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.
4. I have severe ulcerative colitis and I am likely heading towards surgery. I would like to avoid a colostomy bag, and my potential surgeon recommended a restorative proctocolectomy (ileoanal pouch anal anastomosis). What are the possible complications of this surgery?
While most patients do very well following the surgery, and after a period of recovery are able to return to work and normal activity, as with any surgery, there is the potential for complications. The two most common complications of restorative proctocolectomy are pouchitis and small bowel obstruction. Pouchitis is an inflammation of the pouch, occurs in about 30 percent of patients. Symptoms are diarrhea, crampy abdominal pain, increased frequency of stool, fever, dehydration, and joint pain. The condition is treated with an antibiotic, either metronidazole (Flagyl) or ciprofloxacin (Cipro). Less common is bowel obstruction, which may develop due to adhesions or scar tissue from the surgery. Bowel obstruction causes crampy abdominal pain with nausea and vomiting. In about two-thirds of people who have this complication, it can be managed with bowel rest (not eating for a few days) and intravenous fluids. The other one-third of people will require surgery to remove the blockage. About eight to ten percent of patients will have pouch failure, which requires removal of the pouch and conversion to a permanent ileostomy.
We hope you find this general medical and health information useful, but this Q&A is meant to support AND not replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor.
Published On: January 24, 2008