Transcript Understanding Inflammatory Bowel Disease: What Every

Sponsors
Crohn’s & Colitis
Foundation of America
Our Mission:
To cure Crohn’s disease and ulcerative colitis, and to
improve the quality of life of children and adults
affected by these diseases
CCFA Programs and Services
• Information Resource Center (IRC)
– Accessible via 888.694.8872 and www.ccfa.org
• Community website: www.ccfacommunity.org
• Teen website: www.ucandcrohns.org
• Education
– Chapter programs
– Teleconferences
CCFA Programs and Services
• Support groups
• Online resources
• Camp Oasis
– Children with inflammatory bowel diseases (IBD)
enjoy a safe and supportive camp
community
CCFA Signature Events
• “Take Steps”
– Held locally
– Join the walk for a cure
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Fund research
Raise awareness
Be heard
Change lives
– www.cctakesteps.org
CCFA Signature Events
• “Team Challenge”
– Endurance training program to run or walk
a half marathon at an exciting destination
– Help the Foundation raise crucial funds to
find a cure
– 16 weeks of professional training as part
of a team
– “Challenge yourself to change a life!”
– www.ccteamchallenge.org
IBD Research: CCFA’s Commitment
• Invested approximately $150 million in research and
funded more than 1,100 grants
• New initiative: Challenges in IBD Research
– Strategic research plan
– Understand causes and disease processes of IBD
– Identify faster, more effective methods of diagnosis and
treatment
– Sponsors scientific workshops and training programs to provide
guidance on how to perform good clinical studies
Understanding Inflammatory
Bowel Diseases (IBD):
What Every Patient Needs to Know
Today’s Objectives
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Define IBD, its potential causes and diagnosis
Discuss management and treatment
Highlight special populations
Review latest research
Answer questions
What Is IBD?
• Comprises Crohn’s disease (CD) and
ulcerative colitis (UC)
– Overlapping symptoms and complications
• Crohn’s disease can affect any area of the gastrointestinal
(GI) tract, including the small intestine and colon
• UC affects only the colon
• An estimated 1.4 million Americans live with
IBD
• 30,000 new cases diagnosed each year
What Are the Potential Causes of IBD?
Genetic
Predisposition
Immune System
Abnormalities
20%–25% of
patients have
a close relative
with IBD
An inappropriate
reaction by the body’s
immune system
Environmental
Factors
Infections, antibiotics,
nonsteroidal
anti-inflammatory
drugs (NSAIDs),
diet, smoking
The Spectrum of IBD
CROHN’S DISEASE
– Patchy inflammation
– Mouth to anus
involvement
– Full-thickness
inflammation
– Variable involvement
– Fistulas
– Abscesses
– Strictures
– Extraintestinal
manifestations
– Increased risk of
cancer
ULCERATIVE COLITIS
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Indeterminate colitis
10%–15%
Continuous inflammation
Colon only
Superficial inflammation
Variable involvement
Increased risk of cancer
Extraintestinal
manifestations
Understanding Complications
of Crohn’s Disease Obstruction
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Intestinal obstruction
Abscess
Fistula
Stricture
Colorectal cancer
Fistula
Understanding Complications
of Ulcerative Colitis
• Anemia from blood loss
• Perforation (rupture) of
the bowel
• Colorectal cancer
• Toxic megacolon
Perforation
Recognizing Symptoms of
IBD Flares
• Diarrhea
– Often increased from
usual course of disease
– Rectal bleeding
• Abdominal pain or
cramping
• Low-grade fever
• Fatigue
• Extraintestinal
manifestations
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Joint pain/swelling
Eye inflammation
Skin lesions
Mouth ulcers
Diagnosis
Diagnosing IBD
Diagnosing IBD
Normal colon on colonoscopy
UC on colonoscopy
CD on colonoscopy
Management & Treatment of IBD
Comprehensive IBD Management
Provide
emotional
support
Prevent
cancer
Improve
quality of life
Control
symptoms
IBD
Management
Goals
Replenish
nutritional
deficits
Treat
inflammation
Treat
complications
Minimize
treatment
toxicity
Maintain remission
Understanding Treatment Options
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Prescription medications
Over-the-counter agents
