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Mayo Clinic collaborates to advance Crohn’s treatment

admin — Mon, 06 Oct 2008 15:56:48 +0000

Outlook for Crohn’s disease improves due to new therapiesA study led by Mayo Clinic has found that infliximab (Remicade®) administered alone (monotherapy) or in combination with azathioprine is a more effective treatment for patients with moderate to severe Crohn’s disease than azathioprine alone. These findings were presented today at the 2008 American College of Gastroenterology (ACG) Annual Meeting.

Crohn’s disease is an inflammatory disorder of the gastrointestinal tract that affects an estimated 500,000 people in the United States. Symptoms include abdominal pain, fever, nausea, vomiting, weight loss and diarrhea. Crohn’s disease has no known medical cure. One common therapy used to manage the disease is a series of intravenous infusions of infliximab, which blocks tumor necrosis factor, an important cause of inflammation in Crohn’s disease. Azathioprine is an orally-administered, small molecule immunosuppressive which has a broad immunosuppressive effect.

“Historically, patients with Crohn’s disease have been treated sequentially with steroids, then azathioprine, then monoclonal antibodies such as infliximab. The study definitively demonstrates that infliximab-based strategies are more effective than azathioprine,” says William Sandborn, M.D., the lead author and a gastroenterologist at Mayo Clinic. “Clinicians should consider a shift in practice to incorporate this new data.”

The study, conducted at more than 200 sites, included 508 patients who have moderate to severe Crohn’s disease. Researchers found that 57 percent of patients who received combination therapy with infliximab and azathioprine achieved steroid-free remission after 26 weeks. This is compared to 44 percent of patients who achieved remission with infliximab monotherapy and 30 percent with azathioprine alone. Both the infliximab combination therapy and infliximab monotherapy groups were statistically superior to the azathioprine group. In addition, 61 percent of patients who received the combination therapy of infliximab and azathioprine also experienced healing of the bowel demonstrated by colonoscopy (mucosal healing). This is important because previous studies have suggested that patients who have mucosal healing are less likely to require hospitalization and surgery.

“Our goal with this study was to determine if infliximab-based treatment strategies were safe and more effective than treatment with azathioprine in these patients,” says Dr. Sandborn. “For patients, this new therapy is an opportunity for remission and a significant improvement in quality of life.”

Vitamin D deficiency common in patients with IBD, chronic liver disease

admin — Mon, 06 Oct 2008 15:55:24 +0000

Vitamin D replacement may be necessary to reverse deficiency-related bone lossOrNew research presented at the 73rd Annual Scientific Meeting of the American College of Gastroenterology in Orlando found patients with inflammatory bowel disease or chronic liver disease were at increased risk of developing Vitamin D deficiencies. Two separate studies highlight the importance of regular Vitamin D checkups in the evaluation of patients with certain digestive diseases.

For IBD Patients, Vitamin D Deficiency Associated with Lower Quality of Life and Higher Disease Activity

Researchers at the Medical College of Wisconsin investigated whether Vitamin D deficiency in patients with IBD is associated with a lower quality of life or higher disease activity independent of other known risk factors and medication use.

Disease activity and quality of life were assessed using validated questionnaires, which were administered at every clinic visit. The researchers also looked at the prevalence and seasonality of Vitamin D deficiency in this inflammatory bowel disease population, as well as its association with IBD-related hospitalizations, surgeries and medication use.

This retrospective cohort study conducted by Dr. Alex Ulitsky and his colleagues analyzed vitamin D levels of 504 inflammatory bowel disease patients. They recorded the patients’ lowest Vitamin D measurements and date when each low measurement was taken.

Dr. Ulitsky and his team found almost 50 percent of the patients were Vitamin D deficient at some point, with 11 percent being severely deficient. Vitamin D deficiency was not significantly associated with being hospitalized for IBD or having IBD-related surgeries. However, in both Crohn’s disease (CD) and ulcerative colitis (UC) patients, vitamin D deficiency was independently associated with having increased disease activity scores compared to those with normal levels of Vitamin D. Vitamin D deficient CD patients, but not UC patients, had worse quality of life when compared to patients who were not Vitamin D deficient.

