Inflammatory Bowel Disease

Discussing the latest advances in Crohn’s disease and 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 colonoscopyDr. 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

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 stricturesDr. 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

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

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

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

‘Creeping Fat’ 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

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

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–anal 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

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

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

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

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

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

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

July 11th, 2015 · Leave a Comment

Surveillance Colonoscopy May Reduce Colorectal Cancer Risk in Ulcerative Colitis

By kanaazpe kanaazpe

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.

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

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 kanaazpe kanaazpe

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

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 kanaazpe kanaazpe

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.


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 kanaazpe kanaazpe

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

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_Marie Margaret_Marie

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

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_Marie Margaret_Marie

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

Tags: IBD, infliximab, Mayo Medical Labs

May 14th, 2015 · Leave a Comment

IBD and Increased Risk of Melanoma

By Margaret_Marie Margaret_Marie

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

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_Marie Margaret_Marie

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

Dr. Kane is a gastroenterologist at Mayo Clinic.

Tags: IBD, protein, stool testing, Sunanda Kane

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