“But with appropriate care and self-manage- ment, patients can take charge of their disease and live well—even thrive—despite their IBD.” IBD & YOUR DIGESTIVE HEALTH 4TH EDITION, DECEMBER 2010 Managing Director: Jon Silverman [email protected]Editorial Manager: Jackie McDermott [email protected]Responsible for this issue: Publisher: Jamel Franklin [email protected]Business Developer: Luciana Colapinto [email protected]Designer: Missy Kayko [email protected]Contributors: Steven Brant, M.D.; Delbert L. Chumley, M.D., FACG; Raymond K. Cross, M.D., M.S.; Crohn’s & Colitis Foundation of America; Cindy Heroux; Peter Quigley Distributed within: The Wall Street Journal, December 2010 This section was written by Mediaplanet and did not involve The Wall Street Journal or its Editorial Departments. Mediaplanet’s business is to create new customers for our advertisers by providing readers with high-quality editorial content that motivates them to act. Inflammatory bowel disease (IBD) is one of the most common disorders managed by gastroenterologists. The art and science of treating IBD presents an engaging clinical challenge for digestive disease specialists. Taking control of IBD I BD includes both Crohn’s disease and ulcerative colitis—chronic, lifelong in- flammatory disorders of the intestine. The large intestine (colon) is inflamed in ulcerative colitis, and this involves the inner lining of the colon.In Crohn’s disease the inflammation extends dee- per into the intestinal wall. Crohn’s di- sease can also involve the small intesti- ne, or can involve both the small and large intestine. An estimated 1.5 million Americans suffer from IBD. While the cause of IBD is poorly understood, both Crohn’s disease and ulcerative colitis are thought to arise from a disordered immune response to the gut environment in genetically pre- disposed individuals. A prevailing theo- ry holds that a process,possibly viral,bac- terial, or allergic, initially inflames the small or large intestine and, depending on genetic predisposition results in the development of antibodies which chron- ically “attack” the intestine,leading to in- flammation. Approximately 10 percent of patients with IBD have a close family member (parent, sibling or child) with the disease,which lends support to a ge- netic predisposition in some patients. Ebbs and flows For most patients, IBD tends to follow a course marked by periods of disease ac- tivity followed by variable periods during which a patient is symptom-free. Some patients may have continuous disease ac- tivity. For many patients with IBD,there is a significant,often dramatic,reduction in quality of life during flares of the dis- ease which can have an impact on psy- chological health. Patients with active IBD symptoms experience greater levels of distress and feel a lack of self-control compared to the general population and patients with inactive IBD. But with appropriate care and self-man- agement, patients can take charge of their disease and live well—even thrive— despite their IBD. Members of the American College of Gas- troenterology are the physicians on the front lines in treating IBD patients. ACG is committed to providing information and expert guidance to empower pa- tients with IBD. Our experts have devel- oped tips and strategies for living well with IBD, and a new podcast series ad- dresses commonly asked questions. I hope you will explore this special sup- plement and seek to learn more from the many excellent resources available on ACG’s website (www.acg.gi.org), or from the National Institutes of Health (www. niddk.nih.gov) or the Crohn’s & Colitis Foundation of America (www.ccfa.org). Delbert L. Chumley, M.D., FACG President, American College of Gastroenterology Breaking the ice about IBD ! Discussing inflammatory bowel conditions can be daunting; diarr- hea and cramps are rarely conversation topics. Symptoms are invisible, making the disease harder for outsiders to un- derstand. A bad experience with an un- sympathetic listener can make it even harder to connect. But battling the con- dition alone is never a good idea. Isolation can contribute to feeling bad. “Feeling anxious or stressed can af- fect your immune system and increase inflammation leading to a flare,” says Tiffany Taft, a clinical psychology post- doctoral fellow who also has Crohn’s dis- ease.Studies show that keeping IBD a se- cret can lead to depression and is often more difficult emotionally than telling others. Having a trusted friend or ther- apist to help navigate emotional peaks and valleys can contribute to greater well-being. So how do you come out about IBD? Dr. Taft says prepare a script. “Think about what you want to say and how much to share. Say it simply and don’t over-dramatize.” There are resources like the free Crohn’sAdvocate magazine and the CCFA’s Take Charge publication to help guide the