According to Dr. Ulitsky, “All IBD patients, irrespective of their disease, disease location or nature should have their Vitamin D levels checked regularly and corrected aggressively when insufficiency is found.”

Vitamin D Deficiency Prevalent in Patients with Chronic Liver Disease

Researchers from the University of Tennessee in Memphis measured the vitamin D levels of 118 chronic liver disease patients. Researchers found 92.4 percent of chronic liver patients had some degree of vitamin D deficiency and at least one third were severely deficient. Severe vitamin D deficiency was more common among cirrhotics.

“Since deficiency is common among these patients, Vitamin D replacement may hopefully prevent osteoporosis and other bone complications related to end stage liver disease,” said lead researcher Dr. Satheesh P. Nair.

The study included 43 hepatitis C patients with cirrhosis; 57 hepatitis C patients without cirrhosis; 18 cirrhosis patients without hepatitis C. The severity of vitamin D deficiency was divided into three groups: mild (between 20-32 ng/ml), moderate (between 7-20 ng/ml), and severe (less than 7 ng/ml).

Importance of Vitamin D and Bone Health

Vitamin D, a fat-soluble vitamin, helps the body absorb calcium and plays a crucial role in the growth and maintenance of strong, healthy bones. A lack of vitamin D causes calcium-depleted bone, which can weaken the bones and increase the risk of fractures resulting from osteoporosis.

A diet rich in vitamin D, such as fish, eggs, fortified milk, and cod liver oil, is essential to maintaining good bone health.

New studies examine the effectiveness of probiotics in IBS

admin — Mon, 06 Oct 2008 15:52:42 +0000

Several studies presented at the American College of Gastroenterology’s 73rd Annual Scientific Meeting in Orlando highlight the safety and efficacy of probiotics in improving symptoms and normalizing bowel movement frequency in patients suffering from constipation or diarrhea related to Irritable Bowel Syndrome (IBS).New Systematic Review of Probiotics in IBS

A systematic review of the efficacy of probiotics in IBS that included 19 randomized controlled trials in 1,628 IBS patients found that “probiotics are effective in IBS, but we do not have enough information to be sure whether there is one probiotic that is particularly effective or whether combinations of probiotics are required,” according to Dr. Paul Moayyedi, the study’s lead researcher. Moayyedi and co-investigators at Mayo Clinic in Jacksonville, FL and Rochester, MN; McMaster University in Ontario, Canada; University College in Cork, Ireland and Montefiore Medical Center in New York City, conducted this meta-analysis presented at the ACG Annual Scientific Meeting in Orlando.

Multi-Strain Probiotic for IBS Patients with Diarrhea

Dr. Gerald Friedman of The Mount Sinai School of Medicine in New York and co-investigator Greg Biancone conducted a multi-center analysis to determine if a multi-strain probiotic was effective in reducing the frequency of diarrhea in 84 IBS patients (IBS-D). In this small study, a multi-strain probiotic administered daily for 28 days normalized bowel habits in IBS patients compared to those who received the placebo. The average number of daily diarrheal episodes in the probiotic group significantly decreased from day 1 to day 28 compared to slight decreases in the placebo group during the same period.

Analysis of Probiotics in Children with IBS

In a placebo-controlled, double-blinded, cross-over study conducted at seven pediatric GI centers in the United States, Italy, and India, Dr. Stefano Guandalini of the University of Chicago and his research team randomly assigned 59 pediatric IBS patients to receive either a probiotic agent (VSL#3®) or a placebo for six weeks. At the end of six weeks, patients switched to the other arm of the study and underwent six more weeks of treatment. Patients filled out a questionnaire to assess their symptoms and overall quality of life before and after treatment. Researchers found the probiotic agent was safe and significantly more effective than the placebo in alleviating IBS-related symptoms (abdominal pain/discomfort, bloating, stool dysfunction) in children and teenagers.

