Sara Horst, MD, and David Schwartz, MD, on Managing Patient Expectations in Treating Crohn Disease

In part 1 of a 5-part series on the challenges of treating perianal Crohn disease, Sara Horst, MD, and David Schwartz, MD, from Vanderbilt University Medical Center, discuss how to manage patient expectations concerning treatment and outcomes.

Sara Horst, MD, is an associate professor of medicine and affiliated with the IBD Clinic at Vanderbilt University in Nashville, Tennessee, and also serves as Section Editor for IBD on the Gastroenterology Learning Network. David Schwartz, MD, is the director of the Inflammatory Bowel Disease Center and professor of medicine at Vanderbilt University.

You can listen to the podcast on refractory Crohn disease here.

TRANSCRIPT

Rebecca Mashaw:  Hello, and welcome to another podcast from the Gastroenterology Learning Network. I'm your moderator, Rebecca Mashaw. Today, we're beginning a 5-part series on perianal Crohn disease with Drs. Sara Horst and David Schwartz from Vanderbilt University.

In their first discussion, they talk about the challenges of managing expectations among patients with this serious complication.

Dr. Sara Horst:  Hi. I'm Sara Horst, a gastroenterologist at Vanderbilt University who specializes in the care of patients with IBD.

Dr. David Schwartz:  I'm Dr. David Schwartz. I'm also a gastroenterologist at Vanderbilt University. I'm a professor of medicine here and I am the director of the IBD Center at Vanderbilt.

Dr. Horst:  David, thanks for talking with me today. You have been my partner and clinical mentor for a long time, and so I've learned a lot from working with you and taking care of patients with inflammatory bowel disease, in particular, perianal Crohn's disease.

I wanted to pick your brain today and talk about some of the issues for patients who have perianal Crohn's. I'll dive right in. I thought I'd ask you a few questions that might help us tailor the conversation. First, how do you handle patients and expectations, especially when you first diagnose perianal Crohn's disease?

Dr. Schwartz:  I think that's very important. A lot of the expectations are set after we do the initial assessment, so in patients that have -- which is going to be the minority of patients -- who have very simple fistulas, very superficial fistulas, I feel pretty confident that we can get them completely well.

I'll share with them that we are going to go for complete eradication of the fistula or fibrosis of the tract. A vast majority of patients that have more complex disease, at least with the agents we have currently available, what we're really trying to get to is cessation of drainage, which in trials has been considered complete closure or complete remission. In reality, the physical tract is really still there, and in a minority of those patients where you get fibrosis of the tract.

I'll tell patients my goal is to really improve their quality of life to get it to the point where they're having none or very minimal drainage, but to actually get the fistula to go away, at least right now, is going to be very difficult for most patients.

Dr. Horst:  I think that was one of the first things I learned with you when you're going in and talking to patients -- is really setting the expectations so that they understand exactly the treatment course. I think what one other thing I learned too was that it takes time. Especially iterating that the time period that we'll be going over to get improvement can take a while.

I think learning that from you is really important. I think it helps the patients understand that it's not going to magically go away.

Dr. Schwartz:  I think that's key because otherwise patients can be very frustrated. It's such a really devastating complication to Crohn's and understandably, people want to feel better instantly, but it just takes a lot of time, even with the best medicine they have available now.

Rebecca:  Thank you for listening today. Next time, Doctors Schwartz and Horst will talk about when to involve your surgical colleagues in developing a treatment approach for patients with perianal Crohn's disease. Watch for our new podcast coming soon.