Weekday Links Part II: Anti-inflammatory herb for IBD, Stem Cell Crohn's, Detecting Crohn's With Laser, Sweden Highest Crohn's Rate in Europe

Endoscopic Balloon Dilation and Crohn's
So I wasn't familiar with what even a endoscopic balloon dilation (EBD) does. The procedure seems like it is mainly used for strictures and can be used as an alternative to surgery. In the study 43% of patients achieved long-term benefit from EBD.

Vitamin D and Crohn's: Sunlight Decreased of Crohn's Disease 
In a study that looked at over 90,000 women in France higher levels of sun exposure was associated with an decrease in Crohn's but not ulcerative colitis.

Anti-inflammatory herb for IBD?
So it seems as if a Chinese herbal drug may have some benefits in people. The trial looked at just mice however showed that FAHF-2 may be a novel treatment for Crohn's.

Hematopoietic stem cell transplantation in refractory Crohn's. 
Stem cells has been used for Crohn's (however it can be quite dangerous and even deadly). In this trial 26 patients were included. Many patients in this study (which just looked at toxicity) experienced infections and the study recommends to use the stem cells only in extraordinary situations.

Early Detection of Crohn's With Laser
Recently it was announced that a pill camera was approved by the FDA to be used as a colonoscopy. Now it seems as if researchers are taking colonoscopy to the next step by using blue laser which can magnify the intestinal wall and magnify it 1,000 times and see the earliest abnormal cells. The laser is being used by Ohio State Medical Center. Dr. Razvan Arsenescu has been using the laser and the hope is the laser will be used not only to treat IBD but also lung, bladder, and other diseases.

Sweden Highest Rates (In Europe) of Crohn's Disease 
Canada has the highest rates of Crohn's disease in the world and it looks like Sweden has the highest rate in Europe. The study showed that patients who had Crohn's for 40 years had an increased risk for surgery. The mean annual rate for Crohn's was 9.9 people/100,000/year (which is still a very small percentage of the population).

PillCam Approved: Will This Help Treating Inflammatory Bowel Disease and Save Billions in Healthcare Costs?

So the past week the FDA approved the use of PillCam (mind you it is approved to be used in 80 other countries already-the FDA seems slow at this). Note that more than over 1.5 million patients have used this and the FDA is just now getting around to approving it. Colonoscopies can be pretty expensive and as this New York Times article points out can vary depending on where you are in the United States by thousands of dollars. The average price for a colonoscopy in the United States is $1,185 however in Switzerland is only $655.

Given Imaging is the company that makes the PillCam.  The camera is battery operated and takes pictures for about 8 hours and then sends those pictures to a doctor. The patient wears a recording device about their waist. The company has been producing the PillCamera since 2001. One drawback are the images are not as great as an actual colonoscopy. Also if you actually do have a polyp the doctor then has to go in via colonoscopy and get rid of the polyp. However, there are patients who can't complete a colonoscopy (anatomy, previous surgeries, colon diseases, etc). which is about 750,000 people. The PillCam is only $500 which is much less than $4,000 for a typical colonoscopy (an 88% decrease in cost). According to estimates there were about 14.2 million colonoscopies performed in 2002. So just by sheer growth that number is much greater than that today. Now if you had a few million people take the PillCam instead of a traditional colonoscopy you could start saving billions of dollars in healthcare costs.

The company does make a pill camera just for Crohn's which is PillCam SB (Small Bowel). According to the company 75% of Crohn's patients have legions in their small bowel. What is even more interesting is that 62% of Crohn's patients changed their therapy within 3 months of using the PillCamera. The procedure is pretty easy. It requires patients just fast the night before and then you go to the doctor's office and wear a belt around your waist over your clothing, swallow the pill with a tall glass of water, then come back to the doctor's office after the images are sent. The PillCam passes through the bowel movement within 24-72 hours after you ingest it. There are of course risks which are very small (less than 2%) however for Crohn's the risk of retention with the PillCam is 5% (I would imagine if you had a stricture). Since Crohn's and ulcerative colitis patients in general have complications the PillCam might be something that could supplement a traditional colonoscopy. GI's could give monitor Crohn's or ulcerative colitis every couple of years (with a lot less hassle of having to do the nasty prep-honestly the prep for the colonoscopy isn't bad I have had 3 since 2011 and my advice is to start the prep as early as you can).

No question over time the technology will improve, the images will get better, the pills smaller, and the complications will get reduced. Gastroenterologists will have to do fewer colonoscopies which would mean more time to spend with patients. However, gastroenterologists may not be happy if a pill camera is able to replace a job that they do. GI's are some of the highest paid doctors making on average over $340,000 per year and 4% make $750,000 or more (I would assume these are researchers, administrators, or they own a practice). Gastro doctors have to spend 4 years in medical school, 3 years of internal medicine residency, then 2-3 years of a fellowship. My GI for example graduated medical school in 1984 then did a one year internship then 2 year internal medicine residency, then 2 year fellowship for gastroenterology (ending his fellowship in 1989-so 5 years total after medical school). So essentially gastroenterologist go to school or have training for almost a decade after they graduate college! No question though that the PillCam will be an added improvement, potential to save billions in healthcare costs, increase monitoring of Crohn's and ulcerative colitis and most importantly may spare many people the process of having to do the prep the night before!

Crohn’s Colonscopy, Humira Still Working, and Health Update

So the past few weeks of my health has been both good and bad at the same time. The bad is I have been having diarrhea. Around 2 Mondays ago I actually had to go to the bathroom 7 times in one day! On that day I took a warm bath and actually felted cured (for about a day). The other side effect was I had a pain in my backside which has happened before but made worse by the fact that I was always having to go to the bathroom. The only other recent symptom I have noticed is when I lay down sometimes my upper chest hurts a little (however I think this too has past. My gastroenterologist did some blood work and a stool analysis and noticed my white blood cell count made him “nervous”. He scheduled a colonoscopy which I happily did today. The prep is always the worst part. At 5:30 PM I started by prep and by 8:30 P.M. I finished 6 glasses of Gatorade + Miralax + the 4 pills. Honestly the first one seemed like twice as many liquids.  I did my first one on November 30, 2011 and this one was done today (January 29, 2013) so a little over a year since they have been done. Personally I would not mind doing them every couple of years just to check and see how things are going. Today was somewhat of a blur since I got up at 6:00 A.M. my parents drove me over to the medical center. I remember looking at a clock that said 8:03 A.M. and then saw my GI in a cold room where they gave me some sleepy medicine and I was out and woke back up again (the procedure only took about 20 minutes). 

The discharge from today had some findings on it. Finds were “Normal mucosa in the rectum” “Inflammation was found from the sigmoid colon to the cecum. The findings are improved compared to previous examinations. This was biopsied”. “The examined portion of the ileum was normal”. “Biopsies were taken with a cold forceps for evaluation of microscopic colitis”. My GI said there was still evidence when he looked inside that there was still Crohn's however the inflammation really seems to have gone down.

It looks like Humira is still working despite the diarrhea. My GI talked to my parents while I was in the twilight and said my diarrhea could be controlled with some Imodium which I had been taking for a while. The worst case was moving Humira up to once a week which I don’t mind either. My GI is suppose to call me with the results in a week or so.  Will have to wait and see.

It is somewhat strange I had diarrhea however no pain. To me it seems more bacterial than a Crohn’s problem. Hopefully this will only be temporary and I can get out of this little funk I am in. Living with Crohn’s does always make life interesting.