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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 camp community CCFA Signature Events • “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 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? Genetic Predisposition Immune System Abnormalities 20%–25% of patients have a close relative with IBD An inappropriate reaction by the body’s immune system Environmental Factors Infections, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diet, smoking 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 – – – – – – Indeterminate colitis 10%–15% Continuous inflammation Colon only Superficial inflammation Variable involvement Increased risk of cancer Extraintestinal manifestations Understanding Complications of Crohn’s Disease Obstruction • • • • • Intestinal obstruction Abscess Fistula Stricture Colorectal cancer Fistula Understanding Complications of Ulcerative Colitis • Anemia from blood loss • Perforation (rupture) of the bowel • Colorectal cancer • Toxic megacolon Perforation Recognizing Symptoms of IBD 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 Management Provide emotional support Prevent cancer Improve quality of life Control symptoms IBD Management Goals Replenish nutritional deficits Treat inflammation Treat complications Minimize treatment toxicity Maintain remission Understanding Treatment Options • • • • Prescription medications Over-the-counter agents Complementary and alternative therapies Surgery Prescription Medications Class 5-ASA Agents 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 intestine is 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 in Children & 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 in Pregnant 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