Article on treatment for UC and Crohn's

[Peggy]

Vancouver Sun Newspaper
Thursday, November 23, 2006
Dr. Michael F. Byrnes, gastrointestinologist and clinical associate professor, UBC (Univeristy of B.C.)

Imagine being 20 years old and not being able to sit through a movie date without running to the bathroom three or four times.

How about never being able to go to a grocery store on your own because you may need to abandon your cart in search of a washroom.

Or not being able to attend an outdoor concert or your child's basebell game because the bathroom is not easily accessible.

As a gastrointestinologist, I see hundreds of patients like this every year suffering from the debilitating effects of ulcerative colitis (UC), a chronic and painful inflammatory bowel disease (IBD). In fact, Canada has one of the highest rates of IBD in the world, estimated at nearly 170,000 Canadians, with approximately 10,000 new cases diagnosed each year.

The effects of ulcerative colitis can be devestating and can severely affect a person's quality of life. People with UC suffer from diarrhea, severe abdominal pain and cramping, rectal bleeding, and fatigue.

During a disease flare-up, it is not uncommon for patients to go to the bathroom up to 20 times a day, or more. If not properly treated, symptoms may worsen, causing complications such as excessive bleeding from ulceration, and even perforation of the bowel.

The disease normally strikes when a person is quite young, between the ages of 15 and 35; as it is a chronic disease, many patients are looking at a lifetime of discomfort and pain.

Striking as early as it does can also impair self-esteem - social situations may become difficult and embarrassing for young UC patients who need to be on constant lookout for a bathroom.

Standard treatment for ulcerative colitis has typically included medications such as 5-ASA therapies, immunomulators (drugs that alter the immune system), and steroids. These medications help control or reduce inflammation.

5-ASA therapies and corticosteroids can be given orally, through an enema, or in a suppository, depending on the location of the inflammation in the colon.

Immunomodulators are administered orally. However, they are slow-acting and it may take up to three to six months before achieving the full benefit of the medication.

Health Canada recently approved Remicade (infliximab) to treat Canadians with moderate to severe UC, making it the first and only biologic therapy approved to treat UC in Canada (biologics are newer drugs that block specific chemicals which are involved in the inflammatory process).

Remicade has been shown to be an effective therapy that can enhance quality of life, while reducing the need for surgeries and hospitalizations. Remicade is well known to gastrointestinologists like myself, having been used in Canada since 2001 to treat Crohn's disease, the other form of IBD.

Prior to the approval of this medication, surgery was often the only option for those UC patients who had failed on other therapies.

However, the surgical solution, a colectomy, involves the removal of the large intestine and carries some significant risks for patients, such as infertility and incontinence.

A colectomy can reduce the ability of women to become pregnant by as much as 80 percent, and nighttime fecal incontinence can occur in more than 20 percent of the patients.

For some, these risks are too high. (No sh*t Sherlock) If you are a young person, the possibility of never having children or not being able to go to bed at night without wearing a diaper, is just too much to contemplate. (I repeat my above comment...)

It is also important to note that in approximately 50 percent of patients, the pouch formed during surgery to create a new rectum may become inflamed ("pouchitis"), causing pain, bleeding, and diarrhea, all symtoms of UC which the patient had been seeking to avoid through surgery in the first place.

Now, with the approval of Remicade, physicians are able to offer patients a viable alternative to surgery.

In my own practice, I have seen this medication allow patients, who had previously been chronically ill and living with significant disability, lead active and relatively symtom-free lives.

The precise role of this drug in patients with UC is still evolving, and there are still some unanswered questions.

Remicade will not work for everyone, and is not appropriate for everyone. Some patients will still need surgery.

However, there is no doubt that being able to use this drug for UC will provide some patients with a medical alternative to invasive surgery.

With Health Canada's approval, more of my patients will benefit from this treatment, and physicians across Canada will have a new non-surgical option for treating UC.