Inflammatory bowel disease (IBD) is a difficult condition deserving the utmost attention because of the potential severity of its symptoms, because it can be a chronic condition and tends to affect younger people.
Lourdes experienced clinicians can identify this sometimes difficult-to-diagnose condition based on history, symptoms, physical examination and testing. Lourdes GI specialists take an aggressive, proactive approach to IBD to try to minimize the amount the disease interferes with a patient’s life.
Andrew R Conn, MD is here to discuss the approach Lourdes take to help each patient on an individual basis.
Inflammatory Bowel Disease: Crohn's and Ulcerative Colitis
From the Show: Lourdes Health Talk
Summary:
Air Date: 6/14/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Inflammatory bowel disease can be a difficult condition deserving the utmost attention because of the potential severity of its symptoms. Lourdes GI specialists take an aggressive proactive approach to IBD to minimize the amount that the disease is interfering with a patient’s life. My guest today is Dr. Andrew Conn. He’s a gastroenterologist with Lourdes Health System. Welcome to the show, Dr. Conn. What types of issues could constitute inflammatory bowel diseases?
Dr. Andrew Conn (Guest): Well, these are chronic diseases that can affect young people’s lives and, basically, are chronic illnesses that can present with bleeding, abdominal pain, change in growth rate in young children, and can really have a major effect on the quality of life of young people, such as teenagers and even adolescents, which this disease affects. That doesn’t exclude patients who are older. We see even up into the 40s and 50s and, more recently, even an older population which now are being found to have the disease.
Melanie: Since we’re talking about Crohn’s, mostly, and ulcerative colitis, we’re seeing more and more people coming up with Crohn’s, Dr. Conn. What are some of the symptoms that parents for the young people should look out for or even older people, because we all sometimes feel bloating. We all sometimes get diarrhea. What are some red flags that would signal a doctor’s visit?
Dr. Conn: Red flags that really should be considered with anyone, particularly older patients, would be a change in bowel movements, often diarrhea, sometimes bloody diarrhea, lower abdominal pain. In younger people, you tend to see weight loss, failure to thrive. You notice their growth rates are retarded for their appropriate age and height and weight--all should be signals for consideration of an underlying inflammatory process. I think the older people tend to present generally with fairly classic symptoms. If they have Crohn’s disease, many people will have involvement of the distal small intestine, and will present more with right lower quadrant pain, possibly decreased appetite, weight loss. Sometimes they’ll present with complications such as bowel obstructions and require hospitalization and potentially even surgery.
Melanie: So, how would this be diagnosed? If somebody does have some of these red flags or a parent notices that their children are having growth issues, then what is the first thing that you do to diagnose this?
Dr. Conn: Well, first of all, taking a full history, asking about family history. Often there is a genetic component but not necessarily in all patients. You also may do laboratory studies and sometimes measure some simple tests such as inflammatory markers such as the C-reactive protein, erythrocyte sedimentation rate. Often, it really requires an endoscopic evaluation, usually a colonoscopy, and sometimes we use other methods such as video capsule endoscopy to look as small bowel disease. So, those are some of the common tests that we do. We also tend to use imaging but we tend to stay away from simple things such as CAT scans because of the radiation in younger people and now there are better tests that are done through using an MRI scanner that can be very good at looking at small bowel disease and giving good information.
Melanie: So then, if you do diagnose Crohn’s or ulcerative colitis by some of those endoscopic methods and a history, what is the first line of defense? It can be quite a disturbing diagnosis for a parent to hear. So, what do you tell them and what is your first line of defense for treatment?
