 20% of the patients had low grade dysplasia,¬†which are¬†low grade pre-cancers. These are cancers that doctors want to find on surveillance exams, so that they can be treated in a timely manner and prevent¬†the development of cancer.

Read the full study online here.

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

Dr. Kisiel is a gastroenterologist at Mayo Clinic.

 

 

Tags: Clinical Gastroenterology and Hepatology, dysplasia, IBD, interval colorectal cancer, John Kisiel, surveillance colonoscopy

November 20th, 2015 · 1 Comment

Insight into Endoscopic Balloon Dilatation for Crohn's Disease

By kanaazpe kanaazpe

Endoscopic balloon dilatation (EBD) is a recognized treatment for symptomatic Crohn's strictures. Dr. Kenneth Schroeder M.D., talks about a recent study, published in Alimentary Pharmacology and Therapeutics, that examines the efficacy, as well as complication rates for EBD.

The role of EBD in the management of Crohn's strictures may need to be redefined, and future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.

Read the full study online here.

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

Dr. Schroeder is a gastroenterologist at Mayo Clinic.

Tags: Crohn's Disease, endoscopic balloon dilatation, Kenneth Schroeder, strictures

November 9th, 2015 · 1 Comment

Highlights of ACG's Annual Scientific Meeting 2015

By kanaazpe kanaazpe

For five days, from October 16 to October 21, 2015, renowned experts in the field of gastroenterology offered clinical insights and real-world perspectives at the American College of Gastroenterology's Annual Scientific Meeting in Hawaii. Dr. Sunanda Kane, M.D., summarizes some of the bigger studies that were presented at the meeting, including key research done on
    • 6-mercaptopurine (6-MP), (Purinethol)
    • Azathioprine, (Imuran)
    • Infliximab, (Remicade)
    • Ustekinumab, (Stelara)
    • Ozanimod

Learn more about the ACG meeting here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

Tags: American College of Gastroenterology, IBD, Sunanda Kane

October 29th, 2015 · 2 Comments

Relapse Rates High in IBD Patients Who Stop Treatment

By kanaazpe kanaazpe

Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, are chronic disorders of the gastrointestinal tract which require long term treatment to achieve remission, and to prevent relapses. While current therapies are effective, many concerns exist regarding their long term use. Recently, a new area of research has emerged, namely, the question of the optimal duration of treatment in IBD. Dr William Tremaine, M.D., provides valuable insight on a review article published in Gastroenterology, and sheds some light on the relapse rates after withdrawal of well-established therapy in IBD patients.

Frequently, patients raise the question of stopping medication during remission of IBD. There may be several reasons to consider cessation of  treatment: 1) the high cost of medications, 2) the potential for rare, but serious side effects, such as infection or lymphoma, and 3) the possibility that the patient can maintain a durable remission off treatment.

In this study, researchers concluded that early discontinuation of an effective treatment can lead to a high relapse rate:

  • After 1 year, the relapse rate in IBD patients is 50%
  • After 5 years, the relapse rate increases to over 70%
  • After 10 years, the relapse rate is nearly 90%

Researchers also looked at a subset of IBD patients who may be better candidates for drug discontinuation. Dr. Tremaine explains:

  • IBD patients in a deep, prolonged remission¬†may represent a group that could stop medication.
  • Patients with lower blood level measures of the drugs could conceivably discontinue treatment.
  • Reduced rates of relapse were also noted with increasing age, for individuals 65 years and older.

As a final conclusion, the relapse rates in patients with inflammatory bowel disease who discontinued treatment are generally high; however, in case of specific patients, the discontinuation of therapy can be considered the challenge for future research.

Read the full article online here.

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

Dr. Tremaine is a gastroenterologist at Mayo Clinic.

Tags: Crohn's Disease, Gastroenterology, IBD, relapse, remission, treatment, ulcerative colitis, William Tremaine

October 28th, 2015 · Leave a Comment

‚ÄėCreeping Fat‚Äô May Contribute to IBD

By kanaazpe kanaazpe

According to new research data, published in Cellular and Molecular Gastroenterology and Hepatology, intra-abdominal fat cells may play a role in the pathophysiology of inflammatory bowel disease.

Dr. David Bruining, M.D., explains the study.

Fat accumulation surrounding the inflamed intestine, (also known as 'creeping fat' or mesenteric fat), during Crohn’s disease represents a hallmark of the disease. In this study, researchers looked at mesenteric fat in terms of its response to a neurotransmitter, known as Substance P, and observed that the fat cells were likely to elicit more inflammation.

