Early prediction and treatment of Crohn’s disease is becoming increasingly possible, thanks to advanced research in both the US and Europe. An excellent collaboration between medical scientists in two of the top American university hospitals yields some important information and leads to hope that this often debilitating condition may be detected even before symptoms surface.
Let’s begin with a short description of Crohn’s and an idea of why it has been so difficult to treat adequately until now.
What are Inflammable Bowel Disease and Crohn’s Disease?
Crohn’s disease is a condition where there is inflammation of some part of the gastrointestinal (GI) tract. It is one of the Inflammatory Bowel Diseases (IBD) that includes ulcerative colitis but differs from ulcerative colitis because Crohn’s can occur anywhere in the GI tract, from the mouth to the anus. Ulcerative colitis is typically restricted to the lower intestinal tract.
IBD is believed to be an autoimmune condition resulting from the failure of the immune system to recognize the body’s own cells so it attacks them like antigens. Crohn’s disease causes inflammation of the lining of the gut, along with swelling and thickening. It can be dormant for long periods and then flare up without notice. In the active phase, it can even destroy the gut’s wall, causing a fistula that allows gut content to leak into the abdominal cavity or through the stomach wall and outside the body.
Treatments for IBDs
There is currently no cure for IDBs. Surgery to remove affected parts of the bowel or repair fistulas may be the only solution in severe cases. Some longer-term pharmaceutical treatments are designed to reduce the immune system’s activity, relieve symptoms, prevent flare-ups, and induce periods of remission. These are:
- Aminosalicylates like Pentasa and Canasa. These are forms of aspirin that can help reduce inflammation and are more often prescribed during periods of remission or for people with mild symptoms
- Immunomodulators like Purinethol (6-mercaptopurine) and Neoral suppress general immune-system activity to reduce inflammation. These can treat mild to moderate IBD, but there are dangers of the patient becoming susceptible to other infections
- Biologics, such as Humira, will be prescribed for people in the active phase or who have not responded to the other treatments. Biologics work by targeting specific parts of the immune system to reduce inflammation. This means there is no loss of general immunity and no risk of secondary infection.
So far, there is no clear picture of what can cause IBD. There seems to be a genetic predisposition, and if someone in your family has had Crohn’s, there is an increased likelihood that you could also develop the condition. Diet, environment and emotional conditions also seem to play some part.
What US universities are learning about IBD and Crohn’s
An exciting discussion has been published detailing work being done at the Department of Internal Medicine at the University of Michigan, Ann Arbor, in cooperation with the IBD Center at the Icahn School of Medicine at Mount Sinai in New York. The work involved taking large volumes of data from the US Army’s PREDICTS study, drawn from a pool of one thousand active duty US military personnel over many years. This study was unique because it had taken serum (blood) samples from the pool of subjects over the whole life of the study, and now the data was available when servicemen had been diagnosed with IBD. The purpose was to find if there are ways to make prediction and treatment of Crohn’s Disease.
The result is that samples taken regularly, up to ten years before the onset of the IBD symptoms, could be analyzed to see if there was a progression of serum markers. The remarkable findings now reported include “up to 10 years before diagnosis, those people who eventually develop Crohn’s disease have antibodies against microbial antigens. And even more striking, in those who will present with complicated disease at diagnosis, the titers of antibodies are higher, as though they are predestined to develop complicated Crohn’s disease.”
In Crohn’s disease, prevention is better than cure.
As we mentioned above, there is no cure for Crohn’s disease and almost all treatments are aimed towards alleviation of symptoms during flare-ups or prolonging periods of remission. But now, these new studies are showing that there is a real chance for prediction and treatment of Crohn’s Disease. Some steps taken in high-risk patients can either delay the onset of any inflammation or keep the levels down enough so that less aggressive treatments, such as biologic immunosuppressants (Humira and others), will keep people in permanent remission, even though the disease is not actually cured.