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About Irritable Bowel Syndrome

IBS is a functional gastrointestinal (GI) disorder characterized by recurring symptoms of abdominal discomfort or pain associated with an altered bowel habit, either constipation, diarrhea, or both. In IBS, the GI tract may function differently, processing more slowly (or more quickly) than the average person. While the cause of this different “pace” of the GI tract in IBS is not known, and while there is no cure, there are usually ways to help manage specific symptoms. For more information on IBS, go to the ACG Web Site at www.acg.gi.org

About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 10,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients.

The ACG is committed to providing accurate, unbiased and up-to-date health information. Visit the ACG Web site www.acg.gi.org to access educational resources for patients and their families spanning the broad range of digestive diseases and conditions - both common and not-so-common. Organized by disease, state and organ system, these educational materials, developed by ACG physician experts, are offered for the information and benefit of patients and the public.

Intestinal bacteria promote — and prevent! — inflammatory bowel disease

admin — Thu, 29 May 2008 17:03:41 +0000

Scientists search for drug candidates in some very unlikely places. Not only do they churn out synthetic compounds in industrial-scale laboratories, but they also scour coral reefs and scrape tree bark in the hope of stumbling upon an unsuspecting molecule that just might turn into next year’s big block buster. But one region that scientists have not been searching is their guts. Literally.

Now, a team of researchers at Harvard Medical School, Brigham and Women’s Hospital, and the California Institute of Technology have demonstrated that a molecule produced by bacteria in the gut’s intestinal microflora can eliminate symptoms of inflammatory bowel disease (IBD), a condition that includes Crohn’s disease and ulcerative colitis, in animal models.

“Given the sheer number of bacteria in the gut, the potential for discovering new molecules that can treat a whole range of these diseases is promising,” says Dennis Kasper, co-lead author on the study, professor of medicine and microbiology and molecular genetics at Harvard Medical School, and director of the Channing Laboratory at Brigham and Women’s Hospital.

The study will appear as the cover story in the May 29 issue of Nature.

Scientists have known for many decades that the mammalian gut is an ecosystem teeming with approximately 1,000 different species of bacteria, species as distinct from the host as a single-cell amoeba in pond scum. Rather than causing disease, these bacteria are responsible for protecting against infection and aiding digestion. An increasing number of scientists also suspect that recent increases in asthma and even certain food allergies are caused by disruptions in the delicate balance of this intestinal ecosystem.

In 2005, Kasper and Sarkis Mazmanian, then a postdoc in Kasper’s lab and now an assistant professor of biology at the California Institute of Technology, discovered that a species of intestinal bacteria called Bacteroides fragilis could restore immune system balance in mice that were bred to lack intestinal bacteria. A particular product of B. fragilis, a sugar molecule called polysaccharide A (PSA), recovered the equilibrium of a certain subclass of immune system cells (called Th1 and Th2) whose levels became skewed when bacteria in the gut were absent. The researchers referred to PSA as a “symbiosis factor,” one that established a beneficial link between bacteria and mammals. This was the first study in which such a link was demonstrated.

Interestingly, when the study was completed, Kasper and Mazmanian found in these mice an abundance of immune system cells that were known to protect against colitis and Crohn’s disease. In the current report, the groups decided to expand these findings and explore potential links between PSA and inflammatory bowel disease.

When immunocompromised mice with a specific pathogen-free microbiota were given an intestinal bacterium called Helicobacter hepaticus, they soon developed “rip roaring” IBD, according to Kasper. However, when Helicobacter was combined with B. fragilis, the mice were fine. Further experiments revealed that PSA—the special sugar molecule—was the key factor in preventing IBD. In fact, when mice were given Helicobacter combined with PSA purified from B. fragilis bacteria, they showed no symptoms of IBD.

“But then the key question was, if PSA was essential for preventing these animals from coming down with either colitis or Crohn’s, how did it do it”” says Kasper. “What was the mechanism””

The answer came by studying a subset of interleukins, that is, molecules secreted by immune cells.