Dr. Conn: Well, actually, there are couple of things. Besides just having frequent follow up visits to get them to understand their disease and be part of the process of treating their own disease, often, we’ll start with first line agents such as methylamine which come in various forms that people may have heard of such as Asacol or Pentasa. There are various new formulations. There are actually rectally administered formulations for mild disease but as people get disease where they’re having more severe pain, more bleeding, weight loss, and symptoms aren’t responding to basic therapy, one, we may use steroids such as prednisone. There are some newer steroids that tend to have what’s called a “first pass metabolism” to the liver so that you don’t have the long-term side effects potentially of prednisone. But the other thing is, I always tell somebody that once you start on steroids, the patient needs to be started on a higher level of therapy to get them off the steroids because steroids, as you know, just about for any use, has many potential complications, the biggest of which in inflammatory bowel disease patients are osteoporosis as well as affecting blood sugar, potential blood pressure, and something called “osteonecrosis”. And then, for those who are refractory to steroids, we use things such as immunosuppressants such as azathioprine. Now, we use a little more methotrexate because of the possible side effects of azathioprine with concerns of lymphoma. And, we’re using biologic agents, I think, more, I should say, sooner in someone’s therapy than waiting longer in their disease to finally put them on because the biologics tend to be more potent, they tend to be more effective at suppressing inflammation and decreasing inflammation, and getting someone into remission. The problem is if you wait too long, that inflammation that you’ve been treating with this, sort, of, upward scale of methylamine, steroids, immunosuppressants, can lead already to endpoint of disease which is stricturing which can lead to bowel obstructions. And, when you start someone on a biologic like that, it’s not going to be effective. So, newer therapy recommendations or starting patients sometimes sooner with biologics to really suppress the inflammation, especially in people who have certain characteristics who potentially, sort of, prognostically may not do well.
Melanie: Now, let’s talk about diet for a minute because this seems to be a real source of interest. Diet for Crohn’s disease--cutting up raw vegetables. I mean, you want people to eat healthy and yet there’s a lot of things that they cannot eat that would be considered healthy by normal diet standards.
Dr. Conn: Well, it depends a little bit on their disease. For example, if someone has bad Crohn’s disease, and they have a lot of inflammation and potentially because of all of that inflammation, narrowing of their small intestine, you certainly wouldn’t want them to be eating fresh vegetables in roughage that potentially could exacerbate their disease. However, eating healthy is very important because one, you lose an incredible number of calories that are being burned up just due to the inflammation in the gut. So, you’re losing a lot of calories so you’ve got to replace those calories; otherwise you’re going to lose weight. In doing so, if someone’s having a flare, they may actually stay on clear liquids or they may ultimately go on to a bland diet or they may have to chew their food extremely well. There have been lot of studies looking at diet and inflammatory bowel disease and there’s not been any one in particular, i.e., any particular diet, that seems to be more effective in terms of disease outcome than any other. Although, there have been some interesting studies now with diet in affecting the gut microbiome or all of the bacteria, fungus, fungi and viruses that make up the biome inside the large bowel. There have been studies looking at various diets which have had an effect on changing the microbiome in the gut.
Melanie: And now, you’re discussing like probiotics and things that contribute to that good gut flora?
Dr. Conn: Well, anyone for example, who’s taking an antibiotic, you’re potentially going to affect that gut microbiota because even though you’re treating somebody for a specific indication, often these are broad-spectrum antibiotics and often wipeout bacteria elsewhere in the body, especially the gut, even though that's not maybe the intended target. Obviously, taking a probiotic is helpful to try and maintain that normal flora. However, in inflammatory bowel disease, the only true effective use of probiotics has been with ulcerative colitis.
Melanie: In just the last few minutes here, give your best advice for sufferers of inflammatory bowel diseases and why they should come to Lourdes for their care.
Dr. Conn: Well, I think, a couple of responses to that. One is, there is such an incredible wealth of new information, research, and medication availability, that treating people with disease is becoming a little bit more in the boutique fashion to the point of what part of your bowel, how has it been affected, really ultimately may be determined on some of your presenting symptoms. So, I think the armamentarium that we have to treat the disease is tremendous and it is continually increasing based upon a lot of studies done on the immunology and what’s happening at the gut level. Obviously, the main decision is patient standard approach which is ultimately the patient learning so much about the disease and how they’re feeling that they can help guide their own therapy. The other is having the physician with whom the patient feels really comfortable with and can contact if he needs to. So, I think there is tremendous amount of new information, treatments each month, each couple of years--each year—and new biologics coming out different from the ones that are available now all treating inflammatory bowel disease from a different approach. So, I think, there’s great hope for the disease and I think our national leaders believe that there will be a cure in our lifetime which is tremendous.
