Digestive Trac • May 2015

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605-322-7797 To learn more, visit our website at AveraDigestiveDisease.org

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Dietitian Supports Care of GI Patients Advanced Treatment Options: IBD Patients Benefit from Individualized Care Crohn’s and Ulcerative Colitis: Excellent Medical Management Improves Quality of Life

INSIDE THIS ISSUE: DIGESTIVE DISEASES • MAY 2015

DigestiveTrac

ADVANCED TREATMENT OPTIONS IBD Patients Benefit from an Individualized Plan of Care Due to the chronic nature of Crohn’s disease and ulcerative colitis, medical management is the front-line treatment strategy.

Among options:

Specialists follow either a “step-up” or “top-down” approach. Step-up therapy starts with less potent medications, while the top-down approach hits the inflammation hard up front before stepping back on potency as inflammation improves. A patient’s individual treatment plan depends on his or her case.

For example, if the disease is severe and uncontrolled, treatment tends to be more aggressive up front.

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With improved medications available, IBD is much more manageable than two decades ago. Patients are able to remain in complete remission for years if not decades. Active research is underway to further improve the treatment of IBD – including clinical trials available at Avera

• Aminosalicylates: Reduce inflammation and prevent relapses.

• Corticosteroids: Suppress the immune system in treating moderate to severe disease; yet are not used for maintenance due to side effects.

• Immunomodulators: Modulate or suppress the immune response so it cannot cause ongoing inflammation.

• Biologic therapies: The latest class of therapy for moderate-to-severe IBD. Antibodies attach to tumor necrosis factor (TNF) chemicals, allowing the body to destroy TNF chemicals and reduce inflammation.

The goal is sustained inactive disease, or remission.

If medications are not effective, or if complications occur, surgical intervention can help resolve symptoms or repair a life-threatening condition.

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- Steven Condron, MD, Board-Certified Gastroenterologist

NUTRITION EXPERTISE

Dietitian Supports Care of GI Patients

Amanda Curley, MS, RD, LN, is a Registered Dietitian who understands the specific issues of GI patients, from problems with weight loss or weight gain to managing the specific concerns of GI conditions, including IBD.

Because of the close relationship between nutrition and the management of gastrointestinal conditions, Avera Digestive Disease Institute refers GI patients in need of specialized care to the services of a dietitian.

While lifestyle changes and improved diet alone are not sufficient in managing IBD, a well-planned diet can work in concert with medical management to help patients maintain a high quality of life.

“Diet and nutrition for patients with IBD is very individual. Recommendations often depend on what part of the digestive tract is affected, and the severity of symptoms. Certain foods can aggravate symptoms, yet this varies from patient to patient. Beginning with a well-balanced, healthy diet, I guide patients through a process of eliminating and adding back foods that are well-tolerated,” Curley said.

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SIGNS AND SYMPTOMS Inflammatory bowel disease can affect people from children to the elderly. The first peak of incidence happens in the late teen years to early 30s, with a second peak of incidence among people in their 50s and 60s.

Classic presenting symptoms of Crohn’s and ulcerative colitis are similar: • Chronic diarrhea • Bloody stools • Abdominal pain • Cramping

There may also be more vague constitutional symptoms: • Fever • Fatigue • Loss of appetite • Weight loss • General malaise

Avera Digestive Disease Multidisciplinary Team

Avera Digestive Disease Institute brings together a multidisciplinary team to address serious conditions of the digestive tract, all working toward the goal of seamless care and the best possible outcomes.

Gastroenterology Avera gastroenterologists ensure that each patient affected by digestive disease, specifically IBD, is treated with the fullest extent of expertise and the latest medical technology.

NUTRITION

ENDOSCOPY Avera has a full range of endoscopy services, for the purposes of diagnosis, biopsy, removal of polyps or lesions, and specialized procedures. Colonoscopy and upper endoscopy are among the “gold standards” in diagnosis and surveillance of IBD, and can be performed in hospital or clinic settings.

A specialized dietitian works with Avera Digestive Disease patients to develop nutrition and diet recommendations that are specific for each individual patient, based on diagnosis and severity of disease. Dietary changes work in concert with other treatments for optimal management of symptoms.

CROHN’S AND ULCERATIVE COLITIS Excellent Medical Management Improves Quality of Life An estimated 1.4 million Americans – about one in 200 – suffer from inflammatory bowel disease (IBD).

Both Crohn’s disease and ulcerative colitis (UC) result from an abnormal immune response to harmless bacteria in the digestive tract, leading to chronic inflammation, swelling and ulceration. There’s believed to be a genetic component, as well over 120 genes contribute to IBD.

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While these are chronic inflammatory conditions requiring long-term treatment and follow up, excellent medical management makes these diseases very livable.

Crohn’s can affect any part of the digestive tract, while UC affects only the mucosa of the colon. UC ulcerations are shallow and continuous, whereas Crohn’s affects the entire thickness of the intestinal wall with patchy, deep ulcerations as well as fistulas that may affect other structures.

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Accurate diagnosis is key, as IBD can mimic other conditions, such as infection. The workup often includes blood tests, stool studies, endoscopy, colonoscopy or imaging.

One of the latest tools is video capsule endoscopy. The “pill cam” visualizes portions of the small bowel non-invasively that couldn’t be seen otherwise apart from exploratory surgery. The pill cam, about the size of a multi-vitamin, takes 60,000 pictures over eight hours, which are transmitted to a computer pack worn by the patient.

Computed tomographic enterography (CTE) and magnetic resonance enterography (MRE) are imaging techniques involving oral and IV contrast to complement other diagnostic tests.

Crohn’s and UC cases can be mild or moderate to life-threatening. In severe cases, patients may present to the clinic or emergency room requiring surgery for a perforated small bowel or an obstruction.

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- Cristina Hill Jensen, MD, Board-Certified Gastroenterologist

After definitive diagnosis, an individualized medical management program is recommended first, and surgical intervention is the next resort if necessary.

“IBD is a life-changing diagnosis, especially with young patients,” Dr. Hill Jensen said. “While the disease can be a very big part of patients’ lives, it need not take over their life, with a proper, individualized treatment plan in place.”

To learn more, visit our website at AveraDigestiveDisease.org