Jolie Wallace
Senior Seminar
Resources
Driving Question
- What are the methods used to put Crohn’s disease into remission?
Thesis Statement
- Though surgery and a nutritious diet are vital for maintaining Crohn’s disease,
oral medications are the best method to put Crohn’s disease into remission.
Research
A. “Crohn’s Disease.” The Children’s Hospital of Philadelphia. 6 Feb. 2008.
http://www.chop.edu/consumer/yourchild/condition.com
1) Crohn’s disease is an inflammatory bowel disease. It’s a chronic condition
that may recur at various times over a lifetime
2) There are many theories regarding the cause of Crohn’s disease, but none
have been proven yet.
3) Research suggests that there are several factors: genetics, environment, diet
4) 20% of all cases of Crohn’s affect children
5) Males and females are affected equally. About 20% of people with Crohn’s
have a relative with some form of it.
6) Most common symptoms: abdominal pain, fever, lack of appetite, weight loss,
failure to grow, fatigue, rectal bleeding
7) How it’s diagnosed: blood tests, stool samples, endoscopy/colonoscopy,
biopsy
8) Treatment: there is no cure but medication, diet and vitamin supplement,
surgery will help
B. Kuznar, Wayne. “Pharmacological Studies Review Findings on ACE Inhibitors,
Treatment of Crohn’s Disease.” Digestive Disease Week 2006. July 2006.
1) Digestive Disease Week 2006 in Los Angeles, California, yielded important
information about the pharmacological treatment of certain GI cancers and
Crohn’s disease
2) The introduction of anti-tumor necrosis factor (TNF) antibodies has impacted
the treatment of inflammatory bowel disease over the past decade
3) Positive of anti-TNF: rapid onset of action, prolonged benefits, well tolerated.
Negatives: infusion site reaction, risk of infection
4) Currently, infliximab is the only anti-TNF agent approved for the treatment
for Crohn’s
5) Study conducted: see packet
C. “Antibiotic Treatment of Crohn’s Disease: Results of a Muticentre, Double Blind,
Randomized, Placebo-Controlled Trial with Rifaximin.” Alimentary
Pharmacology & Therapeutics. 14 Dec. 2005.
1) Background: clinicians often employ antibiotics in Crohn’s disease.
Rifaximin is active against bacteria frequently found in the intestinal mucosa
of Crohn’s disease patients.
2) Aim: to evaluate the difference in efficacy between once and twice/daily oral
administration of rifaximin and placebo in the treatment of active Crohn’s
3) Methods: enrolled 83 patients with mild-to-moderate Crohn’s disease and
randomized to 3 treatments for 12 weeks:
a. Group A (rifaximin 800mg o.d. + placebo)
b. Group B (rifaximin 800 mg b.d.)
c. Group C (placebo b.d.)
4) Results: Clinical remission was achieved by 32% of (A), 53% of (B), and 33%
of (C). Treatment failures: 12% (A), 4% (B), 33% (C).
5) Conclusions: Rifaximin 800 mg b.d. was superior to placebo for the remission
of active Crohn’s disease. The number of the failures in the placebo group
was significantly higher than those who received rifaximin 800 mg.
6) See packet for further information
D. “Crohn’s Disease.” MayoClinic.com. 31 Jan. 2008. http://www.mayoclinic.com
1) Crohn’s disease, a type of inflammatory bowel disease, is a condition in which
the lining of your digestive tract becomes inflames, causing severe abdominal
pain.
2) Risk Factors:
a. Age: Crohn’s disease can strike at any age, but your likely to develop
it at a young age
b. Ethnicity: Whites have the highest risk. Jewish and European descent
are 4 to 5 times more likely to develop it
c. Family History: Your at a higher risk if you have a close relative with
the disease
d. Where you live: If you live in an urban or industrialized area, you’re
more likely to develop it. It’s possible that environmental factors,
including a diet high in fat or refined foods may play a role
e. Smoking: If you smoke, you are far more likely to develop Crohn’s
3) Treatment: the goal of medical treatment is to reduce the inflammation that
triggers signs and symptoms
a. Anti-inflammatory drugs (taken daily): these medications don’t work
for everyone (includes steroids)
b. Immune system suppressors: these drugs reduce inflammation, but
they target your immune system rather than treating inflammation
c. Antibiotics: these can heal fistulas and abscesses in people
d. Nutrition: a doctor may recommend a special diet given via a feeding
tube or nutrients injected into a vein. Certain foods may also be
recommended or told to avoid.
e. Surgery: a surgeon may remove the diseased part of your digestive
tract and intestines
E. “About Crohn’s Disease.” Crohn’s and Colitis Foundation of America, 2008
CCFA. http://www.ccfa.org/info/about/crohns.
1) Crohn’s disease and ulcerative colitis are two similar diseases that are often
misdiagnosed with each other
2) It is estimated that around 500,000 Americans have Crohn’s disease
3) What medications are used to treat this disease?
a. Aminosalicylates (5-ASA): These medications typically are used to
treat mild to moderate symptoms. They are anti-inflammatory drugs
that are taken orally. They include Asacol, Pentaza, and Colazal.
b. Corticosteroids: These drugs nonspecifically suppress the immune
system and are used to treat moderate to severely active Crohn’s
disease. These drugs have significant short-term and long-term side
effects and should not be used as a maintenance medication.
c. Immune Modifiers: These are used to decrease corticosteroids dosage
and also to help heal fistulas. In addition, immune modifiers can help
maintain disease remission. Imuran and Purinethol are the two main
immune modifiers.
d. Surgery: 2/3’s to 3/4's of patients with Crohn’s disease will require
surgery at some point in their life. Surgery becomes necessary in
Crohn’s disease when medication can no longer control the symptoms.
