Successful Inflammatory Bowel Disease Management

Ulcerative colitis and Crohn's disease are the most common clinical presentations of inflammatory bowel disease (IBD), affecting more than 1 million Americans. Recent advances at comprehensive IBD centers are creating better and more stable management options for both diseases.

IBD specialists at Mayo Clinic in Rochester, Minn., provide care for more than 5,000 IBD patients a year and internationally are at the forefront of improving care. Explains Robert R. Cima, M.D., a Mayo Clinic colorectal surgeon and vice chair for quality and safety in Mayo Clinic's Department of Surgery: "Successful IBD treatment requires a well-coordinated team of experts working on many fronts: skin and wound care, nutrition, use of newer medications such as biologics, and expertise in understanding these new agents' impact on the timing of surgery. In medically refractory cases, the team collaborates with surgeons in deciding the best next step. At advanced centers, this involves mastering the technological innovations of multiple minimally invasive approaches."

Adds Edward V. Loftus Jr., M.D., a Mayo Clinic specialist in IBD who serves as an associate editor of Inflammatory Bowel Diseases and was an associate editor of the American Journal of Gastroenterology: "The development of new medical therapeutic agents such as the biologics is really transforming the treatment of IBD. Mayo is a leader in helping assess their effectiveness through clinical trials, new measures, and new technologies, such as imaging with magnetic resonance enterography."

Ulcerative colitis advances

Up to 30% of ulcerative colitis patients require surgery at some point in the course of their disease. To meet these needs, Mayo Clinic refines and pioneers multiple minimally invasive surgical techniques. For example, in a study of 12-month postoperative functional outcomes of ileal pouch-anal anastomosis procedures, results were equivalent after open surgery and minimally invasive surgery (33 patients in each treatment group). Advantages of minimally invasive surgery include reduced pain and scarring; decreased hospital length of stay from about 7 to 10 days to about 3 to 5 days; and lowered risk of intrahospital complications such as urinary tract infection and pneumonia.

Another recent study determined the short-term safety and feasibility of a minimally invasive total proctocolectomy with Brooke ileostomy for refractory ulcerative colitis. Using Mayo Clinic's prospective IBD database, the research team analyzed results of 44 procedures to determine 30-day safety results. The team concluded the approach is a safe, feasible option for select patients.

Crohn's disease advances

Crohn's disease is a highly complex, incurable disease that is extremely heterogeneous in presentation. Mayo Clinic offers comprehensive treatment for all aspects of the disease, producing results that improve patients' quality of life. When surgery is required, the goals are to preserve as much intestine as possible and to minimize the need for a stoma.

Medically refractory enterocutaneous fistulas and herniated stomas often develop in patients with complex Crohn's disease. Mayo Clinic surgeons have successfully used new biomaterials such as human acellular dermal matrix to help reconstruct the abdominal wall after partial resection. The Mayo team concluded that the biomaterial is safe and effective.

Additional Mayo Clinic contributions to improving the care and treatment of patients with Crohn's disease include transforming management of the disease by helping create a new index of disease activity. Using objective measures and evidence of bowel destruction from enterographic imaging studies, Mayo researchers are helping overcome weaknesses of the current symptom-based index for Crohn's disease severity. It is considered too subjective and unreliable by many as a guide for prescribing the powerful new biologic agents. Mayo also leads US participation in a large multicenter international clinical trial to develop a new objective marker of bowel damage, the International Program for New Indices in Crohn's Disease. For more information, contact Brenda Becker at 507-266-0111.

In addition, Mayo Clinic clinical researchers are participating in clinical trials and assessing results of new biologic therapies. These therapies include immunomodulators to reduce inflammation. Patients who are naïve to or who have failed anti-tumor necrosis factor (anti-TNF) therapies may be eligible for these trials. The biologic agents include ustekinumab (anti-interleukin 12/23), vedolizumab (anti-alpha4-beta7-integrin), and golimumab (anti-TNF).