Though there is no cure for this challenging disease, success can be measured in years of symptom-free, high-quality living.
Crohn’s disease is a very challenging condition to treat,” says Dr. Sunil Khurana. In the 80 years since Dr. Burrill B. Crohn described it in a medical paper, neither its precise cause nor a cure for it has been discovered.
Crohn’s disease (CD) is a chronic inflammatory disorder of the digestive tract. It most commonly affects the lower part of the small intestine and colon but can involve any area of the tract. In most people, it is diagnosed at an early age, between 15 and 35. Because its symptoms are similar to those of ulcerative colitis, another inflammatory bowel disease, and to other intestinal disorders, an extensive series of tests may be needed to arrive at a definitive diagnosis and to discover how much of the GI tract has been affected.
The main goal of treatment has traditionally been seen as controlling the inflammation as a means to relieving the major symptoms—such as abdominal pain, diarrhea, and rectal bleeding—and avoiding long-term complications, which can include the need for surgery. The particulars of the therapies employed depend on the location and severity of the disease and the individual’s response to the various medicines that are available.
As there is no cure, success is measured by control of inflammation and symptoms, and by the ability of therapy to invoke periods of remission. People with Crohn’s disease may be free of symptoms for years at a time, but “flare-ups” and recurrence of symptoms almost invariably occur.
Things are better now In earlier years, physicians focused heavily on symptom relief. “Now, there is enough data that shows that healing is the way to go,” says Dr. Khurana. “If the ulcers and the mucosal inflammation characterizing CD heals, the patient’s prognosis is much better.”
Several categories of drugs, using different mechanisms to control inflammation, have been available for some time. None are effective for every patient, and each has its own side effects and limitations, so the proper drug regimen is arrived at gradually.
In recent years, a new type of drug, called biologicals, has been approved for use in CD. Biologicals are proteins engineered to inhibit components of the immune system that play a role in inflammation.
In Dr. Khurana’s view, “physicians have to be aggressive enough to use biological agents early. You don’t fuss around for a year or two with older medications and use biologicals only as a last-line drug. You need to bring them on pretty early in the treatment. You can really change the course of the disease with these drugs and you can save some people from surgery.
“Things are demonstrably better now for people with Crohn’s disease,” says Khurana. “At one time it was often necessary for Crohn’s patients to be hospitalized following a flare-up or acute episode. With today’s newer medicines and treatment approaches, the need for many such hospitalizations is no longer there.”
Premier’s GI Division is now able to handle most people with CD as outpatients. It operates an infusion center where patients can receive regular infusions of crucial drugs like Remicade. “It’s convenient for patients,” says Khurana. “They don’t have to go to the hospital; they become familiar with the staff; see the same faces all the time… it’s like a social visit.”
Khurana is confident that Premier is able to give its GI patients the best treatment available. “Because we’ve been involved in multiple clinical studies of newer drugs, we are often able to offer treatment to patients who have not responded to established drugs or other protocols.”