Previous studies had shown that two particular interleukins, called IL-17 and IL-23, promote intestinal inflammation and are present at high levels in IBD patients. Here, while the researchers found IL-17 and IL-23 in the guts of animals who had received Heliobacter alone, these interleukins were absent from animals who had also received both PSA-producing B. fragilis and purified PSA.

“We realized that something in PSA must be preventing the inflammation that causes colitis and Crohn’s, which would explain the reduction in IL-17 and IL-23,” says Kasper.

This hunch brought the researchers to consider a third interleukin, IL-10. The opposite of IL-17 and IL-23, IL-10 is anti-inflammatory and had previously been shown to protect against experimental colitis.

The researchers once again administered Helicobacter and PSA-active B. fragilis (the combination that had previously led to healthy mice), only this time they included an antibody that blocked IL-10. As a result, the mice all came down with IBD.

“This demonstrated for us the mechanism by which PSA protects against IBD,” says Kasper.

Indeed, the researchers deduced that PSA prompts immune system cells to secrete IL-10, which in turn suppresses the inflammation caused by IBD. In other words, PSA is an anti-inflammatory.

This research should encourage people (including many scientists) to consider the vast potential for beneficial contributions to human health by “good” bacteria. And what’s more, “This is the first time that a beneficial molecule produced by intestinal bacteria has been shown to work therapeutically in an animal model,” says Mazmanian.

The researchers caution that these findings do not promise any near-term treatments for IBD. “PSA might do the same thing in humans, and it might not,” says Kasper.

However, the mechanism that they’ve discovered should persuade scientists and drug manufacturers to consider new sources for expanding the drug pipeline.

“There is currently no effort to develop molecules that are naturally made by bacteria to use therapeutically,” continues Mazmanian. “This study opens up that possibility.”

What effect does melatonin have in colitis?

admin — Tue, 18 Mar 2008 22:43:38 +0000

In rats with experimental colitis, the marked increase in bacterial translocation in postcolitis rats has been reversed by melatonin administration. This is due to melatonin’s anti-inflammatory and anti-apoptotic effects.

Using an elegant study design, including experimental colitis model, this research was performed by doctors from the Departments of General Surgery, Microbiology, Pathology and Biochemistry of the Faculty of Medicine at the University of Erciyes, Kayseri, Turkey.

This study, performed by a team led by Dr. Alper Akcan, is described in a research article in the February 14 2008 issue of the World Journal of Gastroenterology.

According to the authors, the purpose of this study was to determine whether exogenously administered melatonin had any influence on the impairment of bacterial translocation and apoptosis in experimental colitis. To their knowledge, their study is the first one showing the relation between colitis, melatonin, and bacterial translocation.

The exact pathogenesis in inflammatory bowel disease (IBD) is poorly understood, but evidence exists that IBD involves interactions between immune system, genetic susceptibility and the environment. In IBDs, the intestinal mucosal barrier is disrupted by inflammation and ulceration. In these circumstances, translocation of enteric bacteria and their products through the bowel wall to extra-intestinal sterile sites may result. Bacterial translocation may cause secondary infection of intra-abdominal inflammatory processes, such as intra-abdominal abscesses, or peritonitis. Recent studies have, however, shown the important role of anti-inflammatory and antioxidant agents, including melatonin, in IBDs.

Melatonin is an agent that promotes sleep and is produced at night by the pineal gland. While produced primarily in the pineal gland, melatonin can also be found in cells of the bone marrow and the gastrointestinal tract and plays a fundamental role in the neuroimmuno-endocrine system. In most of the published studies an antioxidative effect, improved microcirculation and a stimulation of intestinal epithelium may also apply in the preventive or therapeutic effect of melatonin on the symptoms of colitis induced in rats has been documented.

Further research should explain the similar effects of melatonin in humans

Caspase-12: MUHC researcher finds new defense mechanism against intestinal inflammation

admin — Thu, 13 Mar 2008 00:29:22 +0000

The body’s first line of defence against pathogenic bacteria that we ingest may not be the immune system but rather the cells that line the intestine. This surprising conclusion is just one facet of a study by Dr. Maya Saleh, a researcher at the Research institute of the McGill University Health Centre that will be published in the journal Cell Host & Microbe on March 12.This, and the various mechanisms revealed by this discovery, could lead to important therapeutic innovations, particularly in the treatment of diarrheal diseases and inflammatory bowel diseases such as Crohn’s disease.

