Inflammatory Bowel Disease

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

Posts (15)

Jan 22, 2014 · Early Azathioprine Therapy Did Not Lead to Crohn's Disease Remission

Two recent studies published in Gastroenterology have found that early administration of azathioprine in Crohn’s disease (CD) patients was no more effective than standard care or placebo for achieving sustained corticosterioid-free remission. Despite these findings, Daisy Batista, M.D., and other gastroenterologists believe there is still a role for azathioprine use in the management of Crohn’s disease.

The first study, published in Gastroenterology, compared the effectiveness of early treatment (within 6 months after diagnosis) with azathioprine versus conventional treatment of CD patients who were at high risk for disabling disease.  In a multicenter, open-lab trial, patients were randomly assigned to treatment with azathioprine or conventional management.  At the end of  a 3-year follow up, researchers concluded that there was no difference between the early azathioprine group compared to the conventional management group in the maintenance of remission.

In a second, separate study, also published in Gastroenterology, patients diagnosed with CD within the previous 8 weeks were randomly assigned azathioprine or placebo.  After 76 weeks of treatment it was concluded that azathioprine treatment was no more effective than placebo to achieve sustained corticosteroid-free remission.  However, subgroup analysis showed that azathioprine therapy was more effective in preventing moderate to severe relapse.

Dr. Batista and other gastroenterologists still believe that azathioprine can be an effective treatment for the management of Crohn’s disease in certain cases.  She notes that in the SONIC trial, patients who were treated with combination therapy with a thiopurine and infliximab were shown to have better response rates in reduction and maintenance of remission.  Also, patients with severe disease seem to benefit from azathioprine treatment.

These studies raise the possibility that perhaps gastroenterologists need to be more aggressive moving forward toward biologic therapy, especially in those patients who don’t seem to be responding to thiopurine therapy and for those who are at high risk for complicated disease and disease progression.

Abstracts for the studies can be viewed here and here.
For more information on IBD, visit: mayoclinic.org/ibd

Dr. Batista is a gastroenterologist and IBD Fellow at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Jan 6, 2014 · Pregnancy and Inflammatory Bowel Disease

When Sunanda Kane, M.D., sees female patients with inflammatory bowel disease (IBD), she is frequently asked how these conditions may affect pregnancy or the ability to get pregnant. A recent study also investigated this issue and found that there was no decrease in fertility in women with IBD who have not undergone significant abdominal or pelvic surgery.

The study, which was published in Alimentary Pharmacology & Therapeutics, conducted a systematic review of fertility in patients with IBD and found that:

  • There is no decrease in fertility rates in women who have IBD and have not had significant abdominal surgery.
  • Women who have had surgical procedures for Crohn’s disease, as long as it did not remove the entire colon, had no decrease in fertility
  • However, women with ulcerative colitis who have undergone a j-pouch (Ileoanal anastomosis) procedure are at an increased risk for infertility.

Full text for the article can be viewed here.
For more information on IBD, visit: mayoclinic.org/ibd

Dr. Kane is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Dec 31, 2013 · Heat Waves Linked to IBD Flares

Edward Loftus Jr., M.D., discusses a recent study published in the American Journal of Gastroenterology that found there is an increase in hospitalizations for IBD during heat waves.

Dr. Loftus mentions that the most obvious culprit for this increase would be bacteria, which most leading hypotheses suggest plays a role in the generation of inflammation in IBD, and perhaps alterations in our ambient temperature affect the growth rate of intestinal bacteria in the colon and small bowel.

While more research needs to be done on this matter, it does offer a fascinating clue as to what may be causing seasonal flares of IBD.

– Full text of article can be found here.
– For more information on IBD, visit: mayoclinic.org/IBD

 

Dr. Loftus is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Dec 17, 2013 · National Survey of IBD Patients Finds Obstacles to Quality Care

Sunanda Kane, M.D., discusses a study presented at the 2013 American College of Gastroenterology Meeting that surveyed patients with IBD and found that they encountered many difficulties with access to care.

Of the 3,802 IBD patients who responded, most said it was very difficult to find adequate healthcare coverage and continue to afford it. A majority of patients also said they had skipped doses of medication, delayed filling a prescription, making an appointment with their physician, or scheduling a test due to costs.

While these concerns are often understood at an individual level, this study, lead authored by David T. Rubin, M.D., FACG, Professor of Medicine at the University of Chicago Medicine, marks the first time that data has been able to show that for a particular disease entity, access can affect both quality of care and disease outcome.

Abstracts and press release for study can be viewed here.

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

Dr. Kane is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Dec 9, 2013 · Cancer Risk Increased with Crohn’s Disease, but Not Ulcerative Colitis

John Kisiel, M.D., discusses a recent study published in the American Journal of Gastroenterology that concluded patients with Crohn’s disease, but not ulcerative colitis, have an overall excess risk of cancer. Specific cancers include colon, lung, cervical, and lymphoma.

Dr. Kisiel also mentions that these findings highlight the increased importance of cancer screening and prevention measures for IBD patients, including:

  • Obtaining adequate colon cancer surveillance
  • Screening of female patients for cervical cancer
  • Vaccinating against HPV in younger patients (male and female)
  • More aggressive counseling for smoking cessation

Dr. Kisiel is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Dec 1, 2013 · Smoking Linked to More Aggressive Crohn's Disease

Laura Raffals, M.D., discusses a recent study published in the Journal of Alimentary Pharmacology & Therapeutics that found smokers were much more likely to have aggressive disease behavior. The study, which came out of Spain, was the largest of its kind, having examined disease behavior and smoking status of over 3,000 patients with Crohn’s disease.

Specifically, the patients who were smokers were more likely to:

  • Have stricturing disease, or narrowing in their intestines
  • Develop perianal disease in a shorter time-frame
  • Require immunosuppressive treatments

Dr. Raffals is a gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Dec 1, 2013 · IBD and the School Day: Tips for Parents and Children

Jeanne Tung, M.D., discusses helpful tips for parents and children that aim to minimize the impact of IBD on school experience.

Among these tips are:

  • Work with your child’s teacher, principal, nurse, and phy-ed teacher, to create 504 plan that will allow for special accommodations during the school day.
  • In this 504 plan, be sure to include items like bathroom privileges, school hours, physical education, and testing accommodations.
  • Send an extra set of clothing that your child can keep in their backpack, locker, or with the school nurse.
  • Make sure your child is staying well-hydrated, especially during flares.
  • Children need extra calories when going through a flare, so send nutritious, yet high-calorie, snacks with your child.
  • Involve your child in this process! It’s their body and they need to feel in control of what is going on.

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with IBD.

Nov 10, 2013 · Dramatic Increase in Hospitalization of U.S. Children with IBD

Michael Stephens, M.D., a pediatric gastroenterologist at Mayo Clinic specializing in the care and evaluation of patients with inflammatory bowel disease (IBD), discusses a recent study published in the Journal of Investigative Medicine that found a dramatic increase in the number of hospitalizations for children with IBD during the past decade in the United States.

For physicians taking care of children with IBD, Dr. Stephens recommends:

  • Doctors who see children with GI symptoms need to be mindful that these diseases are becoming more and more common and make sure to look for these diseases.
  • Doctors in the hospital taking care of these children also need to be mindful of this trend, as well as other co-morbidities like Clostridium difficile infection.

For patients and their families, Dr. Stephens recommends:

  • It’s important to have regular visits to the gastroenterologist to monitor your disease. If signs of a flare-up can be identified early, and physicians can intervene early, that flare may be easier to control.
  • Make sure IBD medication is taken regularly and be proactive when symptoms of a flare-up begin.
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