Researchers also noticed striking differences between inflammatory mediators in fat cells between healthy people when compared to people with Crohn's disease and ulcerative colitis, demonstrating that 'creeping fat' cells may play a role in ulcerative colitis. These findings could mean that targeting 'creeping fa't may be a future focus of treatment for patients with inflammatory bowel disease.

Read the full study online here.

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

Dr. Bruining is a gastroenterologist at Mayo Clinic.

Tags: creeping fat, Crohn's Disease, David Bruining, IBD, Substance P, ulcerative colitis

October 13th, 2015 · Leave a Comment

C-Section Delivery Not a Risk Factor for IBD

By kanaazpe kanaazpe

Cesarean section, also known as C-section,  versus vaginal delivery has been explored as a risk factor for developing inflammatory bowel disease (IBD). During birth, bacteria from the mother and the surrounding environment colonize the infant's gut, and during C-section delivery this direct contact is absent.

Dr. Sunanda Kane, M.D., discusses the most recent findings published in Gastroenterology, which suggest that alteration of the gut microbiome at birth, due to C-section, is not sufficient to enhance the risk for IBD.

Read the full study online here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

 

Tags: cesarean section, gut microbiomes, IBD, Sunanda Kane

September 25th, 2015 · Leave a Comment

The Success of In Vitro Fertilization (IVF) in IBD Patients

By kanaazpe kanaazpe

The ability to become pregnant is an issue that many women face, and having inflammatory bowel disease (IBD) certainly adds to the many challenges.¬†Women who undergo colectomy and ileal pouch‚Äďanal anastomosis (IPAA or J-pouch)¬†are at an increased risk for infertility due to surgical factors, and often consider using assisted reproductive techniques such as¬†in vitro fertilization (IVF).

Dr. Sunanda Kane, M.D., talks about some encouraging news as investigators from two tertiary centers in Boston have shared their experience with IVF.

The information in these studies, which have been published in Clinical Gastroenterology and Hematology, and The American Journal of Gastroenterology, is potentially reassuring, and provides further hope for infertile couples with IBD.

Read the first study online here.

Read the second study online here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

 

Tags: American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, colectomy, IBD, J-pouch, Sunanda Kane

September 13th, 2015 · Leave a Comment

No Association Between Isotretinoin Exposure and IBD

By kanaazpe kanaazpe

The association between the use of Isotretinoin, a synthetic vitamin A derivate, and the risk of inflammatory bowel disease (IBD), remains a controversial issue, according to a study published in JAMA Dermatology.

Dr. Joseph Murray, M.D., and colleagues conducted a single-center study of about 1,000 people in Olmsted County, Minnesota, and separated them into two groups.The exposed group included patients with prior isotretinoin exposure, and the nonexposed group were defined as patients who never received isotretinoin or received it after the diagnosis of IBD. The findings of the study did not show an increased risk of IBD with prior isotretinoin use. If anything, the risk seemed to be decreased!

The existing evidence is also reassuring for dermatologists, as Isotretinoin is the standard treatment for severe acne. Since a causal association between Isotretinoin and IBD remains unproven, Dr. Murray suggests that physicians should not avoid prescribing this effective acne therapy because of concerns for the development of IBD.

Read the full study online here.

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

Dr. Murray is a gastroenterologist at Mayo Clinic.

 

Tags: acne, IBD, Isotretinoin, JAMA Dermatology, Joseph Murray

August 27th, 2015 · 1 Comment

New Stem Cell Therapy for Crohn's Fistula

By kanaazpe kanaazpe

Crohn’s fistula can be a devastating condition with a high recurrence rate. Listen to Mayo Clinic gastroenterologist, William Faubion, M.D., talk about exciting new research that shows how stem cells have been used to successfully treat Crohn’s fistula. This study has been published in Stem Cells Translational Medicine.

Read the study online here

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

Dr. Faubion is a gastroenterologist at Mayo Clinic, specializing in pediatric and adult inflammatory bowel disease (IBD).

 

 

 

Tags: Crohn's Disease, Crohn's fistula, IBD, stem cells, Stem Cells Translational Medicine, William Faubion

August 17th, 2015 · 1 Comment

Fecal Transplants for Ulcerative Colitis?

