Pardee Hospital

FALL 2015

Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.

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1 1 w w w. s p i r i t o f w o m e n . c o m FA L L 2 015 S P I R I T O F W O M E N SHUTTERSTOCK G astrointestinal issues can be tough to talk about, but with Crohn's disease it's essential to open up to your healthcare professional early and often, say experts. One of a group of inflammatory bowel diseases (IBD) that can be painful to the point of debilitating, Crohn's disease is a systemic autoimmune disorder that can have life-threatening complications. The chronic inflammation can affect any part of the gastrointestinal tract and produce symptoms such as diarrhea, pain, weight loss and low energy. That's why working closely with your medical provider is crucial to managing flare-ups and symptoms. The good news is that there have been significant medication advances during the past decade or so that can greatly improve quality of life for Crohn's sufferers. A NEW PROACTIVE APPROACH When Crohn's was less well- understood, it was treated in what Dr. Maya Srivastava refers to as a "pyramid fashion" starting with the mildest but least effective medications, and then progressing to more radical treatments if needed. "We began to realize that this approach was not changing the history of the disease," says Dr. Srivastava, a gastroenterologist affiliated with Kaleida Health Millard Fillmore Suburban Hospital in Williamsville, N.Y. "Too many people were still ending up with severe complications and would ultimately need bowel resection [to remove part of the large or small intestine]." MORE IMPROVEMENTS ON THE HORIZON Research is ongoing to try to improve Crohn's outcomes even further, says Dr. Matt Nichols, a gastroenterologist affiliated with Swedish Medical Center in Denver. "One concept that's being looked at is tailoring the medications to the specific individual," he says. "Since Crohn's is a complex disease that can target different sections of the gastro tract, being able to craft a medication in the lab specific to that patient's individual disease would hit all the end points of targeted treatment." Other areas of research include examining why Crohn's is more common in industrialized societies and less so in agrarian societies. "Interestingly, a big part of future areas of research is actually looking into the past to try to understand why these agrarian societies don't get these diseases," says Dr. Nichols. "We do know they have a more complex biome, whereas Westernized societies live more sterilized lives. It leads us to think that perhaps our internal biome is our buffer, so one of the futures of research is how we can establish good gut flora." Dr. Ryan McWilliams, a gastroenterologist at North Colorado Medical Center, Greeley, Colo., notes that because Crohn's disease can affect different parts of the body, therapies that target specific sites look very promising. And many of them are focused on the human microbiome as well. "To give just one example, some small studies have shown a benefit to fecal microbiota transplants, which would apply to those with colonic- based symptoms," he says. "This type of research is a big area that's very well-funded because it does have so much promise." • Much of the recent change in the medical community's approach to Crohn's is tied to the emergence of an entirely new class of medications called biologic therapies, which are antibody-based therapies that help interrupt the pathways to inflammation. "These medications, which have been available now for more than 10 years, have enabled us to change the natural history of the disease and reduce the risk of inflammation and, thus, surgery and hospitalization," says Dr. Srivastava. MANAGING CROHN'S WITH MEDICATION Unlike some other gastrointestinal disorders, Crohn's can be managed only with the proper medication; alternative therapies simply do not work and can lead to serious, lasting complications, say physicians. While there are side effects to biologic medicines that can be severe, says Dr. Srivastava, these are extremely rare and the rewards far outweigh the risk. In addition, medical professionals can closely screen for these risks and follow their patients to catch any problems early, says Dr. Srivastava, who has suffered from Crohn's disease since she was a child. "I would love to go back in the time machine with just one dose of Remicade [infliximab] in my hand and tell the doctors to give this to me," she says. "That would have been life-changing." In addition to biologic therapies, your doctor may also prescribe more traditional drugs to better target your specific inflammatory response. Unlike some other gastrointestinal disorders, Crohn's can be managed only with proper medication.

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