conversation and pro- vide reading for people interested in knowing more. Joining communities on Facebook or meeting others at CCFA runs or walks can broaden one’s support net- work. It is important to remember that people won’t know you have IBD unless you tell them. CONNECTING PEOPLE WITH CROHN’S DISEASE WE RECOMMEND The importance of nutrition A nutritious, plant- based diet, dietary fiber and fermented foods are recommended PAGE 2 What she doesn’t know is that her symptoms are a result of Crohn’s disease. She doesn’t know her doctor is going to recommend the University of Maryland Inflammatory Bowel Disease Program, where our multidisciplinary team offers the latest therapies and most advanced treatments. She doesn’t know that the combined expertise of gastroenterologists, surgeons, radiologists and nurses, along with the right medications, will help give her the close management she needs to live a normal and productive life. She thinks it was something she ate. * * * * umm.edu/ibd | 800-492-5538 * we heal. we teach. we discover. we care. www.ccfa.org • www.acg.gi.org www.motleyrice.com/drugs/accutane FOR MORE INFORMATION FOR THOSE SUFFERING FROM IBD “It’s alarming that so many individuals fail to meet the recommended daily intake of fiber.” AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET IN THE WALL STREET JOURNAL No.4/December 2010
Transcript
“But with appropriate care and self-manage-ment, patients can take charge of their disease and live well—even thrive—despite their IBD.”
IBD & your DIgestIve health 4th eDItIon, DecemBer 2010
responsible for this issue:Publisher: Jamel [email protected] Developer: luciana [email protected] Designer: missy [email protected]: steven Brant, m.D.; Delbert l. chumley, m.D., Facg; raymond K. cross, m.D., m.s.; crohn’s & colitis Foundation of america; cindy heroux; Peter Quigley
Distributed within: the Wall street Journal, December 2010this section was written by mediaplanet and did not involve the Wall street Journal or its editorial Departments.
mediaplanet’s business is to create newcustomers for our advertisers by providing readers with high-quality editorial contentthat motivates them to act.
Inflammatory bowel disease (IBD) is one of the most common disorders managed by gastroenterologists. The art and science of treating IBD presents an engaging clinical challenge for digestive disease specialists.
Taking control of IBD
IBD includes both Crohn’s disease and ulcerative colitis—chronic, lifelong in-flammatory disorders of the intestine. The large intestine (colon) is inflamed in ulcerative colitis, and this involves the inner lining of the colon. In Crohn’s disease the inflammation extends dee-
per into the intestinal wall. Crohn’s di-sease can also involve the small intesti-ne, or can involve both the small and large intestine.
An estimated 1.5 million Americans suffer from IBD. While the cause of IBD is poorly understood, both Crohn’s disease and ulcerative colitis are thought to arise from a disordered immune response to the gut environment in genetically pre-disposed individuals. A prevailing theo-ry holds that a process, possibly viral, bac-terial, or allergic, initially inflames the small or large intestine and, depending on genetic predisposition results in the development of antibodies which chron-
ically “attack” the intestine, leading to in-flammation. Approximately 10 percent of patients with IBD have a close family member (parent, sibling or child) with the disease, which lends support to a ge-netic predisposition in some patients.
Ebbs and flowsFor most patients, IBD tends to follow a course marked by periods of disease ac-tivity followed by variable periods during which a patient is symptom-free. Some patients may have continuous disease ac-tivity. For many patients with IBD, there is a significant, often dramatic, reduction in quality of life during flares of the dis-ease which can have an impact on psy-chological health. Patients with active IBD symptoms experience greater levels of distress and feel a lack of self-control compared to the general population and patients with inactive IBD. But with appropriate care and self-man-
agement, patients can take charge of their disease and live well—even thrive—despite their IBD. Members of the American College of Gas-troenterology are the physicians on the front lines in treating IBD patients. ACG is committed to providing information and expert guidance to empower pa-tients with IBD. Our experts have devel-oped tips and strategies for living well with IBD, and a new podcast series ad-dresses commonly asked questions. I hope you will explore this special sup-plement and seek to learn more from the many excellent resources available on ACG’s website (www.acg.gi.org), or from the National Institutes of Health (www.niddk.nih.gov) or the Crohn’s & Colitis Foundation of America (www.ccfa.org).