In most cases, the disease part of the intestines or the bowel will be
removed. Wile surgery may leave people symptom free for many year,
it is not considered a cure because in most cases Crohn’s disease will
just occur near the region of the removed intestines.
e. Nutrition: There is no evidence that any particular foods cause or
contribute to Crohn’s disease. Good nutrition is essential for anyone
who has a chronic disease, but it is especially important in Crohn’s
disease for several reasons.
i. First, the appetite is often reduced in people with Crohn’s
ii. Second, chronic diseases tend to increase the energy or caloric
needs of the body
iii. Third, Crohn’s is associated with poor absorption of dietary
protein, fat, carbohydrates, and water. All these symptoms rob
the body of fluids, nutrients, and a wide variety of vitamins and
minerals. Restoring and maintaining proper nutrition is a vital
part of the medical management of Crohn’s.
F. Kuznar, Wayne. “Pharmacological Studies Review Findings on ACE Inhibitors,
Treatment of Crohn’s Disease.”Digestive Disease Week, July 2006.Volume41.
1) Digestive Disease Week 2006 in Los Angeles, California yielded important
information about the pharmacologic treatment of Crohn’s disease
2) Anti-TNF (anti-tumor necrosis factor) modulate the inflammation of Crohn’s
disease, have a rapid onset of action, have prolonged benefits, and are
generally well tolerated
3) Currently, infliximab is the only anti-TNF agent approved for the treatment of
Crohn’s disease
G. “FDA Approves Tysabri to Treat Moderate-to-Severe Crohn’s Disease.”
U.S. Food and Drug Administration. 14 Jan. 2008.
http://www.fda.gov/bbs/topics/NEWS/2008.
1) The U.S. Food and Drug Administration has approved Tysabri for the
treatment of moderate-to-severe Crohn’s disease
2) These patients show evidence of inflammation and they have had an
inadequate response to, or are unable to tolerate, conventional Crohn’s disease
therapies
3) Crohn’s Disease—Tysabri Outreach Unified Commitment to Health (CD
TOUCH): patients using this drug must be enrolled into this program
4) Tysabri can treat suffers of Crohn’s disease but it can also bring a serious risk;
viral infections, liver injury, urinary tract infection.
5) If patients conditions have not improved after three months then Tysabri
should be discontinued
H. “Aggressive Therapy for Crohn’s Disease Produces Better Outcomes.”
Health Day. 22 Feb. 2008. Medline Plus.
http://www.nlm.nih.gov/medlineplus/news/fullstory_61482.html.
1) An international team of researchers reported that treating Crohn’s disease
more aggressively resulted in better outcomes for patients
2) Using more then one immunosuppressive drug shortly after a person was
diagnosed with the disease was more effective in inducing remission than
starting patients on corticosteroids (steroids)
3) Dr. Brian Feagan: “If you treat patients earlier with more aggressive therapy
that may be better than the conventional approach.”
4) Currently, standard treatment for Crohn’s patients starts with steroids. Then, if
side effects or steroid resistance develop, it moves on to broad-spectrum
immunosuppressive drugs. If all else fails, anti-TNF’s are used or surgery.
5) Study
a. Randomly assigned 133 patients at 18 centers in Belgium, Holland and
Germany to receive either combined immunosuppression or the
conventional approach
b. Group A: 67 patients were assigned 3 infusions of Remicade
(infliximab) with Imuran (azathioprine) at the start, two weeks later
and four weeks after that
c. Group B: The remaining 66 patients received steroids followed by the
Remicade and Imuran.
d. At six months, 60% of Group A were in remission while Group B had
36% in remission
Findings
1. Finding #1: There is no cure for Crohn’s Disease.
a. Support: A1, A8, D3
2. Finding #2: Research Studies are necessary to find a method to put Crohn’s
disease into remission.
a. Support: B5, C3, H5
3. Finding #3: Aggressive medications may be more beneficial then conventional
methods.
a. Support: B4, C5, G1, H5, F2
4. Findings #4: Surgery and a nutritious diet are helpful for maintaining Crohn’s
disease.
a. Support: A8, D3: d+e, E3: d+e,
Process Reflection:
What did you learn from conducting this research?
From researching Crohn’s disease I learned more methods to actually treat the
disease. Since I only take oral medications I never thought of the more intense ways
doctors are finding to put Crohn’s into remission. There’s no exact cause of Crohn’s
disease but my research gave me more ideas of why I have it.
What higher-order thinking skills did you employ?
In order to properly complete this project I’m going to have to get used to
intensive research and confusing terminology.
What research skills do you still need to improve?
I need to improve the skill of choosing the right articles for me. I tend to choose
mediocre articles just because there more understandable but now I’m being forced to
step out of my comfort zone and choose harder and more credible articles.
What information did you think you knew before researching that turned out to be either
incorrect or incomplete knowledge of your topic?
Before researching Crohn’s disease I thought I knew all of the ways to treat
Crohn’s disease but after my research I learned that there’s more methods being tested all
the time.