Complementary and alternative therapies
Surgery
Prescription Medications
Class
5-ASA Agents
Agents
• Balsalazide (Colazal®)
• Mesalamine formulations
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Delayed release tablets (Lialda®, Asacol®, Asacol HD®)
Controlled release tablets (Pentasa®)
Extended release capsules (Apriso™)
Rectal suspension (Rowasa®)
Rectal suppository (Canasa®)
• Olsalazine (Dipentum®); Sulfasalazine (Azulfidine®)
Corticosteroids
• Adrenocorticotropic hormone
• Budesonide (Entocort®)
• Hydrocortisone (Cortenema®, Cortifoam®)
• Methylprednisolone (Medrol®)
• Prednisone
Antibiotics
• Ciprofloxacin (Cipro®)
• Metronidazole (Flagyl®)
• Rifaximin (Xifaxin®)
Prescription Medications
Class
Agents
Immunologic Agents • Azathioprine (Imuran®, Azasan®)
• Cyclosporine (Neoral®)
• 6-Mercaptopurine (Purinethol®)
• Methotrexate
• Tacrolimus (Prograf®)
Biologic Agents
• Adalimumab (Humira®)
• Certolizumab pegol (Cimzia®)
• Infliximab (Remicade®)
• Natalizumab (Tysabri®)
Over-the-Counter (OTC) Agents
• Address only specific symptoms
– Antidiarrheal agents
– Laxatives
– Pain relievers
• Important to discuss with physician before
taking any OTC medications
Complementary & Alternative
Therapies: Probiotics
• “Good” bacteria that restore balance to the
enteric microbiota-bacteria in the intestines
• May be helpful in aiding recovery of the
intestine and maintaining remission
• Important to discuss with physician before
initiating treatment
Complementary & Alternative
Therapies: Supplements
• Fish oil supplements containing omega-3 fatty acids
– May reduce pain and inflammation when added to standard therapy
– Clinical trial results are inconsistent
– No clear recommendation
• Natural aloe supplement
– Works within intestines to break down impacted food to cleanse the
bowel
– Many formulations can actually be harmful to the bowel
• Alternative therapies should not replace prescription
medications
Surgery in IBD
Crohn’s Disease
– Strictureplasty
– Resection of small
intestinal segment
– Colectomy (partial or
complete)
– Proctocolectomy
• Unlike UC, CD cannot be
cured with surgery
Ulcerative Colitis
– Proctocolectomy
(removal of the colon
and rectum)
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With ileostomy
Restorative (ileoanal
or J pouch)
• Disease is “cured” once
the colon is removed
Understanding the Importance of
Diet & Nutrition in Managing IBD
• Causes of nutritional deficits
– Decreased intake (no desire to eat)
– Active disease
• Protein and fluid loss
– Decreased absorption of
nutrients (when small intestine
is affected by CD)
• Fat
• Vitamins
Small intestine
Understanding the Importance of
Diet & Nutrition in Managing IBD
• Create a food journal
– Eliminate problematic foods
• Strive for a well-balanced, healthy diet based on
– Hydration
– Electrolyte balance
– Continual adequate nutrient intake
IBD in Special Populations
Understanding IBD in
Children & Adolescents
• Special considerations
– Ability to swallow capsules or tablets
– Side effects of drug therapy
• Risks of long-term corticosteroid use
• Emotional/social concerns
– Adherence
– Growth failure and need for
nutritional supplementation
– Emotional well-being
Understanding IBD in
Pregnant Women
• Special considerations
– IBD should be controlled before
considering pregnancy
– Remain on most prescribed
medications
– Well-balanced diet with vitamins,
including folic acid
– Ongoing communication between
obstetrician and gastroenterologist
IBD Research
IBD Research
• Genetics
– Several genes linked to both CD and UC
– Large genome-wide studies continue
• Biologic markers
– Measurable substances that may help
characterize disease
• Clinical trials
– Better understand disease
– Develop novel therapies
IBD Research:
Agents on the Horizon
• Antibiotics
– Rifaximin (Xifaxan®)
• Steroids with new delivery systems, such as
COLAL-PRED®
• Hormone
– Teduglutide
• Mesenchymal stem therapy
Living Well With IBD
• Be compliant with medications
• Understand your disease and possible
complications
• Schedule follow-up appointments
• Maintain a well-balanced diet
• Establish a support system
• Empower yourself with information
• Follow “Helpful Tips” handout
Questions & Answers