Articles from prior issues of The Advocate

January/February, 1998

Advancements in the Treatment of Crohn’s Disease and Ulcerative Colitis
by LaJuana Burgess, Texas DDS and Susan Hammett, Mississippi DDS


DR SUSAN GALANDIUK, A SPECIALIST on staff at the University of Louisville in the diagnosis and treatment in Crohn's disease and ulcerative colitis, gave a very informative presentation. Dr. Galandiuk’s session proved most helpful in considering the impact of recent treatment therapies for these diseases. Both diseases are a result of auto-immune system breakdown and are considered to be “modern”, in that there is little to no documentation prior to 1932. Both are primarily “Western” conditions since the greatest incidence of disease occurs where fast foods are consumed. As other cultures adopt the fast-food lifestyle, they evidence the same symptoms and problems. Diagnosis is difficult since both diseases evidence varying symptoms yet the patient’s appearance is normal. Most patients are young. The course of the disease is highly unpredictable and often appears in those with type “A” personality. Many are not taken seriously and are often referred to a psychiatrist for emotional problems. There are increasing incidences of both diseases. Location of ulcers is the primary way to differentiate between the diseases. Ulcers will be localized in the bowels if the diagnosis is Ulcerative Colitis. In Crohn’s Disease, the ulcers can be anywhere and may even perforate into nearby organs. Patients can experience up to 40 bowel movements daily. Other colonic manifestations include impacted obstruction, fistulas or abscesses, blood loss, anemia, fatigue, weight loss, and dehydration from frequent diarrhea. Most patients really do know their public toilets. There are sometimes extra-colonic symptoms: these can be on the skin, severe headaches due to brain involvement, liver failure, and severe eye infections (iritis). There is a higher risk for colon cancer in these patients - about six times the average risk. One of the most debilitating symptoms is that of ankylosing spondylitis, an arthritis which is refractive to treatment and irreversible.

Both are primarily “Western” conditions since the greatest incidence of disease occurs where fast foods are consumed.

Many patients require surgery. Of these, one out of three will need additional surgery. Under past treatment, surgeons would remove large portions of the colon but the death rate was high. They now perform strictureplasty (removing the ulcerations then stitching lengthwise rather than crosswise) which reduces scar tissue build-up. Another approach in surgery is a J-pouch procedure (removal of the ulceration and folding the portion back on itself to form a rectum). This could reduce bowel movements to four or five daily--quite an improvement for maintaining a more normal daily activity. With Crohn's disease, there is a 30 percent recurrence within 10 years. There is a cancer risk after eight years for patients with ulcerative colitis. There has been successful preventive treatment in England on auto-immune disease recurrence. Researchers have developed Azathioprine (known as Budesonide in Canada and Europe). It is a first-pass steroid that combats TNF activity. Interleukins, IL 10 and IL 11, are also effective in combatting recurrence of the disease. FDA approval for these medications is expected within the next four years. Also, geneticists have isolated IBD-1 from Chromosome 16. Family members can now be identified earlier and receive preventive treatment. Treatment, from page 1

Dr. Galandiuk cautioned examiners to be cautious in denying these types of claims based solely on whether or not the claimant has weight loss. Many obese patients are no less debilitated. She also urged examiners and physicians to weigh the exacerbations/treatment/function of the patient rather than give a perfunctory duration denial.