Question and Answer with Dr. Eisner

Dr. Eisner answers questions about the causes of IBD, treating Crohn's with Tysabri, and surgery for Ulcerative Colitis. If you are wondering about these same issues read more to find the answers!

1. How common are ulcerative colitis and Crohn's Disease and do we know what causes the two diseases?

The incidence of ulcerative colitis and Crohn's disease ranges from 1 to 10 cases per 100,000 people annually. The peak age-specific incidence occurs near 20 years of age, and a second, smaller peak occurs near age 50. The prevalence of ulcerative colitis and Crohn's disease ranges from 10 to 70 per 100,000 people. In the United States, males and females are equally affected, but both whites and Ashkenazi Jews are at much higher risk of developing inflammatory bowel disease than the rest of the population. The causes of ulcerative colitis and Crohn's disease are not known. It is felt that still to be identified antigens, possibly a bacteria or virus such as mycobacterium or paramyxovirus, or possibly components of cigarette smoke, activate resting macrophages to release a wide variety of cytokines. These cytokines serve to stimulate the immune system and cause an inflammatory reaction, thus producing tissue damage in the intestinal mucosa.

2. I have ulcerative colitis, and it seems that whenever I have a flare, my arthritis acts up. Am I just imagining things?

As ulcerative colitis (and Crohn's disease) are systemic diseases, patients may develop or even present with symptoms and complications outside of the intestines. Common findings include: aphthous ulcerations of the mouth; ophthalmic problems such as inflammation of the iris (iritis) or of the white of the eye or sclera (episcleritis); arthritis either of the small joints, or large joints (Ankylosing spondylitis or sacroilitis); rashes of the lower extremity (Erythema nodosum) or painful ulceration of the lower extremity (Pyoderma gangrenosum); and finally, inflammation of the bile duct (Primary sclerosing cholangititis). Some of these conditions can be present and progress despite control of the colitis, but a lot of them parallel the colitis, i.e. if the colitis is well controlled, the extr-intestinal symptoms will improve as well. If you are experiencing any of these conditions and you have inflammatory bowel disease, check with your physician with regard to the best treatment option for you.

3. I have severe Crohn's disease and have been operated on numerous times. I am currently in a severe flare that has not responded to Remicade or Humira. One doctor recommended surgery again, but my wife has a friend who was recently treated with Tysabri. Is this a safe alternative?

Tysabri was recently approved for the treatment of Crohn's disease; however its use has been limited because of concerns of significant side effects. Tysabri was originally approved as a multiple sclerosis treatment in November 2004 but was pulled off the US market in February 2005, after three patients developed a rare and potentially deadly brain infection, progressive multifocal leukoencephalopathy. While progressive multifocal leukoencephalopathy is very rare, it is recommended that patients be followed closely for neurologic problems, which may include frequent neurologic examinations and even magnetic resonance imaging (MRI). Prior to undergoing another surgery, it would be very reasonable to at least discuss this option further with your physician.