Some of the steps that the discussion suggests are:
- Controlling any prior infection, like E. coli, Shigella, Salmonella, and Campylobacter. Studies done in Denmark and Sweden show that infected patients are at increased risk for IBD up to five to ten years later. This probably comes from the prior infection shifting either the microbiota or the host reaction to them in a way that predisposes patients to IBD
- Controlling the reaction to the gut’s contents (the barrier effect) when the immune system is triggered by what appear to be invading substances. Medications like Entocort-EC contain the budesonide molecules that prevent the release of chemicals that are important triggers in the immune system. When levels of these chemicals are decreased in the gut, inflammation can be reduced. More recently, Jason kinetic inhibitors (JAKi) have been shown to act similarly for raising barriers against immune system elevations.
What happens if you don’t take medication for Crohn’s?
Crohn’s, if left untreated, can have severe, even life-threatening results. Apart from acute discomfort, problems with the gut’s general functions can also result in serious side effects, such as dehydration, diarrhea and diabetes. Even worse, highly active Crohn’s attacks can cause fistulas, where the bowels are ruptured. This can cause the bowel contents to leak into the abdomen, triggering acute infection and even death. Surgical intervention may be required in emergencies, which carry other serious risks.
What is the latest research on Crohn’s Disease?
One study just published by Cincinnati Children’s Hospital suggests that a two-drug combination may offer a new way to treat IBDs and Crohn’s Disease. It’s needed in cases where patients have no response or intolerance to standard treatments with aminosalicylates, antibiotics, or corticosteroids, develop steroid-dependent disease, or have fistulas that do not respond to antibiotics. Combining Humira in combination therapy can bolster and optimize the effect of the biological drug and prevent the development of resistance. Since it may take up to six months to see an improvement in patients treated with biologics alone, steroids at low doses may be used simultaneously to produce a faster response and prevent recurring flare-ups with fewer side effects. The main benefit of combination therapy is to decrease any long-term need for steroids (“steroid-sparing”).
Is Crohn’s Disease an autoimmune disease?
Although there is no absolute proof, much of the evidence points to Crohn’s disease as coming from an immune reaction.
Research has shown that genetic mutations or events such as damage to the intestinal epithelium can cause cell-to-cell messages to get scrambled. In such cases, the immune system can treat the cells as invasive and overreact, leading to inflammation and ultimately to IBD.
Foreign bodies in the intestines that are detected by the immune system induce cells to deliver signals to produce a protein (IL-1) that activates the IL-1 receptor on intestinal epithelial cells. This pulls cytokine cells to the tissue and drives the excessive inflammatory response that damages the intestine’s walls.
Can someone have Crohn’s disease and ulcerative colitis?
Crohn’s disease and ulcerative colitis are both forms of Inflammatory Bowel Disease. The only substantial difference is that ulcerative colitis is more localized, while Crohn’s disease can occur anywhere in the gut, from mouth to anus. Studies have shown that about one in ten people with IBD will simultaneously have some features of ulcerative colitis and Crohn’s disease.
How to know if Humira is working?
When being prescribed Humira, Crohn’s disease patients should start to see some improvement in their symptoms within two to four weeks. However, there are no strict guidelines because the speed of response depends on many external factors. Amongst others, these are the degree of inflammation when treatment started, whether the patient is still exposed to the environmental, psychological or dietary triggers that can set off flare-ups and other similar variables. Patients should talk to their prescribing doctor and pharmacist to discuss therapy progress.
Does diet play a role in the onset of Crohn’s disease?
Studies have shown that diet can play a big part in predisposing a person to Crohn’s disease. One of the primary triggers of IBD is a reaction to food content in the gut. Like most immune disorders, the triggers can vary substantially from person to person and can also change as you age.
At what age range does Crohn’s disease usually occur?
Most people who develop Crohn’s disease begin to show some symptoms between the ages of fifteen and forty. More recently, a growing number of people in their late seventies and eighties are developing the condition – now known as late-onset Crohn’s.
What are the symptoms of Crohn’s disease?
Symptoms differ from person to person and according to whether the condition is active or in remission. In general, they are:
- abdominal pain and cramping
- bloody stools
- rectal bleeding
- sudden need to have a bowel movement
- incomplete bowel movement
- unexpected weight loss
- irregular periods in females
- fever or night sweats
- joint pain.