By kanaazpe kanaazpe

There is currently great interest in treating ulcerative colitis with fecal microbiota transplantation (FMT), which involves transplanting gut fecal bacteria from healthy people into patients with ulcerative colitis. Edward Loftus Jr., M.D., a gastroenterologist at Mayo Clinic, talks about two newly published studies in Gastroenterology; both studies examined the efficacy of fecal microbiota transplantation in ulcerative colitis, but arrived at different conclusions.

In the first trial, adult participants received fecal transplants from healthy anonymous donors via retention enema. Results from this trial showed that fecal microbiota transplantation safely induced remission in patients with active ulcerative colitis.

In the second study, patients with moderately active ulcerative colitis were also treated with donor stool; this time it was delivered via nasoduodenal tube, where a tube is inserted down the nose, through the oesophagus and stomach, and into the duodenum. However, the outcome of this study showed no significant improvement in the disease.

Researchers explored the reasons why one trial of FMT for ulcerative colitis was positive, while another was negative. They questioned the different modes of delivery of fecal microbiota, raising the possibility that administering it via the upper GI route might render the active bacteria ineffective by the time it reaches the diseased colon. The difference in frequency of infusions between the two trials could also have been a significant factor.

The jury is still out on whether FMT can effectively treat ulcerative colitis, and Dr. Loftus strongly cautions against a do-it-yourself or at-home treatment. Rather, he encourages patients to be part of a clinical trial, and there is hope that as researchers are able to better understand the active component of FMT, it will enable future therapies.

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

Dr. Loftus is a gastroenterologist at Mayo Clinic.

Tags: Edward Loftus, fecal transplant, Gastroenterology, IBD, ulcerative colitis

August 7th, 2015 · Leave a Comment

Therapeutic Management of Children with Very Early-Onset Bowel Disease

By kanaazpe kanaazpe

Once a medical rarity in children, inflammatory bowel disease (IBD) is increasingly common in kids today. Patients who are diagnosed with this disease at a very young age, sometimes less than 6 years old, have what is known as very early-onset IBD (VEO-IBD). Mayo Clinic gastroenterologist, Michael Stephens M.D., discusses a study published in The Journal of Pediatrics, that evaluates the diagnosis, management and long-term outcomes of children with very early-onset IBD.

The study found that children with VEO-IBD can present unique challenges to physicians and health-care providers. It starts as a relatively mild disease, and tends to be isolated to the large intestine. Over time, however, it changes in behavior, becoming more severe, and involving other regions of the intestine.

VEO-IBD is appearing more frequently on physicians' radars, and it is important to recognize that children are not small adults. Many of the children have definable problems with their immune system, and collaborating with good immunologists, as well as advanced genetic testing can facilitate more customized and enhanced treatment.

Read the full story online here.

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

Dr. Stephens is a gastroenterologist at Mayo Clinic.

Tags: genetic testing, IBD, immune system, Michael Stephens, The Journal of Pediatrics, VEO-IBD

July 30th, 2015 · Leave a Comment

IBD vs. IBS: What's the Difference?

By kanaazpe kanaazpe

Often, inflammatory bowel disease (IBD) is easily confused with irritable bowel syndrome (IBS). Clinical manifestations of irritable bowel syndrome and inflammatory bowel disease can overlap. However, there are some clinical characteristics that can help differentiate between them:

  • IBD refers to the chronic swelling (inflammation) of the intestines.¬†Crohn's disease and ulcerative colitis are the two terms most often associated¬†to the different types of IBD. Most people with IBS will not develop IBD,¬†but¬†irritable bowel syndrome symptoms can occur with increased frequency and severity in patients with chronic IBD.
  • IBS is not a disease, and it does not lead to colon cancer or bleeding. IBD, on the other hand, can put patients at risk for colon cancer, and bleeding is a common symptom. Watery diarrhea is common in both, but¬†bloody diarrhea is consistent with IBD and¬†does not occur in IBS.
  • Excess gas, bloating, heartburn are more likely to be due to IBS, rather than IBD.
  • IBS is characterized by a combination of¬†abdominal pain,¬†cramps,¬†constipation, and¬†may be¬†relieved by a bowel movement. Abdominal pain due to IBD is often constant, in a specific location, and not relieved by a bowel movement.
  • Weight loss is common in active IBD, but is uncommon in IBS.

The facts above are by no means a complete list of signs and symptoms, but do give a general idea of the basic distinguishing factors between IBS and IBD.

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

Tags: Colon Cancer, Crohn's Disease, IBD, IBS, ulcerative colitis