Leading-Edge Inflammatory Bowel Disease Therapy at Northwestern Memorial

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Crohn’s disease and ulcerative colitis are two types of inflammatory bowel disease (IBD). In this webcast, sponsored by Northwestern Memorial Hospital, Dr. Terrence Barrett discusses state-of-the-art management of inflammatory bowel disease, the latest treatments, where research is headed and also the efforts to head off increased risk of cancer. Dr. Barrett is chief of the Division of Gastroenterology at Northwestern Memorial Hospital and professor of Medicine and Microbiology/Immunology at Northwestern University’s Feinberg School of Medicine.

Over the last few years newer treatments combined with older treatments are helping people to better manage inflammatory bowel disease. Dr. Barrett begins with an explanation of what exactly IBD is, delving into the specifics of Crohn’s disease and ulcerative colitis. He then goes on to talk about how the disease is treated, when surgery is indicated, and the various drug treatments such as steroids and biologic therapies. He also touches on how the disease varies in individuals and how controlling inflammation through diet and treatment are key.

Cancer risk is also a part of the discussion. Dr. Barrett speaks about the risk in general, and how you can lower your risk. He also provides answers to listener questions about specific drugs, their side effects and colon cleanses. Dr. Barrett closes by talking about the future of IBD treatment and why he’s hopeful. To quote Dr. Barrett “I think the opportunities out there for patients have just gone up like light years. I got out of fellowship in 1991, and from the early 90s to now it's been just really a warped speed increase in our understanding of the disease.” If you’re looking for hope about your condition, or simply to learn more about IBD, listen to this informative program.

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Transcript

Andrew Schorr:

Crohn's disease and ulcerative colitis are both forms of what's called inflammatory bowel disease. We're going to hear from an expert from Northwestern Memorial Hospital about the latest treatments and also where research is headed and also the efforts to head off increased risk of cancer. Stay with us. It's all coming up next on Patient Power.

Hello and welcome to Patient Power. I'm Andrew Schorr, and this program, like so many we've done before, is sponsored by Northwestern Memorial Hospital, where we connect you with a leading expert. Today we're talking about inflammatory bowel disease, and that breaks down into Crohn's disease and ulcerative colitis, and altogether in the US it affects about a million people. Fortunately there have been developed over the last few years newer treatments working together with some older treatments in helping people do better, and also a lot more continues to be learned about the management of these diseases.

With us today is Dr. Terrence, Terry, Barrett. He's chief of the division of gastroenterology at Northwestern Memorial. He's also professor of medicine and microbiology/immunology at Northwestern's Feinberg's School of Medicine. Doctor, thank you so much for joining us. Help us understand just to begin what Crohn's and colitis are.

Dr. Barrett:

Crohn's disease could be thought of a disease that potentially could involve the entire GI, gastrointestinal tract, from the mouth all the way down to the anus. It's usually seen as a segmental or a sporadic disease where it can involve one area, have another intervening area that's completing normal, then have another area of involvement. Basically what you're looking at with involvement is ulceration and inflammation of the wall of the intestine that penetrates through the intestine itself and actually can go through the wall of the outer part of the intestine resulting in these little tubular like structures we call fistulas. It can result in an abscess or an infection on the outside of the intestine. So this is a more penetrating illness that can be spotty.

On the reverse side you have ulcerative colitis, which only involves colon. Typically it is very regimented in that it starts in the very end of the colon, in the rectum, and then marches up into the sigmoid colon and marches up into the left colon. It doesn't have to progress in everybody, but in about 15 to 20 percent of the patients it can involve the entire colon, which is the end, left side, the transverse, which is the middle one, and then the ascending, which is the right side. Again, the disease is different in that it typically involves the surface innermost lining. It doesn't penetrate through like Crohn's does, but in severe cases it can form intense inflammation, ulceration, it can have bleeding, and you can even get abscess and potential death. So in the ulcerative colitis patients they can really progress if they're the tiny minority that's really severe, and in the end it can be transmural, but that's only in the most severe cases. Usually it's just a superficial inflammation.

Andrew Schorr:

Now, I've known people over the years with both conditions, and being Ashkenazic Jewish myself I know that can be a risk factor, and these people I'm thinking of actually are of that same background. In Crohn's certainly we've had newer medicines, biologics, that seem to have made a difference. I know one woman in my town, she's a cheerleader and maybe she would have never had the confidence to be a high school cheerleader with Crohn's before. And then in colitis I know a man in my synagogue, he had surgery, and he's leading a very normal life. So are we doing better, do you think, in the management of these diseases?

Dr. Barrett:

The answer is yes. The data would suggest, as you gave the example with the young woman who is a cheerleader, that anti TNF, this is the biologic therapies that we'll talk about, the main benefit that's been demonstrated in a lot of these trials has been really quality of life, number one, and number two, limiting the number of surgeries that people had to have. And that's important because these medications cost a great deal of money, up to eight or ten thousand dollars every two months in some cases, so it's a burden to the insurance and medical payer industry. But on the flip side it's a huge, huge benefit to our patients. And us physicians, like myself, we aren't worried about the financial aspect as much as we're worried about the patient, so we're going to do everything we can for that young cheerleader. Or if it's a 22 year old person who's starting in the business world, or if it's a young lawyer that just got out of law school and doesn't want to run to the bathroom every 30 minutes, those are our patients, and we're trying to get the disease under control so that they can lead a more normal life. And that's what these agents are allowing us to do.

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