When pathogenic E. coli bacteria infect the body, they bind to epithelial cells on the interior wall of the intestine before injecting infectious material into the cells with a syringe-like mechanism. This contact triggers a defence reaction within the epithelial cell called the Nod pathway, which results in alerting the immune system as well as in the release of antimicrobial peptides called defensins.

Defensins act as antibiotics: they kill bacteria directly by puncturing holes in their walls. These peptides also play a role in activating the immune system itself and tuning the inflammatory reaction.

“This mechanism expands our idea of immunity: it hinges upon epithelial cells, not immune cells, early on during infection,” says Dr. Saleh. “Furthermore, our study demonstrates that this mechanism is regulated negatively by the Caspase-12 protein, meaning that this protein limits defensin production. This hampers the elimination of bacteria, which then trigger an intense inflammatory reaction manifested by various symptoms including severe diahrrea.”

These fundamental discoveries change our understanding of the immune defence. They also open new avenues for a deeper understanding and more targeted treatments of diseases related to intestinal inflammation, such as diarrheal diseases caused by pathogenic E. coli or Crohn’s disease.

In the case of diarrhea, intestinal inflammation is caused by a process similar to the one described above by Dr. Saleh. Treatments that target Caspase-12 would decrease inflammation by acting on the source rather than on the symptoms.

Crohn’s disease is the chronic inflammation of the digestive tract, and its specific causes are unknown. What is known, however, is that this pathology is linked to a genetic mutation in the Nod pathway. “This study allows us to consider three possible explanations for Crohn’s disease: the Nod pathway mutation could induce either a lack of bacterial “sensing” or a hyperactivation of the immune system resulting in both cases in excessive inflammation against bacteria naturally present in the digestive system; it is also possible that the pathology is caused by an excessive and recurring reaction against a pathogenic microorganism,” says Dr. Saleh. The debate is now open.

In each of these cases, medication targeting Caspase-12 would decrease inflammation symptoms by directly attacking the underlying cause.

TNF-alpha antagonist stops inflammation-induced colon cancer in its tracks

admin — Thu, 24 Jan 2008 23:26:13 +0000

Individuals with the inflammatory bowel disease ulcerative colitis are at increased risk of developing colon cancer. New data generated by Naofumi Mukaida and colleagues at Kanazawa University, Japan, identified a central role for the soluble factor TNF-alpha in the development of colon cancer in mice in which inflammation of the bowel was induced by administration of azoxymethane (AOM) followed by repeated dextran sulfate sodium (DSS) ingestion. Expression of TNF-alpha was increased in the colon of normal mice treated with AOM and DSS and this was followed by the development of tumors in the colon. Mice lacking one of the receptors for TNF-alpha and mice treated with an antagonist of TNF-alpha were markedly protected from the effects of treatment with AOM and DSS, developing less inflammation of the colon and fewer tumors in the colon. As suggested by the authors, and by Ezra Burstein and Eric R. Fearon in an accompanying commentary, these data provide clear rationale for the idea that drugs antagonizing TNF-alpha (such as those used to treat individuals with rheumatoid arthritis) might be useful in reducing the risk of colon cancer in individuals with ulcerative colitis.

Controlling a Cell Eating Parasite Could be Key in Treating Colin Inflammations

admin — Mon, 21 Jan 2008 12:32:39 +0000

A parasite that attacks, kills and eats human immune cells in the colon may be controllable through a protein.

The parasite is called entamoeba histolytica, an amoeba that causes inflammation of the colon (colitis) mainly in children. Globally, the infection affects 50 million people annually causing diarrhea, malfunction and death.

The parasite attacks human immune cells then hides the evidence by eating the cell corpses. Without the cell corpses, the immune system doesn’t know there are damaged cells and the disease spreads.

