The Ostomy Files: Inflammatory Bowel Disease Update

    Between one¹ and two² million Americans have either ulcerative colitis or Crohn’s Disease. Because of their mechanisms of action/effect, both are categorized as inflammatory bowel diseases (IBD).

Whatever the cause of the initial event, the acute phase becomes chronic and establishes a self-perpetuating cycle of inflammation and damage to the bowel mucosa in genetically susceptible people. The Crohn’s and Colitis Foundation of America (CCFA) in conjunction with the National Institute of Health (NIH) is currently supporting The IBD Epidemiology Study at the Centers for Disease Control (CDC) to understand the precise extent of the disease in our country. Even though current research has opened exciting new windows of enlightenment, the etiology and treatment of these diseases remain somewhat enigmatic.

    In addition to the aforementioned study, two other research studies are being supported by grants from the CCFA — Identification of Biomarkers for Dysplasia and Cancer for Patients with Ulcerative Colitis and Microbial Antigens. Microbial antigens have increasingly become a subject of considerable interest in discussions of IBD. Understanding which microbial antigens trigger IBD may help develop treatment approaches and simplify the diagnosis process. The CCFA has funded six research programs specifically targeting microbial antigens.¹

    As we know, multiple types of bacteria reside in the intestine. Some are beneficial and some are pathogenic. Microbial antigens are present on common intestinal bacteria in the gut. The immune system of patients with IBD, however, seems incapable of distinguishing between beneficial bacterial and harmful bacteria. The immune system treats them both the same way, mobilizing the immune system against them. This response causes inflammation of the intestinal walls. The response by the body’s inflammatory cells may be responsible for causing more damage than the original offending agent. One inflammatory cytokine — tumor necrosis factor alpha (TNF-alpha) — has been identified in the pathogenesis of Crohn’s Disease.² Release of this substance damages the intestinal mucosa and perpetuates IBD by permitting a steady stream of antigens to continually challenge the immune system. Too much inflammation causes the symptoms of IBD.

    Unlike IBD, irritable bowel syndrome (IBS) a functional bowel disorder, causes no evident organic changes in the intestine even though the symptoms (pain, discomfort, urgency, bloating, and alteration in bowel habits) are similar to IBD. The syndrome has a variety of names, including spastic colon, spastic colitis, mucus colitis, and nervous diarrhea. It is the number one digestive condition in the US, affecting between 10% and 20% of adults, with predominance in women.³

    Researchers at the Cleveland Clinic Foundation (CCF) have discovered a gene (NODZ)² associated with Crohn’s Disease that may help explain why the disease seems to run in families. Optical coherence tomography (OCT),² an innovation first used at the CCF, examines and evaluates layers of intestinal wall for microscopic areas of inflammation. This technology can assist in making more definitive diagnoses between Crohn’s Disease and ulcerative colitis. Historically, distinguishing between the two has been a difficult challenge for diagnosticians.

    Some of the more common medications used to treat IBD include:
  • corticosteroids (prednisone and methlyprednisone) — help reduce intestinal inflammation, but have severe side effects
  • aminosalicylates (sulfasalazine and olsalazine) — aspirin-like anti-inflammatories, often used as first-line treatment in early disease
  • immunosuppressives (6-mercaptopurine and azathioprine) — help control the immune response; also can help maintain remission and, therefore, help reduce corticosteroid dosage
  • metronidazole — an antibiotic with immune system effects
  • infliximab (Remicade,® Centocor, Inc., Horsham, Pa.) — blocks the release of TNF-alpha and helps reduce inflammation. The FDA has approved this non-steroidal drug for use in Crohn’s Disease. Infliximab helps reduce signs and symptoms of Crohn’s Disease and induce and maintain remission. It is indicated for patients with moderate to severe Crohn’s Disease whose disease is still active despite other treatments.⁴

    Dedicated research will continue to shed new light on the puzzling duo of Crohn’s Disease and ulcerative colitis, hopefully leading to relief from symptoms, improved quality of life, and a cure for the thousands of people who suffer daily with IBD.

    The Ostomy Files is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.

1. Crohn’s and Colitis Foundation of America. Available at: www.ccfa.org. Accessed July 24, 2005.

2. Cleveland Clinic Foundation. Available at: www.ccf.org. Accessed July 24, 2005.

3. The Irritable Bowel Syndrome Self-Help and Support Group. Available at: www.ibsgroup.org. Accessed July 24, 2005.

4. Remicade® information. Available at: www.remicade.com. Accessed July 24, 2005.