Melanie: Oh, wow. That’s such great information, Dr. Conn. Thank you so much.
Dr. Conn: You’re welcome.
Melanie: Thank you for being with us today and sharing your expertise. You’re listening to Lourdes Health Talk. For more information, you can go to Lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Inflammatory bowel disease can be a difficult condition deserving the utmost attention because of the potential severity of its symptoms. Lourdes GI specialists take an aggressive proactive approach to IBD to minimize the amount that the disease is interfering with a patient’s life. My guest today is Dr. Andrew Conn. He’s a gastroenterologist with Lourdes Health System. Welcome to the show, Dr. Conn. What types of issues could constitute inflammatory bowel diseases?
Dr. Andrew Conn (Guest): Well, these are chronic diseases that can affect young people’s lives and, basically, are chronic illnesses that can present with bleeding, abdominal pain, change in growth rate in young children, and can really have a major effect on the quality of life of young people, such as teenagers and even adolescents, which this disease affects. That doesn’t exclude patients who are older. We see even up into the 40s and 50s and, more recently, even an older population which now are being found to have the disease.
Melanie: Since we’re talking about Crohn’s, mostly, and ulcerative colitis, we’re seeing more and more people coming up with Crohn’s, Dr. Conn. What are some of the symptoms that parents for the young people should look out for or even older people, because we all sometimes feel bloating. We all sometimes get diarrhea. What are some red flags that would signal a doctor’s visit?
Dr. Conn: Red flags that really should be considered with anyone, particularly older patients, would be a change in bowel movements, often diarrhea, sometimes bloody diarrhea, lower abdominal pain. In younger people, you tend to see weight loss, failure to thrive. You notice their growth rates are retarded for their appropriate age and height and weight--all should be signals for consideration of an underlying inflammatory process. I think the older people tend to present generally with fairly classic symptoms. If they have Crohn’s disease, many people will have involvement of the distal small intestine, and will present more with right lower quadrant pain, possibly decreased appetite, weight loss. Sometimes they’ll present with complications such as bowel obstructions and require hospitalization and potentially even surgery.
Melanie: So, how would this be diagnosed? If somebody does have some of these red flags or a parent notices that their children are having growth issues, then what is the first thing that you do to diagnose this?
Dr. Conn: Well, first of all, taking a full history, asking about family history. Often there is a genetic component but not necessarily in all patients. You also may do laboratory studies and sometimes measure some simple tests such as inflammatory markers such as the C-reactive protein, erythrocyte sedimentation rate. Often, it really requires an endoscopic evaluation, usually a colonoscopy, and sometimes we use other methods such as video capsule endoscopy to look as small bowel disease. So, those are some of the common tests that we do. We also tend to use imaging but we tend to stay away from simple things such as CAT scans because of the radiation in younger people and now there are better tests that are done through using an MRI scanner that can be very good at looking at small bowel disease and giving good information.
Melanie: So then, if you do diagnose Crohn’s or ulcerative colitis by some of those endoscopic methods and a history, what is the first line of defense? It can be quite a disturbing diagnosis for a parent to hear. So, what do you tell them and what is your first line of defense for treatment?