A new study done by researchers at the University of Virginia and the University of Vermont identified a protein on the surface of the amoeba called a kinase, PATMK. The scientists used a special technique called RNA interference to inhibit the kinase which, in turn, prevented the amoeba from eating dead cells.

Dr. William Petri led the research team. “By blocking the kinase, we have for the first time prevented the amoeba from colonizing and invading the gut,” said Petri. “This means we are a step closer to preventing this disease which wrecks havoc among children worldwide.”

Another researcher, Douglas Boettner, said the protein might be a pivotal vaccination target because by preventing the parasite from eating the dead cells, helpful immune cells will be able to find and recognize damage and eliminate the infection. The discovery brings science one-step closer to the ultimate goal of preventing this particular colitis.

Breath test can discriminate between IBS and a bacterial overgrowth

admin — Wed, 19 Dec 2007 16:31:15 +0000

The gastrointestinal (GI) tract is colonized by bacteria immediately after birth; Escherichia coli, Streptococci and Clostridi are the first bacteria harboured by the colon, followed by anaerobic Enterococci, Lattobacilli and Bacteroidi. These commensal bacteria inhabiting the human intestine (i.e., intestinal microflora) participate in the development and maintenance of gut sensory and motor functions, including the promotion of intestinal propulsive activity; on the other hand, intestinal motility represents one of the major control systems of gut microflora, though the sweeping of excessive bacteria from the lumen. There is emerging evidence indicating that changes in this bi-directional interplay contribute to the pathogenesis of gut diseases, such as small intestinal bacterial overgrowth (SIBO).

Many factors affect the type and distribution of the bacteria along the GI tract, starting from the type of delivery and nursing in the first days of life, up to the food habits during the adult life: a SIBO is often present in adult population of westernized countries, because of poor daily intake of fibres and faecal stasis; such an overgrowth contributes to a chronic inflammation on intestinal mucosa and development of symptoms, such as abdominal pain, diarrhoea or stipsis.

These symptoms look like those of inflammatory bowel diseases (IBS) and, unfortunately, most of these patients with a bacterial overgrowth are inappropriately treated with topically-active non-steroidal anti-inflammatory agents. In fact, these compounds have no antibacterial activity and, therefore, they do not remove the causative factors of the symptoms (bacterial overgrowth) and are likely to provoke even severe adverse events.

The “breath test” is a recently developed test, which is able to detect elevated concentrations of hydrogen in the expired air. In presence of a SIBO, dietary carbohydrates are metabolised with production of massive amounts of hydrogen that are eliminated with the breath. Thus, the “breath test” consists in administering 50-75 grams of lactulose and assaying the concentrations of hydrogen in the expired air; if these concentrations exceed 10 to 20 part per million, the subject is suspected to have a SIBO and should be appropriately treated with antibiotics.

Clinicians should be encouraged to perform a “breath test” to promptly identify a bacterial overgrowth, because the disorder has several systemic consequences ranging from malabsorption of lipids and liposoluble vitamins and loss of electrolytes, to a more severe translocation of bacteria (usually, gram-negative and aerobic bacteria, such as Escherichia, Proteus, Enterobacter and Klebsiella) from the GI tract to extraintestinal tissues; all these factors may lead to sepsis and multiorgan failure.

Today, there is an effective treatment for bacterial overgrowth, which is rapidly corrected by the use of locally acting non-absorbable antibiotics, such as rifaximin polimorph A, which reverses the process (intestinal bacterial overgrowth) and prevents the cascade of events leading from intestinal low-grade inflammation to symptom development.

Nationwide survey reveals differing physician and patient perceptions regarding impact of UC

admin — Fri, 07 Dec 2007 15:36:15 +0000

Nearly three out of four patients with ulcerative colitis (UC) consider feeling unwell to be a normal part of life, while gastroenterologists estimate this to be true for only 37 percent of their UC patients, according to results from a nationwide series of surveys presented today at the 2007 Crohn’s & Colitis Foundation’s 6th Annual Advances in the Inflammatory Bowel Diseases conference.

