By Tracy Hampton, PhD, BIDMC Correspondent
Inflammatory bowel disease includes Crohn’s disease and ulcerative colitis—conditions that can cause a range of symptoms in patients, from mild and only occasional discomfort to intolerable abdominal cramps, bloody stool, frequent diarrhea, and rarely, life-threatening complications.
It is not yet completely clear what causes these conditions to occur, but there is a genetic component as well as environmental triggers. These appear to cause the patient’s immune system to go into overdrive and activate immune and inflammatory cells when no foreign invader is present. This is what leads to the inflammation in the intestines.
In this way, inflammatory bowel diseases may respond to drugs that have been successful in treating other immune mediated inflammatory diseases such as rheumatoid arthritis. One such drug is adalimumab (Humira), which has been approved for some time for Crohn’s disease and was recently approved for moderate-to-severe ulcerative colitis. Golimumab (Simponi) was also very recently approved for moderate-to-severe ulcerative colitis. Like adalimumab, it targets tumor necrosis factor (TNF), a molecule involved in inflammation. Budesonide MMX (Uceris), a steroid with less side effects than prednisone, was also recently approved for mild-to-moderate ulcerative colitis.
Other promising drugs are currently being tested in clinical trials. “The research in the immunology of inflammatory bowel disease is likely to make the greatest impact in the next few years, and one exciting treatment that will hopefully be approved in the next year is vedolizumab,” says Dr. Adam Cheifetz, the Director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and an Associate Professor of Medicine at Harvard Medical School.
This drug blocks inflammatory cells from exiting the blood stream and getting to the gut. “It’s nice because it has a different mechanism of action from the commonly prescribed anti-TNF medications, it looks very exciting, and it appears safe,” says Dr. Cheifetz.
In addition to the discomfort they experience, patients with a third or more of their colon involved with either Crohn’s or ulcerative colitis are at increased risk for colon cancer.
“This is likely due to the effect of the inflammation changing the colon cells,” says Dr. Cheifetz. “Patients in this category should be in a colon cancer surveillance protocol. After 8 years of disease, they should have colonoscopies every 1 to 2 years with numerous biopsies throughout the colon,” he advises.
Dr. Cheifetz notes that a technique called chromoendoscopy is a relatively new screening procedure that involves spraying a special dye on the colon.
“This has been shown to improve the sensitivity of finding precancerous lesions. Some academic centers, including ours, are doing this for patients at high risk for cancer.”
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted September 2013