Inflammatory Bowel Disease

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

Posts (72)

Jun 4, 2015 · Pros and Cons of Imaging Modalities for Pediatric IBD

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 29, 2015 · Infliximab Quantitation with Reflex to Antibodies to Infliximab

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.

May 14, 2015 · IBD and Increased Risk of Melanoma

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.

May 8, 2015 · IBD and Stool Testing

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.

Apr 30, 2015 · Infliximab for Patients with Severe Ulcerative Colitis

Jeanne Tung, M.D., discusses infliximab for patients with severe ulcerative colitis. Specifically, Dr. Tung focuses on a recent study published in Clinical Gastroenterology and Hepatology that studied using an accelerated schedule compared to the usual dosing schedule of 6 weeks.

Infliximab, otherwise known as Remicade, was approved for Crohn’s disease in 1997. Clinical trials demonstrated it could be useful for patients with moderate to severe ulcerative colitis. The typical dosing schedule for both Crohn’s disease and ulcerative colitis is an induction schedule (0, 2, and 6 weeks) then switching to a maintenance schedule of every 8 weeks. However, in patients with severe ulcerative colitis, infliximab may not prevent surgery.

In the recent study published in Clinical Gastroenterology and Hepatology, researchers at St. Vincent’s University Hospital in Ireland specifically looked at their experience using an accelerated scheduled (approximately 3 infusions within 24 days) compared to the usual 6 weeks schedule.

In both scenarios, patients who were able to avoid surgery went on to infusions every 8 weeks. All of the patients had been sick enough to receive IV steroids before starting infliximab.

Who did better?

  • Short term: fewer patients went to surgery on the accelerated schedule (6.7% vs 40%)
  • The C-Reactive Protein seemed to decrease more in the group with the accelerated schedule.
  • In one year, 60% of patients in both groups required surgery (59% accelerated vs 59% standard).

The researchers didn’t report whether there were adverse events, particularly related to infections.

This was a relatively small study but does suggest for doctors to consider giving infliximab more frequently than standard induction schedule for patients with severe ulcerative colitis.

Read the full study online here.

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Apr 23, 2015 · Cognitive Function in Pediatric IBD Patients

Jeanne Tung, M.D., discusses two studies presented at the Advances in IBD conference. The studies focus on the brain and cognitive function of pediatric patients with inflammatory bowel disease (IBD).

In the first study, 12 preteens and young teenagers with Crohn’s disease had MRI scans of their brain. All of the patients were on steroids due to a Crohn’s disease flare. The MRI scans were compared to healthy children without Crohn’s disease. All patients also took memory, IQ, emotion, and attention tests. In the patients with Crohn’s disease, a portion of their brain called the cortex was a bit thinner compared to healthy children of the same age. Patients on higher doses of steroids and with higher inflammatory markers in their blood work were more likely to have the thinning of the cortex.

In the second study, a combination of 85 children with Crohn’s disease and healthy children were interviewed. The researchers also reviewed school records and tests of memory and IQ. Children with Crohn’s disease were more likely to have trouble with memory, even when in remission. They were also more likely to have issues at school including general school problems (23.5% vs. 8.1%), use of 504 plan for academic reasons (38.8% vs 0%), and need for special education classes (45.9% vs. 2.7%).

What are the takeaways from the two studies?

  • If possible, avoid steroids or discontinue them as soon as you can.
  • Work with your gastroenterologist to find the treatment regimen that will get you in remission.
  • Work with your school teachers to look for any emotional or learning issues. A formal test of IQ and learning ability may or may not be necessary. If issues are found, work on an individualized education plan to get the needed resources.

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

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Apr 23, 2015 · New Crohn’s Disease Progression Index

David Bruining, M.D., discusses a recent study published in Gastroenterology about a new measuring index for Crohn’s disease progression. The Lémann Index is the first comprehensive scoring index to assess bowel damage from Crohn’s disease.

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

Dr. Bruining is a gastroenterologist at Mayo Clinic.

Apr 8, 2015 · New Treatment for Ulcerative Colitis

Edward Loftus Jr., M. D., discusses the recent Food and Drug Administration approval of a new treatment for ulcerative colitis. Dr. Loftus explains the process Uceris, a budesonide foam, went through to receive FDA approval. The phase three trials found higher remission rates, improvement in disease activity, and rectal bleeding.

The new drug will be available soon for treatment of ulcerative colitis.

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

Dr. Loftus is a gastroenterologist at Mayo Clinic.

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