Thursday, November 28, 2013

Weekend Links: Thalidomide Crohn's Remission, Humira More Effective After Surgery, Delay in Crohn's Diagnosis and Greater Risk of Surgery, Leukocyte Apheresis Helps Crohn's in UK

Thalidomide Clinical Remission for Pediatric Crohn's Patients
So it appears according to this study that thalidomide helped improved the condition of Crohn's patients. The study involved 56 children and was conducted over a 4 year period. Basically the trial showed that the true benefit for thalidomide came 2 months after the dosage was initially started (no change after the first month). Overall a little over 63% of the children achieved clinical remission which is quite impressive. What is even more impressive is that clinical remission was achieved for almost 3 and half years (181 weeks). Thalidomide  for Crohn's has been studied for a while with even positive results yet it is curious why more trials haven't been conducted given the good results. Here is a case of a 31 year old executive secretary woman who had severe Crohn's for 15 years (was on 6-MP and drugs like Prednisone) and then took thaldomide for erythema nodosum and her Crohn's went into remission (interesting how experimentation works). She according to the article was in remission for 4 years. Here is another study from 2011 that reached a similar conclusion that thalidomide was useful for pediatric Crohn's. Perhaps thalidomide needs to be used more to see if it can really help more patients with Crohn's.

Humira More Effective than Azathrioprine & Mesalamine After Resection for Crohn's
This study in the November 2013 issue of American Journal of Gastroenterology showed that Humira (Adalimumbab) had a lower endoscopic recurrence (12.4%) than Azathrioprine (65%) or patients taking mesalamine (50%). The quality of life was also highest for patients taking Humira after the surgical resection.

Delay in Crohn's Diagnosis = More Complicated = Greater Risk of Needing Surgery 
So this study studied 905 Crohn's patients and placed the patients into various categories depending upon when patients were diagnosed. What researchers found was that the longer patients waited to get diagnosed was correlated with a surgery required. This may be a situation were correlation and causation are running the same direction given the more damage Crohn's is causing to your intestines the less likely it is they can be healed. I was lucky in that my gastro doctor made the correct diagnosis within 3 weeks. Hopefully we can develop better testing to distinguish between different digestive diseases.

Leukocyte apheresis helps first Crohn's patient in United Kingdom
A 24 year old guy who failed both medical and surgical therapy used leukoctye apheresis treatment which lead to a successful treatment. Basically apheresis is removing blood from the patient taking the blood and separating into different parts (using a centrifuge) and the blood is then retransfused into the patient (stem cells are done in this way often times).

Thursday, November 21, 2013

Weekend Links: Diet Helps Crohn's Woman, Fecal Transplant Helps Crohn's Patient With Fistula, Jog May Keep Crohn's At Bay, Possible Cure For Crohn's?

Diet Helps Woman With Crohn's
So here is a story about a diet that helped a Crohn's patient. Tara Rosas was having issues with Crohn's and when she was told she would need surgery she tried changing her diet and actually is now in remission. She eliminated all grains, potatoes, and certain sugars and began eating spinanch, celery, carrots, apples, and lemons. After 7 months she was symptom free (I would love to see a colonoscopy before and after and was able to stop all types of medications. She has been in remission for 3 years. It can be tricky because sometimes people can go into remission for years and maybe not even me on medication and be fine.

Fecal Transplant Helps Crohn's Patient With Fistula 
Here is a case study that showed how a fecal transplant helped someone with refractory Crohn's disease (patient had a fistula).  The patient was a 32 year old Chinese man who had Crohn's disease. A CT scan in the patient showed an abdominal mass. A fecal transplant was performed (mid-gut) and a week after the fecal transplant the patient no longer had a fever, bloody stool, or abdominal pain, and his mass became smaller. His CDAI score decreased from 537 to 228. After three months his CDAI score dropped to 62 (remission).

Jog A Day May Keep Crohn's At Bay
So this recent study looked at women (194,000) over a long period of time (between 1984-2010). The studies conclusion is that "physical activity was inversely associated with risk of Crohn's disease but not ulcerative colitis". This is interesting because I partly have a theory that my insane workout routine pre-Crohn's may have lowered my immune system and possibly lead to met getting Crohn's disease. What studies like this fail to do is look at what caused what. Exercise in some people may increase or decrease risk of Crohn's (it depends on the person since everyone is different). The next study that should be done should try to answer the why.

