Crohn's and Dental Health

Today, I went to a periodontist (gum dentist) who said my gums were inflamed and it wasn't due to gingivitis. In the back of my mind I knew Crohn’s might have something to do with it as it can cause gums to be inflamed along with intestines.  This special dentist said that I needed to get a deep cleaning of my gums and they would have to do a biopsy of the gum to see what the cause was. It is odd though because my bottom gums are healthy pink just my top gums are causing trouble. I was a little nervous when the dentist said I might have to go on a steroid. This seems interesting because from what I understand drugs like medicine can cause bones to be weaker. Also I am weighing around 156 (with clothes off) these days and really don’t want to add any more weight when I use to be 140-150 lbs.

I did some research and found a forum were people discussing this similar issue.  In doing more research I found that Crohn’s patients perceive their oral health to be worse than people who don’t have Crohn’s.

This study from 1989 showed that Crohn’s patients have a higher risk and need more preventive care. Although these studies link certain things I would be more curious to find out why gums can become inflamed. My own theory is that autoimmune diseases have to deal with the good bacteria attacking the body which is what causes the inflammation which could be happening in the mouth. Although, the mouth and stomach are far apart I am reminded that the definition of Crohn’s is pain from anus to mouth which includes the gums. 

Michael Seres Crohn’s Transplant for Bowel

I saw this pretty cool story about Michael Seres who got a transplant for his bowel. Michael who is 42 years old for the past three years had to have feeding tubes in order to eat like a regular person. Michael has had Crohn’s since 1982 and already had 20 surgeries (poor guy!). His bowel went from 197 inches to 27 inches. The procedure Michael had is still risky (only 10 are done a year). Rejection of the tissue transplanted to the new bowel is a concern. Michael had to stay in the hospital for three months because his immune system was so weak. These days he is back to eating regular meals.

Hopefully, the procedure Michael had will be studied more to where it can be safe and effective and present as another option for people with Crohn’s. No question the procedure will get safer and better the more times it is done. 

STELARA (Ustekinumab) Promising Results for Crohn's

I was thrilled to see that STELARA (ustekinumab) seems to help Crohn’s patients in this study just published by the New England Journal of Medicine. The drug was approved for psoriasis in 2009 (interesting how so many autoimmune drugs work for so many various things! STELARA in the trial was used after one TNF drug failed (Remicade, Humira, Cizmia). The results showed that 40% of patients saw a decrease in their CDAI (Crohn’s Disease Activity Index). The drug was given every 2 months via I.V. STELARA works by targeting interleukin-12 and interleukin 13 which plays a role in Crohn’s disease. The trial was pretty large with 526 patients (which means it also was very expensive to run the trial). Around 40% of patients had a clinical response by the end of 6 weeks which was greater than the 24% with the placebo). On a side note it seems risky to be injecting a placebo into patients with Crohn’s.  In addition to this 31% of patients who took usterkinumab were in remission didn’t need steroids.

Although the drug is not approved yet I personally would take it seeing its benefits and a trial from last year showed that it has benefits for Crohn’s patients. I hope the FDA will approve STELARA for Crohn’s patients seeing how it is effective and seems safe (no adverse side effects). Approval for this drug would also create more competition for treatments which would bring the costs of TNF drugs down which benefits consumers.

Colon Cancer and Crohn's: How You Can Reduce Your Risk

One of the things I hear is that Crohn’s patients are at greater risk of getting colon cancer. Me being the researcher I am decided to do some research to see what the causes of colon cancer are and if anything can be done to prevent it.

This study puts the risk of getting colon cancer at 7% for Crohn’s patients after having the disease for 20 years. The risk was greater for patients who get it younger than 25. However, this meta-analysis (combined multiple studies) at least for ulcerative colitis found a non significant increase in risk over time for colon cancer.  This study shows that ulcerative colitis and Crohn’s only account for 1-2% of all cases of colon cancer however accounts for 15% of the deaths related to inflammatory bowel disease. 5-ASA’s do seem to help reduce the risk. This study which studied patients from 1940-2001 showed that there as only a slight increase in the risk of getting colon cancer for Crohn’s patients (6 patients got colon cancer vs. 3.2 that were expected).

So what can we do to reduce the risk of colon cancer? I am glad you asked because I did some research and found in this study (in men) cutting back on red meat, eating beef, pork, or lamb less than 5 or more times per week. Poultry, fish, dairy products, and vegetable fat can slightly reduce the risk of colon cancer.  This New England Journal of Medicine article that studied woman found that woman should avoid eating animal fat because it increased the risk of colon cancer and substitute fish and chicken for meats high in fat. This study showed that low physical activity in a physical job can lead to an increase risk in colon cancer.

A company called Exact Sciences is trying to create a better screening for colon cancer. The test is known as Cologuard and could hit the market by 2014 if the FDA approves it according to this Barron’s article.  If you get a colonoscopy done and precancerous growths are caught early enough they can be removed during the colonoscopy. The problem is that more than 50% of colon cancers are diagnosed in the late stages when death increases dramatically.  The test is pretty easy and just requires a stool sample that is sent to a lab to see if it has precancerous growths. The cost may cost $300 which is still much more than stool-based blood tests.

On the drug side the FDA just recently approved a drug called Stivarga which helps for people that have the cancer spread to other parts of their body. The drug extended life almost 6 and half months.

