What researchers discovered about Crohn's disease in the past year
Autoimmune diseases like Crohn’s are poorly understood by researchers. Scientists are still uncertain about how the body’s immune system attacks perfectly healthy cells to lead to disease like type 1 diabetes, lupus, Crohn’s disease, multiple sclerosis and more. But 2013 has lead to some advances in understanding Crohn’s disease that can lead to better treatment and improved quality of life for those suffering from the condition that can be debilitating.
Understanding Crohn’s disease with fibrosis
Researchers from University of Bristol uncovered the culprit for scarring and hardening of the intestines that can happen with Crohn’s disease and often requires surgery.
Fibrosis causes the intestines to narrow and become thick so nutrients cannot be absorbed and feces can no longer pass.
In their study, the scientists isolated a protein known as IL-13 that is overly expressed that promotes Crohn’s disease fibrosis. The result of the finding will lead to better therapies for the disease that can be started before fibrosis and the need for surgery occurs. The finding was published in the journal PLoS ONE in December, 2012.
New drug therapy on the horizon for Crohn’s disease?
The drug Vedolizumab is currently under development for treating Crohn’s disease.
One of the important highlights of the medication should it pass approval is that preliminary studies show it delivers targeted treatment to stop the inflammatory process that happens with Crohn’s disease and ulcerative colitis, both of which are are forms of inflammatory autoimmune diseases that affect the small intestine and colon.
Current treatments help Crohn’s disease, but with potentially serious side effects such as risk of infection, weight gain and blood sugar elevation that can come from taking steroids. Immunosuppressive medications can also make people more vulnerable to infection and are associated with lymphoma.
William Sandborn, MD, principal investigator of the Crohn's disease study, said the clinical trials so far offer new hope to the more than one million Americans who suffer from inflammatory bowel disease (IBD) and do not respond to treatment. Two studies showed vedolizumab induced remission of the disease that allowed participants to stop taking prednisone.
Genes found for Crohn’s disease
More than 200 genes were found in the past year that can contribute to Crohn’s disease.
Findings from researchers at University College London, published in The American Journal of Human Genetics is also an advance for understanding how treatment for Crohn’s disease can be personalized.
Dr Nikolas Maniatis, senior author from the UCL Research Department of Genetics, Evolution and Environment, said in a press release: "The discovery of so many gene locations for Crohn's Disease is an important step forward in understanding the disease, which has a very complicated genetic basis.”
The researchers said finding so many genes associated with Crohn’s disease helps explain why the disease doesn’t act the same for everyone that will in turn make treatment more individualized.
A potential cause for Crohn’s disease
A study published in the journal Clinical and Translational Gastroenterology found a potential cause for Crohn’s disease, though more studies are needed to confirm that a virus may be responsible.
In June, 2013, researchers from Uppsala University announced for the first time that they found a link between all children with Crohn’s disease and an enterovirus (intestinal virus). The scientists are pursuing the possibility that enterovirus may be an underlying cause for the inflammatory bowel disease.
New treatment guidelines for Crohn’s this year
The American Gastroenterological Society updated guidelines for treating Crohn’s disease this year. Experts recommend using biological therapies first for moderately severe cases of Crohn’s disease.
The impetus for the guidelines was a combination of patient preferences for Crohn’s treatment, clinical evidence about what works and what doesn’t and risk and benefits of various treatments.
What do Crohn’s disease patients need in 2014?
EmaxHealth had an opportunity to interview Jennifer Hope who runs a Crohn’s disease forum (Crohnsforum.com)
I asked Jennifer specific questions about difficulties people share who are affected by Crohn’s disease and what clinicians and others might do to help patients. Jennifer had some insightful responses that are noteworthy for the public and healthcare providers alike.
“We may be affected in different locations, have different symptoms, have different levels of severity, take different medications or other forms of treatment and have different trigger foods but we have a lot in common. The impact it has on our daily lives and future is very similar. Some of the most common problems that we see mentioned on the forum are not enough awareness, lack of information from doctors, medical costs, the amount of time it takes to receive proper care, quality of care in general, fear when it comes to running out of treatments to try, fearing side effects from current medications, fear of judgment from others, having a hard time holding down a job, made to feel guilty for not working or receiving financial assistance, anxiety, depression and we all have a love hate relationship with Prednisone.
As far as symptoms go there are many common ones such as fatigue, abdominal pain, joint pain and diarrhea. These may be treated with pain medications, supplements and other medications but the impact it has on our daily lives isn't so easily treated.
There are multiple ways for clinicians to improve so they can help patients better. They should provide brochures on Crohn's disease for newly diagnosed patients and the medications they are prescribing. They should contact their patients by phone rather than force them to wait 1-6 months for an appointment for prescriptions, tests they want done at another clinic or hospital, test results, and listen to their patient's symptoms. Both my past and current GI contact me by phone most of the time because it helps speed up care. If a prescription or test isn't covered by our insurance then the doctor should fight for that medication or test and fill out the proper paperwork to at least try and get it approved. If a doctor doesn't know what's wrong, keep trying to figure it out rather than endanger the lives and well being of your patients by telling them it's just IBS even though they have symptoms that IBS does not cause.
I think the biggest problem of all is lack of awareness by the general public. With more awareness we may get more funding to go towards more research for finding better treatments and hopefully a cure. More awareness will also help the impact the disease has on our daily lives.”
The past year has brought several important research findings in addition to new guidelines for treating Crohn’s disease. Perhaps one of the most exciting - and anyone suffering from the disease might agree - is the discovery of how genes make Crohn’s disease behave differently for everyone. Personalized therapy may be the future of treating IBD now that researchers are beginning to understand why “one size does not fit all”. It takes a variety of therapies to calm Crohn’s disease. People dealing with Crohn’s are often left to trial and error in their personal lives when it comes to diet and lifestyle to manage the disease. We look forward to and hope for increased awareness of Crohn’s disease, better understanding from healthcare providers about how to individualize care, improved treatments and more research funding for understanding IBD.
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