Possible Crohn's Cure? Anti-MAP
So I probably have discussed this before on this blog but Dr. Naser at University of Central Florida is doing some interesting work in trying to possibly develop a cure for Crohn's. Naser has been at UCF since 1995 and been studying Crohn's for about 18 years. There will be no doubt that the upcoming clinical trial he has started will see once and for all whether or not MAP causes Crohn's disease (I hope it does because if so it could be a large breakthrough for Crohn's patients). Redhill Biopharma is already conducting Phase III clinical trials. Results probably won't be expected for 2-3 years (although if patients really were cured they would most likely suspend the trial and allow patients who suffer to take the medication).

Tuesday, November 12, 2013

Going Back To Humira Every Other Week!

This year has been an interesting journey. At the very beginning of the year I caught c difficile (my internist doctor doesn't believe so since I didn't have symptoms of fever) which lead me to try Dificid many times and went up to Mayo twice (first to confirm c diff and the second for the fecal transplant). I then was still having issues and my Humira was increased on June 14, 2013 and I discussed in this blog post only to have a solid bowel movement by August 25, 2013 (I can still remember it). At any rate I am feeling pretty good these days with only very very minor pain (probably .25 on a scale of 1-10)

My GI called right before lunch today and told my blood test with great results and we were going to decrease the dosage of Humira from every week to every other week. When I met with him in person (we met for about 10 minutes) I asked him since I was use to the dosage every week would my body build up a tolerance. His response was it shouldn't and I should be okay even if we scaled back. Hopefully this turns out to be correct. The c diff could have caused a minor flare up which made things worse for a while but it honestly didn't feel like a flare up (I was going to the bathroom at night which didn't even happen when I as hospitalized in 2011). At any rate this is great news and that would be truly amazing if I could get off Humira completely (I might need some more of those cold pool swims!)

Sunday, November 3, 2013

Weekend Links: Cold Water Helps Crohn's?, Remicade + Immunomodulator Reduces Surgery/Hospitalization, Diet and IBD-No Link, Sleep and Crohn's Hand & Hand

I am across this interesting article that discusses how a man named Rob Starr. He has had the disease for 24 years and beginning in 2010 started swimming in very cold sea water. What is really interesting is that he woke up at 3 A.M. one morning in pain and then started to swim and was pain free after that. Sometimes with Crohn's you can have pain for periods and then they go away. Starr notes that swimming in warm water doesn't help. Six years ago he stopped all medications.

This study was done with mostly older men and showed that when Remicade (infliximab) was mixed with an immunomodular it lead to fewer hospitalizations and surgeries. The study look at over 20,000 veterans with IBD over an 8 year period.   

This study looked at how long it took patients to receive a diagnosis for Crohn's disease. A 25-month delay in diagnosis resulted in being more likely to require intestinal surgery. The longer wait also resulted in a higher risk of patients having a bowel stenosis. 

This  research shows that the data that "altering diet can change the natural history of IBD are scarce". The data is actually contradictory the author points out. The author of the paper Dr. Jason Hou of Baylor College of Medicine also has this interesting paper were he looked at nearly every study done on diet and Crohn's disease and ulcerative colitis and found "high dietary intakes of total fats, PUFAs, omega 6 fatty acids, and meats were associated with an increased risk of Crohn's and ulcerative colitis. However high fiber and fruit intakes were associated with a decreased risk of Crohn's disease." Growing up I didn't eat too many fruits. However, I wonder if people who have the genes to get Crohn's just prefer to eat other things.

Sleep and Crohn's Go Hand and Hand
In this abstract Dr. Jami Kinnucan of the University of Chicago discussed the connection between sleep quality and the quality of life with people with IBD. However, Dr. Stephen Hanauer correctly pointed out that this is trying to figure out what causes what. Does lack of sleep affect sleep or does having a flare up cause an impact on sleep. I personally believe that more sleep does make you feel better if you have Crohn's from personal experience. In fact my first solid bowel movement in many months was the night after I got 9 hours of sleep (I felt quite amazing that day too).