So I have been busy with work and haven't been able to blog much. Here are some articles related to Crohn's I have found interesting lately. For even more research check me out here on Twitter.
Discontinuing anti-TNF and Endoscopic Remission 12 months After
This recent study published in the June 2014 issue of Inflammatory Bowel Disease showed that patients who were in deep remission (defined as fecal calprotectin < 100 ug/g)) with IBD with an anti-TNF (Humira, Remicade, etc) who discontinued taking the drug. In the study up to 67% of patients still had clinical remission 12 months after their follow up. 70% of patients who had Crohn's disease in the trial did not have relapse which is a pretty high percentage. What is even more interesting is that 85% of patients sustained an endoscopic remission.
Split dosing for bowel prep is superior than taking bowel prep night before
This study showed that breaking up the bowel prep dosage to the night before and the day of may actually lead to a better colonoscopy. So IBD patients are known for undergoing colonscopies and understand about taking the bowel prep the night before. Anyone who has a colonoscopy knows the bowel prep which can be a pain but is the hardest part of the colonscopy. Anyways usually the doctor will ask you to drink all of the bowel prep the night before. Well a study showed that if you split the dosage into two parts (one the night before) and one the morning of you it could actually lead to superior results. The table in the study shows that since 1997 studies have shown that a large majority of the studies show that splitting up the bowel prep does lead to better results. The one issue however is patients have to get up very early (sometimes 4 A.M.) to drink the bowel prep.
FDA approved test for colorectal cancer (that is much easier than a colonoscopy)
So this past week the FDA actually did something good by approving a test called Cologuard which combines fecal blood and DNA and is able to detect 92% of colon cancer and 69% of polyps with high-grade dysplasia. The test will cost $599 and will be covered by Medicaid and Medicare. The test was actually developed by a gastroentrologist at the Mayo Clinic (Dr. David Ahlquist). This gives doctors another tool to catch colon cancer early and ensure patients don't have to have surgery or chemotherapy. Hopefully, this test will save many lives and also free up gastroentrologist since they won't have to do as many colonoscopies! Between Cologuard and PillCamera it is now much easier for doctors to monitor patients and avoid colonoscopies.
Fecal transplants show mixed results (depending on which study you look at)
So as someone who has actually had a fecal transplant which cured me of c difficile I find it interesting to see the research examining if fecal transplants can help patients with Crohn's or ulcerative colitis. One issue I have with some of the fecal transplant studies is they just look at one infusion of a fecal transplant when I believe it may take more than just one infusion in order to obtain remission for Crohn's and ulcerative colitis patients. In a study 27 ulcerative colitis patients were given fecal transplant enemas. Only 15% of patients achieved clinical remission (higher than the placebo). 26% of patients saw an improvement. In a Crohn's study 8 patients with Crohn's were given one single fecal transplant infusion (by colonoscopy) and after one month 62% of patients achieved clinical remission. A couple of patients required an increase in dosage of medication (my Humira had to be increased from every other week to every week after my fecal transplant as I still was having issues). Fecal transplants seem most effective in children with Crohn's disease. One study showed that after a single transplant through the nose (you can't taste it if you are wondering) 78% of patients were in clinical remission within 2 weeks which is quite remarkable.
Jet Prep for colonoscopy-helping patients with poor bowel prep
So some patients don't prepare well for their colonoscopy (some patients can't tolerate drinking all the bowel prep which is pretty gross to drink). Sometimes gastroenterologist are not happy with the prep patients. There is actually a video of Jet Prep on YouTube here . Jet Prep is made by a company called Medivator. The device allows the doctor to flush loose stool and obstructions off the colon wall with pressurized water and the doctor can also back-flush the device channel if there is too much liquid or feces and aspirate the dirty fluid out of the patient.