IBD: Know Your Disease

Dr. Adam Cheifetz has a particularly vivid memory from when he was a medical resident. After a long night on call, he shared an x-ray he'd been carrying around with the attending physician. That doctor took a quick look at the x-ray and said, "I'd hate to be that guy!" What he didn't know was, Dr. Cheifetz was that guy. Around 2:00 a.m, suffering from severe abdominal pains, he asked a colleague for an x-ray, which showed an obstruction in the small intestine. After several similar episodes, he was diagnosed with Crohn's disease.

Fast forward 18 years and Dr. Cheifetz is now the Director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, where he has dedicated his career to caring for patients with Crohn's disease and ulcerative colitis and helping to enhance their quality of life. The winner of the 2015 New England Chapter Crohn's and Colitis Foundation of America (CCFA) Humanitarian of the Year Award, Cheifetz wants patients to know that though IBD is a chronic disease, it is treatable.

Crohn's Disease and ulcerative colitis, the two main forms of Inflammatory Bowel Disease (IBD), are immune-mediated disorders characterized by chronic inflammation of the gastrointestinal (GI) tract. The diseases have many similar symptoms, but they affect different areas of the GI tract. Ulcerative colitis is confined to the colon, causing inflammation, and sometimes ulceration, of the inner layer of the lining of the colon. Crohn's can appear anywhere along the GI tract, though it typically affects the ileum, the distal most portion of the small intestine and the beginning of the colon, called the cecum.

Ulcerative colitis typically presents with rectal bleeding and diarrhea. The symptoms of Crohn's disease are more variable – diarrhea, bloating, abdominal cramping and pain – and can be similar to those for Irritable Bowel Syndrome (IBS) or other diseases. It is critical for people who experience symptoms to get proper testing and diagnosis.

Knowledge is Power!

"Once a diagnosis has been made, knowing your disease is the best way to partner with your doctor to manage it," says Cheifetz. "Patients should know the location in the GI tract that is affected. If you have Crohn's, is it in your small intestine, your colon or both? Patients should know what surgeries they have had, what has been removed, and why. If the patient has ulcerative colitis they should know how much of your colon has been involved. Patients should know what medications they're on, what has worked for them, what medications they have failed, and what side effects they've experienced. And they should be able to identify complications of IBD that can occur outside the GI tract, such as inflammation of the eyes, liver or certain skin lesions."

Cheifetz encourages his patients to do research on IBD to better understand the complications associated with their disease. But he cautions that the internet can be overwhelming and it's important to look for reputable sources.

"Patients can be nervous. They often worry about what their life's going to be like, if they're going to be sick all the time, and they go to the web for answers," Cheifetz says. "Responsible Googling should be a New Year's resolution – there's some useful information on the web, but there's also plenty that is inaccurate, and that can be frightening for patients."

Suggested Websites:

• The Crohn's and Colitis Foundation of America (CCFA)
• The National Digestive Diseases Information Clearinghouse (NDDIC)

Newly diagnosed patients are often concerned about stress and diet.

"At least half of the studies that have been conducted suggest stress may be a trigger for an IBD flare. So, whatever you do to reduce stress – exercising, getting better sleep, meditating – overall you're going to do better," he says. "Diet has not yet been well studied, so there's not one particular diet we suggest to treat IBD or specific foods to avoid. What I tell my patients is to eat a healthy, well-balanced diet. If you find a food that causes symptoms, avoid it, but that doesn't mean another patient needs to avoid the same food."

Many patients are interested in incorporating complementary therapies like probiotics and curcumin, a derivative of the spice turmeric, into their diets. Dr. Cheifetz says patients can sometimes benefit from supplements, but stresses that they should be considered complementary and not alternatives to prescription medications. Patients should always let their doctor know if they are taking any alternative therapies as they can have side effects and interactions with medications.

Take Your Medications!

Since 1997, when Dr. Cheifetz was first diagnosed, powerful new medications, called biologics, have been developed to treat IBD, and they've had a huge impact on the health of people with these diseases. Biologics are therapies made from living organism that involve blocking the action of specific proteins or receptors of inflammation. They are designed to help the restore the body's ability to fight the disease.

"Twenty years ago, achieving a partial response to medications or being dependent on steroids was often the norm, says Cheifetz. "There are currently six biologic therapies approved for the treatment of Inflammatory Bowel Disease which have had a huge impact on the treatment of IBD and other immune-mediated diseases," he adds. "We now discuss complete clinical remission and even endoscopic healing of disease. I tell my patients that my goal is to get them feeling so well that they forget they have IBD."

The key to success with any medications is taking them as prescribed. Noncompliance with the medication regimen is associated with an increased risk of a flare of their disease.

Dr. Cheifetz is researching how to use these newer medications even more effectively. He is deeply committed to research aimed at improving treatment options and is currently focusing on optimizing the use of biologics involving the proactive application of drug concentrations and antibodies. Dr. Cheifetz believes this work has the potential to change the way we utilize our present therapies.

Seeing his patients get better is the part of Dr. Cheifetz's job he loves most.

"I get to watch them graduate college, get married and have kids while helping them battle and overcome IBD."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted January 2016