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