Monthly Archives: September 2016

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A New Care Plan for Crohn’s Disease

Combined treatments helped heal patients with Crohn’s disease

Septic perianal Crohn’s disease is a complication that has long been difficult to treat, but a new type of care plan may help.
Researchers at Penn State College of Medicine spent more than 10 years developing and testing a care plan that helps doctors decide how and when to treat patients with septic perianal Crohn’s disease.

Crohn’s disease is one of several inflammatory bowel disorders. Patients have severe abdominal cramping, bleeding and diarrhea. About 41 percent of patients with Crohn’s disease develop infected abscesses that become fistulas–open wounds that are very difficult to treat.

At one time surgery was the preferred treatment, but a medication called infliximab, know by the brand name Remicade, helped suppress the inflammatory condition in about 59 percent of patients. After a year, however, only 25 percent of the patients still experienced healing.

“What was thought to be a silver bullet of sorts for this problem really is not,” lead author Walter A. Koltun, MD, said in a press release.

Dr. Koltun is a professor of surgery at Penn State College of Medicine.

Despite the expense and possibility of significant side effects, many patients with Crohn’s disease stay on infliximab through fear the condition will become worse if they stop the medication. Dr. Koltun and colleagues have developed a care plan that helps doctors determine whether and when to continue the medication or to move to a surgical solution. The care plan is the first of its kind.

An analysis of 135 episodes of septic perianal Crohn’s disease found that 60 percent of the patients treated with the new care plan healed and remained healed for at least six months. Half of the remaining patients improved, but did not heal completely. The remainder did not heal and required surgery.

The researchers also analyzed genetic variations to see how they might affect healing, but results were not statistically significant.

“What we did with this study is look at a combined medical and surgical protocol for managing this problem, recognizing that there’s a role for the medicines, and there’s a role for the surgery,” Dr. Koltun said in the press release. “Our protocol provides a paradigm for when you perhaps should stop the drug and when to consider surgery with or without medication.”

The research and care plan were published in the June issue of the Journal of the American College of Surgeons.

Funding for the care plan was provided by the Carlino Fund for Inflammatory Bowel Disease Research.

None of the authors reported a conflict of interest.

An article from dailyrxnews, by Matt Wilson

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Crohn’s disease: Potential treatment to prevent fibrosis uncovered

Scientists from the University of British Columbia in Canada have found a mutation that switches off a hormone receptor, which prevents mice from developing fibrosis. This discovery could lead to potential treatments to prevent fibrosis in people with Crohn’s disease.

Crohn’s disease is a long-term condition that causes inflammation to the lining of the digestive system. While the disease can affect any part of the gastrointestinal tract, the most commonly affected areas are the end of the small intestine (the ileum) or the large intestine (colon).

One of the main complications of Crohn’s disease is the development of fibrosis, which is where the intestines become blocked – by thickened and scarred connective tissue – and so narrow that food and feces are unable to pass.

Fibrosis takes place due to an overproduction of proteins – including collagens – that are usually involved in the tissue healing process.

Mutation turns off hormone receptor, prevents fibrosis

While there has been some success in treating the inflammation associated with Crohn’s disease, there are no effective drugs to treat fibrosis. Understanding how fibrosis occurs can help scientists to develop new medicines to treat patients.

Surgery and repetitive surgery is common and often required to restore proper digestion. Around 70 percent of people with Crohn’s disease will eventually need surgery. Approximately 30 percent of individuals who have surgery for Crohn’s disease experience recurrence of their symptoms within 3 years, and up to 60 percent will have a recurrence within 10 years.

Scientists infected mice with a type of salmonella that imitates the symptoms – including fibrosis – caused by Crohn’s disease.

The team found that a particular mutation prevented the mice from developing fibrosis and, furthermore, the mutation had switched off a hormone receptor that is responsible for inducing part of the body’s immune response – inflammation.

“We found what we think are the inflammatory cells that drive fibrosis,” says co-author Kelly McNagny, professor at the Department of Medical Genetics and co-director of the University of British Columbia (UBC) Biomedical Research Centre (BRC).

“The gene that was defective in those cells is a hormone receptor, and there are drugs available that may be able to block that hormone receptor in normal cells and prevent fibrotic disease,” he adds.

Reversing fibrosis may promote tissue regeneration

McNagny and colleagues indicate that their breakthrough could also be applied to other tissue types that experience fibrosis.

McNagny notes that the potential fibrosis prevention method could be used for conditions that result in tissue fibrosis such as liver cirrhosis, chronic kidney disease, scarring from heart attacks, and muscle degeneration.

“We think that we can potentially block complications of all these age-related fibrotic diseases by dampening these particular inflammatory cell types,” concludes McNagny.

Future work by McNagny and team will focus on testing drugs to observe if fibrosis can be stopped or reversed in mice.

This article published on http://www.medicalnewstoday.com/ by Hannah Nichols