By Rhonda Mann, Tufts Medical Center Staff
Elysha Schickel was in fifth grade when she first was diagnosed with Crohn’s Disease, a type of Inflammatory Bowel Disease (IBD).
“I had recently started at a new school which is the interesting part because stress and IBD tend to be connected,” said Schickel, now 29. “Most of my flares since then have come at a really stressful time in my life.”
IBD, a chronic inflammation of the gastrointestinal (GI) tract, affects about 1.6 million Americans, most of who are diagnosed before age 35. The disease starts with inflammation in the gastrointestinal (GI) tract – when it involves the colon, over time, this condition can induce changes in the lining of the colon putting these patients at a greater risk for colorectal cancer. IBD is a chronic, lifelong condition that can be managed, but not cured. There is, however, good news.
“There was a time when primary care physicians would ignore IBD because many patients complained of belly cramps. It took, on average, seven years to diagnose it,” said Joel Weinstock, MD, Chief of Gastroenterology at Tufts Medical Center. “Now physicians are more educated about the disease and with better diagnostic testing and treatments, patients can usually live normal lives.”
Symptoms of IBD can include persistent diarrhea, abdominal pain, rectal bleeding, weight loss and fatigue. For most people, the symptoms start in their teens or 20s. Anyone can get IBD. IBD tends to run in families. Some genetic traits as well as poorly defined environmental factors predispose people to these diseases.
There are new medications available to help control the symptoms and the disease. Stelara was approved by the Food and Drug Administration in 2016 for adults with moderate to severe Crohn’s disease who have failed other treatments. Entyvio is delivered regularly by IV infusion and has been found to be safer than some of the other drug treatments, noted Dr. Weinstock.
“Traditional treatments like infliximab and adalimumab are still used, but they do not help everyone. It is great to have newer alternative therapies,” said Dr. Weinstock.
Newer Screening Test
Since those with IBD are more prone to colorectal cancer, they must be screened frequently for the disease. Traditionally, determining the presence of these changes meant taking a variety of random biopsies from the colon. But in the last decade, new screenings have emerged, and the American Society for Gastrointestinal Endoscopy has changed its guidelines.
“Chromoendoscopy involves spraying dye on the inside of the colon. It helps highlight areas of concern, making it easier to spot and to direct biopsies to areas of the colon at greatest risk for cancer. ,” said Dr. Weinstock.
Elysha considers herself pretty lucky. She’s had only a few major flare ups over the years. When she was 22, she had part of her ileum (part of the small intestine) removed. She tries to eat healthy (fatty foods can cause problems). And she has an infusion of Entyvio every six weeks.
“It’s an invisible disease – you wouldn’t know by looking at me that I have a chronic illness,” she said. “I generally feel good, but I have to be careful. It’s easy to get complacent and let ‘good’ slowly slip to ‘bad’ without realizing it.”
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