IBD.”
Delbert L. Chumley, M.D., FACGPresident, american college of gastroenterology
Breaking the ice about IBD
! Discussing inflammatory bowel conditions can be daunting; diarr-
hea and cramps are rarely conversation topics. Symptoms are invisible, making the disease harder for outsiders to un-derstand. A bad experience with an un-sympathetic listener can make it even harder to connect. But battling the con-dition alone is never a good idea.
Isolation can contribute to feeling bad. “Feeling anxious or stressed can af-fect your immune system and increase inflammation leading to a flare,” says Tiffany Taft, a clinical psychology post-doctoral fellow who also has Crohn’s dis-ease. Studies show that keeping IBD a se-cret can lead to depression and is often more difficult emotionally than telling others. Having a trusted friend or ther-
apist to help navigate emotional peaks and valleys can contribute to greater well-being.
So how do you come out about IBD? Dr. Taft says prepare a script. “Think about what you want to say and how much to share. Say it simply and don’t over-dramatize.” There are resources like the free Crohn’sAdvocate magazine and the CCFA’s Take Charge publication
to help guide the conversation and pro-vide reading for people interested in knowing more.
Joining communities on Facebook or meeting others at CCFA runs or walks can broaden one’s support net-work. It is important to remember that people won’t know you have IBD unless you tell them.
ConneCting people with Crohn’s disease
we reCommendThe importance of nutritiona nutritious, plant- based diet, dietary fiber and fermented foods are recommendedPage 2
What she doesn’t know is that her symptoms are a result of Crohn’s disease.
She doesn’t know her doctor is going to recommend the University of Maryland
Inflammatory Bowel Disease Program, where our multidisciplinary team offers the latest
therapies and most advanced treatments. She doesn’t know that the combined
expertise of gastroenterologists, surgeons, radiologists and nurses, along with the
right medications, will help give her the close management she needs to
live a normal and productive life.
She thinks it wassomething she ate.
* * *
* umm.edu/ibd | 800-492-5538 *
w e h e a l . w e t e a c h . w e d i s c o v e r. w e c a r e .
2 · DecemBer an InDePenDent suPPlement From meDIaPlanet In the Wall street Journal
ChalleNges
Understanding IBD and IBsIBD has increased 50 percent among children in the past decade, affecting 150,000 children under the age of 18 nationwide.
But what exactly is IBD?IBD, or inflammatory bowel di-seases, is a group of digestive condi-tions that affect the gastrointesti-nal tract. The two major types of IBD are Crohn’s disease and ulcera-tive colitis.
No one knows exactly what causes IBD, but one thing is for certain, these diseases are chronic conditions. This means that Crohn’s and colitis are long-term illnesses and can be con-trolled with treatment, but not medi-cally cured.
“I wish we had a treatment that was 100 percent effective and 100 per-cent safe. We do not,” comments Co-rey Siegel, MD, of the Crohn’s & Coli-tis Foundation’s National Scientific Advisory Committee. “However, we have come an extremely long way in the last four to five years, and this is an exciting time for treating IBD.”
A difficult diagnosisThe symptoms of IBD can include di-arrhea, abdominal pain, nausea, fe-ver, loss of appetite, weight loss, fati-gue and, at times, rectal bleeding. However, diagnosing IBD can be so-mewhat difficult since there are a number of other conditions that can produce similar symptoms.
Doctors have come to rely on var-ious medical tests, such as blood tests, stool tests, and colonoscopies to rule out other potential causes like infection.
If you’re experiencing similar ab-dominal symptoms, but your doctors have ruled out IBD, it could be IBS, otherwise known as irritable bowel syndrome. Many people are easily confused by the two types of gastro-intestinal disorders—IBD and IBS—but there are distinctive differences.