Dr. Conn: Well, actually, there are couple of things. Besides just having frequent follow up visits to get them to understand their disease and be part of the process of treating their own disease, often, we’ll start with first line agents such as methylamine which come in various forms that people may have heard of such as Asacol or Pentasa. There are various new formulations. There are actually rectally administered formulations for mild disease but as people get disease where they’re having more severe pain, more bleeding, weight loss, and symptoms aren’t responding to basic therapy, one, we may use steroids such as prednisone. There are some newer steroids that tend to have what’s called a “first pass metabolism” to the liver so that you don’t have the long-term side effects potentially of prednisone. But the other thing is, I always tell somebody that once you start on steroids, the patient needs to be started on a higher level of therapy to get them off the steroids because steroids, as you know, just about for any use, has many potential complications, the biggest of which in inflammatory bowel disease patients are osteoporosis as well as affecting blood sugar, potential blood pressure, and something called “osteonecrosis”. And then, for those who are refractory to steroids, we use things such as immunosuppressants such as azathioprine. Now, we use a little more methotrexate because of the possible side effects of azathioprine with concerns of lymphoma. And, we’re using biologic agents, I think, more, I should say, sooner in someone’s therapy than waiting longer in their disease to finally put them on because the biologics tend to be more potent, they tend to be more effective at suppressing inflammation and decreasing inflammation, and getting someone into remission. The problem is if you wait too long, that inflammation that you’ve been treating with this, sort, of, upward scale of methylamine, steroids, immunosuppressants, can lead already to endpoint of disease which is stricturing which can lead to bowel obstructions. And, when you start someone on a biologic like that, it’s not going to be effective. So, newer therapy recommendations or starting patients sometimes sooner with biologics to really suppress the inflammation, especially in people who have certain characteristics who potentially, sort of, prognostically may not do well.
Melanie: Now, let’s talk about diet for a minute because this seems to be a real source of interest. Diet for Crohn’s disease--cutting up raw vegetables. I mean, you want people to eat healthy and yet there’s a lot of things that they cannot eat that would be considered healthy by normal diet standards.
Dr. Conn: Well, it depends a little bit on their disease. For example, if someone has bad Crohn’s disease, and they have a lot of inflammation and potentially because of all of that inflammation, narrowing of their small intestine, you certainly wouldn’t want them to be eating fresh vegetables in roughage that potentially could exacerbate their disease. However, eating healthy is very important because one, you lose an incredible number of calories that are being burned up just due to the inflammation in the gut. So, you’re losing a lot of calories so you’ve got to replace those calories; otherwise you’re going to lose weight. In doing so, if someone’s having a flare, they may actually stay on clear liquids or they may ultimately go on to a bland diet or they may have to chew their food extremely well. There have been lot of studies looking at diet and inflammatory bowel disease and there’s not been any one in particular, i.e., any particular diet, that seems to be more effective in terms of disease outcome than any other. Although, there have been some interesting studies now with diet in affecting the gut microbiome or all of the bacteria, fungus, fungi and viruses that make up the biome inside the large bowel. There have been studies looking at various diets which have had an effect on changing the microbiome in the gut.
Melanie: And now, you’re discussing like probiotics and things that contribute to that good gut flora?
Dr. Conn: Well, anyone for example, who’s taking an antibiotic, you’re potentially going to affect that gut microbiota because even though you’re treating somebody for a specific indication, often these are broad-spectrum antibiotics and often wipeout bacteria elsewhere in the body, especially the gut, even though that's not maybe the intended target. Obviously, taking a probiotic is helpful to try and maintain that normal flora. However, in inflammatory bowel disease, the only true effective use of probiotics has been with ulcerative colitis.
Melanie: In just the last few minutes here, give your best advice for sufferers of inflammatory bowel diseases and why they should come to Lourdes for their care.
Dr. Conn: Well, I think, a couple of responses to that. One is, there is such an incredible wealth of new information, research, and medication availability, that treating people with disease is becoming a little bit more in the boutique fashion to the point of what part of your bowel, how has it been affected, really ultimately may be determined on some of your presenting symptoms. So, I think the armamentarium that we have to treat the disease is tremendous and it is continually increasing based upon a lot of studies done on the immunology and what’s happening at the gut level. Obviously, the main decision is patient standard approach which is ultimately the patient learning so much about the disease and how they’re feeling that they can help guide their own therapy. The other is having the physician with whom the patient feels really comfortable with and can contact if he needs to. So, I think there is tremendous amount of new information, treatments each month, each couple of years--each year—and new biologics coming out different from the ones that are available now all treating inflammatory bowel disease from a different approach. So, I think, there’s great hope for the disease and I think our national leaders believe that there will be a cure in our lifetime which is tremendous.
Melanie: Oh, wow. That’s such great information, Dr. Conn. Thank you so much.
Dr. Conn: You’re welcome.
Melanie: Thank you for being with us today and sharing your expertise. You’re listening to Lourdes Health Talk. For more information, you can go to Lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
