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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 campcommunity
• “Take Steps”– Held locally– Join the walk for a cure
• 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
CCFA Signature Events
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• 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?
GeneticPredisposition
20%–25% of patients have
a close relative with IBD
Immune System Abnormalities
An inappropriate reaction by the body’s
immune system
EnvironmentalFactors
Infections, antibiotics, nonsteroidal
anti-inflammatory drugs (NSAIDs),
diet, smoking
Indeterminate colitis10%–15%
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– Continuous inflammation– Colon only– Superficial inflammation– Variable involvement– Increased risk of cancer– Extraintestinal
manifestations
Understanding Complications of Crohn’s Disease
• Intestinal obstruction• Abscess• Fistula• Stricture• Colorectal cancer
Obstruction
Fistula
Understanding Complications of Ulcerative Colitis
• Anemia from blood loss• Perforation (rupture) of
the bowel• Colorectal cancer• Toxic megacolon
Perforation
Recognizing Symptoms ofIBD Flares
• Diarrhea– Often increased from
usual course of disease– Rectal bleeding
• Abdominal pain or cramping
• Low-grade fever• Fatigue
• Extraintestinal manifestations– 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 ManagementControlsymptoms
Treat inflammation
Treatcomplications
Provide emotional support
Prevent cancer
Improve quality of life
Replenishnutritionaldeficits
Minimize treatment toxicity
Maintain remission
IBDManagement
Goals
Understanding Treatment Options
• Prescription medications• Over-the-counter agents• Complementary and alternative therapies• Surgery
Prescription MedicationsClass Agents
5-ASA Agents • Balsalazide (Colazal®) • Mesalamine formulations
– 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)
• 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 intestineis 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 inChildren & 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 inPregnant 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