IBS vs. IBDFirst of all, IBS is not a disease, but better classified as a functio-nal gastrointestinal disorder. The symptoms of IBS include abdomi-nal pain and diarrhea, much like IBD, but IBS does not cause inflam-mation of the intestine, making it a less serious condition.
Despite the prevalence of IBD and other gastrointestinal disor-ders, many people have never heard of these maladies nor the help and support made available to them through groups, such as the Crohn’s & Colitis Foundation of America (CCFA).
In particular, the CCFA offers up to date information on IBD on its website—www.ccfa.org—as well
as via phone at 888.MY.GUT.PAIN (888.694.8872). The nonprofit group also recently revamped its commu-nity site—www.ccfacommunity.org —where patients, loved ones and the simply curious can find detailed information about IBD in relation to their symptoms, ask questions directly to medical experts and connect with others impacted by the disease.
Enduring a gastrointestinal disor-der can be difficult at times, but you don’t have to do it alone. Visit the CCFA’s website for more informa-tion and know that there are others out there who can relate to your sit-uation.
* The information in this article is not meant to replace the advice of a trusted medical professional. If you or someone you know is suffering from IBD or IBS, talk to your physi-cian immediately about treatment options.
The importance of diet and nutrition■ Question: What should I eat to preserve my digestive wellness? ■ Answer: a nutritious, plant-based diet, dietary fiber and fermented foods all contribute to digestive health.
In addition to a constant flow of nu-trients, your GI tract also has some special needs. If these are not met, the gut fails to function properly and your whole body can pay the price.
High quality nutrition that sup-ports digestive health is most easily
achieved by choosing a plant-based diet of whole, unprocessed foods.
Why plant-based?Studies have shown a link between red meat, processed meat and colon cancer. A recent study conducted by the Harvard School of Public Health also linked processed meats to an increased risk of heart disease and diabetes.
Plants provide lots of nutrition per calorie, are loaded with antioxidants and phytochemicals, and are the only source of dietary fiber, one of the most
important foods for a healthy diges-tive system.
Why is fiber important? Like aerobics for your intestines, fi-ber keeps everything moving. It ab-sorbs water and expands, softening your stools and stimulating the muscles of your GI tract to contract. It helps lower your cholesterol and provides nourishment for the billi-ons of healthy bacteria that dwell in your gut.
Experts recommend consuming 25–35 grams of fiber per day, but few
people get that much. “It’s alarming that so many individuals fail to meet the recommended daily intake,” says Robin Plotkin RD, a culinary & nutri-tion expert based in Dallas, TX. “It’s not that difficult. When I tell people that there are eight grams of fiber in a cup of raspberries, and two hand-fuls of pistachios contain nearly three grams of fiber, they breathe a sigh of relief as if to say, ‘It’s not going to be as hard as I thought.’”
Lingering digestive troubles may be irritable bowel syndrome, probiotics can help
■ Digestive ailments come in nume-rous forms. Many people don’t realize their symptoms may be part of a larger dysfunction such as Irritable Bowel Syndrome (IBS) and, instead, continue to put up with daily discomfort. Accor-ding to the International Foundation for Functional Gastrointestinal Disor-ders, IBS is the most common functio-nal gastrointestinal (GI) disorder, affec-ting 10 to 15 percent of the U.S. popula-tion. IBS symptoms range from annoy-ing to debilitating, from severe consti-pation in some, to chronic diarrhea, bloating, gas, fatigue, heartburn, and depression in others.
While the direct cause of IBS is un-known, many medical professionals agree it stems from dysfunction with-in the intestines. In the past, those who suffer from IBS have taken a reg-imen of antibiotics aimed at elimi-nating bacterial overgrowth; howev-er, these antibiotics end up attacking and eliminating essential, beneficial bacteria along with harmful bacteria. Antibiotics may offer some quick re-lief, but they are by no means a long-term solution.
Control IBS with lifestyle changes■ Reversing the effects of IBS can be a slow process, but with an integra-ted approach that includes an appro-priate probiotic supplement, results can be encouraging and long lasting. IBS symptoms can often be controlled with various lifestyle changes such as diet, stress reduction, hydration, an increase in dietary fiber and a healthy balance of intestinal microflora.
