More than one million Americans suffer from inflammatory bowel diseases (IBD), primarily Crohn’s disease and ulcerative colitis. Affecting people of any age, race or gender, IBD causes chronic inflammation of all or part of the digestive tract. Crohn’s can strike in any part of the system, while ulcerative colitis is only found in the large bowel. Patients’ symptoms vary widely, but the most common are diarrhea, abdominal pain or both.
As with many other digestive disorders, patients with IBD are constantly on a quest to find the right treatment regimen to relieve the symptoms that interfere with their everyday lives. This search for effective IBD treatments was one of the many topics my colleagues and I discussed during Digestive Disease Week® (DDW), the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Throughout our discussions, a number of themes came up consistently. First, health-care providers are still uncertain about the best ways to use the therapies that are currently available. Second, treating these diseases is about more than just symptom management; we must look deeper to make sure that we are getting at root causes of the symptoms. And lastly, new research and highly anticipated therapies will change an already dynamic treatment landscape.
We can all agree that there really is no “one-size-fits-all” answer to IBD treatment. That was the primary conclusion of a session on old and new treatments led by myself and Peter Irving, MD, of Guy’s and St. Thomas’ Hospital in London. Treatment regimens will have to be tailored in terms of monotherapy versus combination therapy, the sequence in which medications are tried, and the optimal dosage for each patient. Even two novel biologics — vedolizumab and ustekinumab — are not silver bullets for IBD.
Gary Lichtenstein, MD, professor of medicine and director of the Center for Inflammatory Bowel Disease at the University of Pennsylvania, reminded us that both patients and clinicians can no longer judge treatment effectiveness based just on symptom relief. Patients and their teams of providers need to discuss how their individual regimens are working to reduce the disease’s social and occupational effects.
Patients should also know that there are more objective methods available — going beyond external symptoms — to determine if treatment is actually working. Often times, even though symptoms have gone away, the lining of the digestive tract is still not healed and IBD can flare back up. This is when MRIs and colonoscopies can be useful because they give clinicians the ability to visualize the digestive tract and make treatment decisions with objective data.
Research presented at DDW also gives us a sneak peek into possible new treatments for these tough-to-treat diseases. Josie Libertucci, a PhD student at McMaster University in Ontario, Canada, presented initial findings from her study of fecal microbiota transplant treatment (FMT) for ulcerative colitis patients. Her team found that there were some commonalities in the patients who responded to FMT. Although a randomized controlled trial of once weekly FMT treatments did not show efficacy, it’s still interesting to consider whether FMT could be an additional treatment option for IBD, specifically ulcerative colitis, if treatment regimens might be improved.
Finding the right treatment for IBD is not easy, but from what I saw at DDW, the field continues to move forward in making it easier for patients to live with Crohn’s disease and ulcerative colitis. I believe a key in this entire process is the provider-patient relationship. If patients and clinicians are partners throughout the treatment process, success is much more likely.