The series of surveys, titled “UC: NORMAL (New Observations on Remission Management and Lifestyle),” were sponsored by Shire Pharmaceuticals, a specialty biopharmaceutical company, which markets once-daily LIALDA™ and PENTASA® (mesalamines) for UC.

“Before these surveys, patient and physician views on UC’s impact had not been compared and the ‘real-life’ impact of UC had not been explored to this extent,” says lead author David Rubin, MD, a gastroenterologist and associate professor of medicine at the University of Chicago Medical Center who helped design the surveys. “This series of surveys brings to light some challenges for the UC community: patients accept a high level of disruption from UC on their lives; physician and patient views regarding the impact of UC are not in alignment; and compliance with medications requiring multiple daily dosing is a challenge.”

The UC: NORMAL surveys were fielded online between February and March 2007. For the physician survey, doctors were recruited by fax from a complete list of US board-certified gastroenterologists. Gastroenterologists who spent less than half their time in direct patient care were excluded from the study.

At the time the surveys were fielded (prior to the availability of a once-daily mesalamine), patients reported they found it difficult to adhere to medication dosing schedules. Forty-six percent of patients (n=451) reported they had not taken all of their medication in the past week and 41 percent of gastroenterologists (n=300) believed their patients were not adhering to their medications. Interestingly, 83 percent of patients report they would be willing to change to a new medication if their physician advised that they do so, and 89 percent of patients report that they would be interested in trying a once-daily 5-ASA medication.

According to survey results, some gastroenterologists may underestimate the level of disruption UC can have on patient lives. For example, 42 percent of patients surveyed report symptoms of UC cause some disruption to their everyday activities, while physicians estimate that this is true for just 17 percent of patients.

These physicians and patients also differ in their beliefs on flare frequency. UC patients surveyed report experiencing an average of eight disease flares per year (self-defined: five flares for mild patients, eight flares for moderate patients, and 11 flares for severe patients). Additionally, the frequency of disease flares was underestimated by physicians: 58 percent of gastroenterologists estimate that patients with mild UC will experience only one flare-up per year; 40 percent of gastroenterologists estimate patients with moderate UC will experience two flare-ups per year and 30 percent of gastroenterologists estimate three flare-ups; while 22 percent of gastroenterologists estimate patients with severe UC will experience six or more flare-ups per year.

The authors conclude that many patients find it difficult to adhere to multi-dose medication schedules and have accepted frequent flares, symptoms, and disruptions as normal rather than re-examining their disease management strategies and helping to improve compliance. “Improved physician-patient communication and more convenient medication dosing regimens, such as once-daily formulations, could result in better disease control and we believe, improved quality of life for those who suffer from UC,” says Dr. Rubin.

Ulcerative Colitis: Patients’ Perception Compared with Other Chronic Diseases

A second presentation of the surveys’ findings analyzed UC patients’ responses to quality of life questions as compared to the responses of patients with three other chronic diseases (rheumatoid arthritis [RA], asthma, and migraine) and found that UC takes a relatively high psychological toll. Patients were recruited through an actively managed panel of approximately 900,000 US adults that includes people from all US demographic and geographic groups.

More UC patients indicate that they think their disease is controlling their lives (53 percent; n=451) than RA patients (44 percent; n=309), asthma patients (19 percent; n=305) or migraine patients (37 percent; n=305) (p < 0.05). UC patients also report feelings of stress (82 percent), depression (62 percent), and embarrassment (70 percent) at higher rates than patients with any of the other chronic conditions surveyed (p < 0.05).

The majority (62 percent) of patients with UC feel that the disease makes it difficult to lead a normal life, which is significantly higher than the proportion of patients with asthma (33 percent) or migraine (59 percent) who feel this way (p < 0.05).

“We conclude that patients with UC experience a significantly higher psychological burden, and their symptoms are frequently more disruptive to their lives, than patients with the other diseases in the survey. As such, we as physicians should initiate communication with UC patients on quality of life issues in order to better understand the effects this disease is having on them and aggressively treat the disease and its concomitant psychological effects to lessen the burden,” said Dr. Rubin.