Probiotics are live microorgan-isms which, when consumed in ade-quate amounts, provide a health ben-efit to the host. These beneficial bacte-ria help restore the proper microflora environment in the GI tract and once achieved, help minimize the number and severity of IBS symptoms.
When choosing a probiotic, it is important to do some consumer re-search. Probiotic supplements should provide at least five billion bacteria colony forming units (CFUs) per day and contain strains that have been clinically tested and thoroughly re-searched—strains such as Chr. Han-sen’s LA5® L. acidophilus and BB12® Bifidobacterium.
don’t miss!
Is there a cure for IBD?Inflammatory bowel disease (IBD) affects 1.4 million Americans, resulting in abdo-minal pain and diarrhea. The use of immu-ne suppressants and biologics has impro-ved outcomes in IBD. Research is ongoing to identify genes associated with IBD to guide the development of new drug thera-pies and ultimately a cure for this disease.
Best Probiotics Brands Publisher’s Pick:VidazorbChewable probiotic supplements
■■ www.vidazorb.comGoodbellyDairy-free and soy-free probiotic juice drinks
■■ www.goodbelly.com
ActiviaCreamy yogurt with a unique probiotic culture
■■ www.activia.comAttuneAll-natural probiotic chocolate and granola bars www.attunefoods.com
tips
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E. Frank Hodal, Jr., Founder and creator of Vidazorb
Raymond K. Cross, M.D., M.S.associate professor of medicine,University of maryland school of medicine,director, iBd programUniversity of mary-land medical Center
In the U.S. alone, there are more than 1.5 million people living with the devastating effects of IBD. New patients are diagnosed every day.
“... we have come an extremely long way in the last four to five years, and this is an exciting time for treating IBD.” Corey Siegel, MDCrohn’s & Colitis Foundation’s national scientific advisory Committee
DecemBer · 3an InDePenDent suPPlement From meDIaPlanet In the Wall street Journal
INspIraTIoN
an NFl star’s toughest battle yet■ Question: When star quarterback David garrard was diagnosed with crohn’s Disease, how did he find a silver lining?■ Answer: By using his experiences to inspire children living with the disease, and by taking steps to fight to find a cure.
Garrard, star quarterback for the Jack-sonville Jaguars, entered 2004 as a newly married 25 year old. While pre-paring for the upcoming football sea-son, Garrard began experiencing severe chest and stomach pains, leaving him virtually immobile. After a harrowing few days in January, his ailments pas-sed, leading him to assume that he had suffered from a virus.
The road to diagnosisWhen training camp began, Garrard men-
tioned his symptoms to his athletic trai-ner, who prescribed a diuretic. When the diuretic would not quell the symptoms, Garrard was referred to a gastroenterolo-gist. X-rays were taken, and a diagnosis of Crohn’s Disease was suggested.
“This can’t be too serious—I’ve never even heard of Crohn’s Disease,” Garrard re-members thinking. He was about to learn just how serious the disease can be.
He was placed on a regiment of pills. Af-ter six weeks, however, Garrard suffered a major flare-up which landed him in the hospital for a week and resulted in the re-moval of a twelve-inch section of his in-testine. This led to an experimental treat-ment involving the drug Remicade, which involves intravenous administrations of the drug every eight weeks. It has success-fully controlled Garrard’s flare-ups and in-duced remission.
A champion, on the field and offGarrard participated in the 2004 NFL sea-
son without requiring daily medication. He has been symptom free since 2005, and continues Remicade treatments eve-ry eight weeks. His career has taken off in this time. He won the starting quar-terback position and received a six year contract extension. He was selected to the 2009 Pro Bowl and is currently leading his team towards the playoffs.
While achieving this success on the football field, Garrard also has managed to champion the cause for research into In-flammatory Bowel Disease (IBD), in the hopes of finding a cure for this disease.
While most people diagnosed with Crohn’s Disease are in their twenties, Garr-ard states that it is becoming more com-mon for children to be diagnosed. With a young son of his own, Garrard has become a familiar face in the fight to find a cure.