The policy recommendations for reducing risk of colon cancer are avoid meat (eat chicken or fish instead), work out, get a colonoscopy, and if something is wrong talk to your doctor for early detection and you should reduce your risk of getting colon cancer.

Olmstead County, Minnesota 1970-2004 Crohn’s Study

I saw this recent saw this article in the Journal of Gastroenterology (my night time reading) that studied a group of people from Olmsted County, Minnesota. The study is ongoing and looked at people from 1970-2004 (updated from 2001). The study concluded that the cumulative probably of having major abdominal surgery were 38% at 5 years, 48% at 10 years, and 58% at 20 years.  The major factors that were significantly associated with major surgery were being male, smoking, early steroid use, and penetrating disease behavior. What seems to be positive though is that if you look at this chart that shows the cumulative risk of having surgery after being diagnosed in different decades.  In recent times it seems that the people who were diagnosed in the early 2000’s who are a little below 10 years from diagnosis have the lowest risk out of all the decades of having to have surgery at around 35% (which is down from 60% which is was in the late 1970s). Also remember Humira was not introduced for Crohn’s until February of 2007 which may bring down the requirement for surgery even more. My gastro doctor had told me one time that with Humira he was seeing fewer and fewer patients in the hospital and fewer requiring surgery which fits the data. What was also interesting is that people claim Crohn’s has a genetic component to it (however even my gastro doctor said none of his patients had family members who have it and neither do I) and the data in this graph supports that as close to 86% of patients have no family history of inflammatory bowel disease.

This data makes me feel a little bit better. With the cost of genome analysis going down it might be interesting to see if certain genes affect who has to get surgery or multiple surgeries. Although the odds are by definition I will need surgery I think I will be able to handle this and hope it is years away when the technology will improve and perhaps down without a scratch with NOTES as I mentioned in this post. I will be honest the thing I am scared of most of having an ostomy bag.  I know other Crohn’s and ulcerative colitis patients worry about it and I would even be okay with a temporary one if I had to but a permanent one would scare me just a little bit.  

Amy Brenneman Ulcerative Colitis and CCFA PSA

Actress Amy Brenneman who now stars in Private Practice and Judging Amy (she isn't bad on the eyes either) is doing a PSA for the Crohn’s and Colitis Foundation. Amy had her colon removed in 2010. When her colon was taken out she had an ileostomy bag in for three months but then had it taken out in a second operation that reconnected the insides. She took about six weeks to recover. Amy was in the emergency room three times in two weeks. She admits her body fell apart. She recently talked about on October 1, 2012 on the show “The View”.  Amy suffered from ulcerative colitis and was diagnosed during her second pregnancy. She took Humira, 6-MP, Colazal, and other drugs. 

Celebrities brining light to inflammatory bowel disease is a good thing. If more stars talk about the diease the more knowledge average people will get which will be good. Raising awareness is always great. Even individuals can spread the word about it. In fact tell complete strangers.

Crohn’s and Depression

I saw this recent story of a young man named Michael Isreal who was only 20 years old who suffered from Crohn’s and also suffered from prescription drug abuse. He committed suicide in May 2011. He was an architecture major at University of Buffalo. He suffered Crohn’s since he was 12 years old.

Once Michael turned 18 his prescriptions started to change. He took pill after pill and they never fixed his Crohn’s. Michael was taking 21 pills per day. Among these drugs were hydrocodone which can become addicted I am curious if he ever took Humira or Remicade which has actually helped people. He told his father about his addiction and enrolled in a detox program (however the detox program was out of beds). Right after this is when Michael Isreal took his life at only 20 years old.

In light of Michael’s death the family is pushing for the Internet System for Tracking Over Prescribing Act (I-STOP)  which would set up databases to give doctors information on prescription drugs that patients take. This would just create an underground market for drugs like hydrocodone and other pain medications which would make the problem worse. If anything we should be allowing more people to use these type of drugs in order to treat the addiction people have. If people really want to take their own life they will. If you make it harder to use prescription drugs people will commit suicide in other ways.

I did some research on any links between Crohn’s and depression or other mental illnesses. In this study found that Crohn’s patients had a greater chance of having psychiatric disorder and more had depression then the controls. Personally when I was younger I use to see a psychotherapist who helped me through some self esteem issues however that was when I was a young adolescent. The only other time I really filled down was right after I got Crohn’s. At first I had no idea what I had and when I was in the hospital felt good and then when I came out came to the realization of what I had and got down knowing I had a life long illnesses. A few of the first nights I cried and was kind of blue. Over time I came to realize I have to live life to the fullest and not let Crohn’s get in the way. After Humira I felt like I never had Crohn’s.

In this study it was found that lifetime prevalence for Crohn’s patients is 29% which is higher than ulcerative colitis (21%) or cystic fibrosis. It should be pointed out that this study was done in 1989 which was before Humira, Remicade, and other biologics were introduced. In an odd way if you get Crohn’s now is the time to get it given all the technological advances that have been made.  This doesn't even include the future things that will be discovered or created

I wonder if any genes are related to Crohn’s and depression. This would be an interesting study for researchers to undertake. Also who knows what advances they might make in treating depression. I have a feeling studying the genome, understanding of inflammatory bowel diseases, and understanding the immune system better will give patients a better shot of turning their frown upside down.