Among the major advances in treating IBD since the late 1990s, Goldberg said, is the development of biologic agents, which are drugs designed specifically to interfere with certain chemical transmitters related to the inflammatory process. The medications include Remicade, (the generic equivalent is infliximab), Humira, (adalimumab) and Cimzia (certolizumab pegol).
But in interrupting the body’s inflammatory process, the drugs are trying to block the body’s immune system, which can lead to other issues. Still, in the majority of cases, doctors say the diseases can be managed.
For those with severe cases of IBD, and those who haven’t responded to traditional therapy, both the University of Miami and the Cleveland Clinic in Weston have Crohn’s and colitis centers that use a multidisciplinary approach, with doctors from various specialties in addition to gastroenterology, including surgery, radiology and pathology.
“In the past 10 or 15 years we’ve seen a revolution in the understanding of the disease, and a lot of drugs have been released, and we are one of the centers looking at new classes of drugs,” said Dr. Amar R. Deshpande, a gastroenterologist and assistant professor of medicine at the University of Miami Health System.
“There are 100 trillion bacteria in our gut … And there is a lot of work going on to understand the ways in which these trillions of bacteria activate the immune system in those with certain genetic susceptibility,” he said.
Drugs, including those that have been approved and others that are being studied in clinical trials, have different mechanisms to trick the immune system to shut off, Deshpande said.
And at the same time, research is under way to understand the genetic component. So far, 100 genes have been found to be associated with IBD, he said.
Three clinical trials of drugs for IBD are taking place at the University of Miami.
The Cleveland Clinic in Weston is also involved in several clinical trials, including a new drug for Crohn’s disease, said Dr. Nicole Palekar, a gastroenterologist there.
A surgical trial is also under way there for perianal fistulas, which are passageways or connections in the perianal rectal area, which can occur with Crohn’s. Weeks, the young woman living in Washington, first experienced this in college.
The surgical procedure, called a LIFT procedure, has been shown to be effective in other types of perianal fistulas, but had not yet been studied with Crohn’s disease, she said.
Meanwhile, advances have also been made in diagnosing IBD. To make a definitive diagnosis for both Crohn’s and colitis requires a colonoscopy with biopsies, Palekar said.
Doctors are also now using Magnetic Resonance (MR) Enterography, which looks for active inflammation in the small intestine as well as strictures and fistulas, she said.
“Diagnostic testing has evolved over the last several years, and radiographic evaluations have improved over the last five years, using MR enterography to evaluate the small bowel,” she said
Such testing not only provides better images, but also does not require radiation, she said.
“It’s a manageable disease, but there’s a spectrum of patients that based on the severity of disease will have lots of different complications throughout their life,” Palekar said. “That is why it’s important to have a good support network and to go to a center that provides comprehensive care.”