Improving the lives of childrenGarrard’s charitable work is impressive. He works closely with the Crohn’s & Coli-
tis Foundation of America, and served as honorary chair for the Take Steps Jackson-ville Walk in 2009 and 2010. This program enables patient families and community members to join together to build aware-ness of IBD while raising critical funds.
Garrard’s In the Zone for Crohn’s cam-paign has helped raise more than $350,000 for CCFA. He hosted a fishing tournament in the Jacksonville area last year to raise funds, and is hosting a golf tournament this year.
In a remarkably selfless way, Garrard says he feels “blessed to have been diagno-sed with Crohn’s Disease. This way, I can be an inspiration to kids who have the sa-me disease as me.” His hard work on and off the field is an inspiration to children and adults alike, with or without IBD.
For more information about IBD, visit www.ccfa.org or www.davidgarrard9.org.
A word of warning about AccutaneAccutane, a drug used by over 16 million people worldwide to treat severe acne, has been linked to an increased likelihood of developing Inflammatory Bowel Disease (IBD). While no longer available by brand name, generic versions of the drug still exist and are still prescribed.
Originally manufactured by Roche, production ceased due to increased costs associated with lit-igation. Currently, more than 1,600 people are engaged in legal actions against Roche, claiming that the drug increases the risk of devel-oping debilitating bowel diseases such as Crohn’s Disease and ulcer-ative colitis.
Accutane’s generic name, iso-retinoin, continues to be a very successful remedy for severe acne in adolescents and adults. How-ever, Roche’s failure to disclose its risks associated with IBD is what has gotten the company into such hot water. The American Journal of Gastroenterology has published a study stating that the side ef-fects of isoretinoin quadruple the chance of developing ulcerative colitis.
Knowing this, it should be a warning sign to any patients that are considering beginning acne treatment with isoretinoin. There have been several reported cases of patients with IBD whose isoreti-noin use has triggered flare-ups of their disease. The Crohn’s & Coli-tis Foundation of America (CCFA) warns that the drug should be used with caution in patients with both IBD and severe acne, and only after careful consultation with one’s gas-troenterologist and dermatologist.
The importance of diet and nutritionHow important is early detection for those suffering from IBD?Early diagnosis allows medical therapy to quickly put the disease in remission and avoid complications. Complications, including intestinal blockage, fistulas,
abscesses, and relentless IBD inflamma-tion might necessitate surgical interven-
tion including removing a portion of the bowel. Untreated colitis is a risk for deve-loping IBD associated colon cancer.
What are a few of the best prac-tices for those living with IBD?Get proper vaccines to avoid increased
risk for infections from potential im-mune suppressing therapies, main-tain adequate vitamin D, avoid aspirin and aspirin-like medications, and of great importance for Crohn’s disease, don’t smoke!
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Accutane (isotretinoin) is a potent drug derived from vitamin A and was originally developed for use in chemotherapy treatment. It was discovered that isotretinoin decreases the amount of oil produced by the skin’s sebaceous (oil) glands and regulates the natural “waterproofing” of the outer layer of skin. Therefore, Accutane was touted as a miracle drug for those suffering from severe acne. For nearly 30 years, it was one of the leading acne drugs until it was removed from the market by manufacturer Hoffmann LaRoche in 2009. Accutane’s potentially life-altering side effects may have impacted thousands of unsuspecting users across the country. Generic forms of this drug are still available today.
Accutane use has been linked to serious gastrointestinal side effects which may include inflammatory bowel disease, Crohn’s disease and ulcerative colitis. More than 2,500 cases have been filed relating to the harmful effects believed to have been caused by Accutane and generic forms of isotretinoin.
A recent study in the
American Journal of Gastroenterology found that ulcerative colitis is strongly associated with previous isotretinoin exposure.
IMPORTANT FACTS you should know about ACCUTANE® SIDE EFFECTS
Steven Brant, M.D., director of the meyerhoff inflammato-ry Bowel disease Cen-ter at Johns hopkins medicine
