Crohn’s Disease. Ulcerative colitis. Microscopic colitis.
The illnesses go by many names, but they all fall into the general category of inflammatory bowel disease (IBD). And they all have the ability to make people utterly miserable.
Now, however, there’s new hope for people with IBD. While a cure for many of the diseases in that group is still elusive, University of Minnesota Health Gastroenterologist Byron Vaughn, MD—who cares for patients through our inflammatory bowel disease program—says a new class of drugs and improved use of current medications have led to complete remission of symptoms in many patients.
We spoke with Vaughn so that he could share his expertise about IBD, condition management and innovative treatment options.
What is inflammatory bowel disease?
Broadly speaking, inflammatory bowel disease is an umbrella term used to describe disorders of the gastrointestinal system that result in chronic inflammation. The two most common forms of IBD are Crohn’s disease and ulcerative colitis. In severe cases, these diseases can be debilitating and may lead to weight loss, malnutrition and quality of life issues, among other complications.
What are the symptoms?
Symptoms of IBD are broad and depend on the specific type of IBD and the location in the intestine where inflammation is occurring. The most common symptoms are abdominal pain, bleeding and diarrhea. Nutritional deficiencies are also very common. Often, people with IBD will have mild nutritional deficiencies. In severe cases, people can become very malnourished and require supplemental nutrition. This group of diseases can be inhibiting and very detrimental to a person’s quality of life.
What causes these diseases?
There’s no single cause. Genetics is known to play a role in the development of IBD and over 100 genes have been associated with IBD. Unfortunately, researchers have yet to identify one single gene that has been found to cause IBD. IBD occurs more often in industrialized countries, and it is not clear whether this is related to a “western diet” or to some other environmental factor. Generally, researchers believe an environmental trigger or multiple triggers may work to cause the disease in an individual who is already genetically vulnerable.
What’s the traditional treatment?
Generally speaking, doctors will first seek to suppress the inflammation caused by IBD through use of mild anti-inflammatory drugs like mesalamine. However, most patients will need a stronger immune suppression to control disease and prevent the disease from recurring. This usually involves corticosteroids, which can cause a large number of side effects. We try very hard to avoid these whenever possible and limit their use when needed.
They may also prescribe more sophisticated drugs that suppress certain parts of the immune system that play a role in chronic inflammation. Typically these drugs are not “gut-selective” and suppress the immune system throughout the body. Often, these are lifelong medications, and if stopped, the disease can return.
What are you doing differently?
In May of 2014, a new drug, vedolizumab, was approved for use in IBD treatment that blocks certain immune cells from getting into the gut, but not other issues. This means decreased inflammation in the intestine, with less risk of infection or side effects elsewhere. Having this drug available has been a huge help given the overall small number of drugs available for IBD. While we still need to learn about many of the long term side effects of this drug, in the short term (one to two years) it seems to be very safe.
Additionally, we are learning how to use our older drugs better. Typically, medications dosages for IBD are based on weight, but we have found a more effective means of dosing by measuring the concentration of a drug in a specific person.
What kinds of results are you seeing?
Unfortunately, a single IBD medication may not work for every single person, which is likely because we don’t fully understand what causes IBD. Even new IBD drugs typically help roughly half of patients into remission after a year of use. However, as we learn more about these new drugs and how best to optimize them, I am quite hopeful that more people will benefit from them.
Our improved use of older drugs is just as exciting as the development of new drug therapies. During treatment, the body will eventually produce antibodies that reduce drug effectiveness. Personalizing dosing through monitoring a patient’s drug level and combination therapy (use two drugs at once) can prevent these antibodies from forming, which means the medications will stay effective longer.
How’s that working?
Our program has had a lot of success stories. Our goal is to not just to improve IBD symptoms but to actually heal the inflammation in patients’ intestines. This is called “deep remission”. Once we get people into deep remission, we work hard to keep them in remission by using the safest most effective therapies.
We also work to take care of patients beyond the treatment of inflammation. This often involves educating patients about diet and IBD, pregnancy and IBD and mechanisms for stress reduction, among other topics.
We recognize that every person with IBD is different and we work hard to develop a treatment plan that is individualized, safe and effective.