Excellent Care Makes Inflammatory Bowel Disease Manageable

When he was 16, David Binion was diagnosed with a condition called Crohn's disease. That event gave a name to the unpleasant symptoms he had been experiencing - abdominal pain and frequent diarrhea. It also inspired an interest in becoming a physician who specialized in treating patients like him who suffer from Crohn's or ulcerative colitis, both lifelong illnesses that collectively are called inflammatory bowel disease, or IBD. It also fueled a desire to improve the lives of patients through medical research.

Today, David G. Binion, MD, Associate Professor of Medicine at the Medical College of Wisconsin, follows the health of more than 1,300 IBD patients who have been treated in the Inflammatory Bowel Disease Center at the Froedtert & Medical College Gastroenterology and Hepatology Clinic. In addition to his clinical practice, he directs the IBD Center and is one of the country's leading researchers in the diagnosis and treatment of IBD

"We have a very active IBD Center," says Dr. Binion, who was recruited by the Medical College in 1997 to organize and launch the center. "Every patient we treat we also track for research. Our patients understand that their involvement with the IBD Program encompasses much more than just their care. What we learn from their experiences with IBD today will influence and improve future medical treatments."

Crohn's disease causes inflammation in the gastrointestinal tract, primarily affecting the small and large intestine. It most commonly occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation may extend deep into the lining of the affected organ. Symptoms are variable, and can cause pain and weight loss and lead to frequent bowel movements and diarrhea.

The other major form of inflammatory bowel disease, ulcerative colitis, causes inflammation and damage in the lining of the large intestine, leading to rectal bleeding, cramping and diarrhea. About one in three IBD patients may have Crohn's colitis, Dr. Binion says.

The Distinction between IBD and IBS
IBD should not be confused with Irritable Bowel Syndrome, or IBS, Dr. Binion emphasizes. "IBS is a syndrome of symptoms such as abdominal pain or discomfort. It affects about 10% of the population. Although it's unpleasant, it does not damage the bowel, as IBD does."

If left untreated, IBD can be disabling and even life-threatening, Dr. Binion says. "It can be an isolating disease. It affects patients' ability to function productively in society." IBD can cause chronic, systemic inflammation and scarring in the intestinal tract, which damages the intestinal wall and can cause painful bowel blockages. It may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin.

Extra-intestinal manifestation of IBD can include inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system, including cancer. Some IBD complications resolve during treatment for disease in the digestive system, but some must be treated separately.

The National Institute of Diabetes and Digestive and Kidney Diseases describes IBD this way: "Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible."

Higher Standards at Medical College
"We have higher standards for our patients' outcomes than many other medical facilities," Dr. Binion says. "Our goal for every patient is to attain and remain in lifelong remission. Our expectation is getting people back to a normal quality of life."

Accomplishing that goal is quite an achievement. In recent studies, as many as 16% of IBD patients are classified as permanently disabled. But only 5.5% of patients treated at the IBD Center meet that classification.

"Not everyone is treated with the same therapy," Dr. Binion says. He notes that approximately one-third of IBD patients are classified as having a mild form of the disease. Another one-third to 40% are classified as moderately severe, and the remaining one-third have a severe form. Treatment may include drugs, nutrition supplements, surgery or a combination of those options. "Medications that work well for some patients may not be tolerated well by others. Some patients require surgery; others do not." The key, he says, is determining which body part is affected and defining how severe the illness is.

Diagnosis is Complex
"Diagnosing IBD is complicated," notes Dr. Binion. "There is no gold standard that applies in every case. We use a variety of tests in the process of diagnosing patients. It can require a constellation of steps - a thorough patient history, lab tests, endoscopy and a pinch biopsy, and diagnostic imaging."

Many patients, like Dr. Binion himself, are diagnosed as teenagers or young adults - "although I've seen patients as young as 2 years old and as old as 92." IBD does tend to cluster in families, and researchers have identified genetic mutations that seem to contribute to Crohn's. He notes, however, that most patients have no family history of IBD. Dr. Binion has focused his laboratory research on understanding the cellular mechanisms that give rise to the chronic inflammation.

Currently, there is no cure for IBD, he says, although researchers are exploring that option, along with new and better ways to identify and prevent the condition. Dr. Binion credits his IBD Program colleagues with helping Medical College patients attain such successful outcomes. "We have outstanding surgical talent," he says, citing Mary Francis Otterson, MD, MS, Professor of Surgery, whose patient emphases include IBD.

Mazen Issa, MD, Assistant Professor of Medicine, joined the faculty from the Cleveland Clinic and is conducting research on dietary influences on IBD and other conditions. Sue Skaros and Josh Knox work as Physician Assistants. The team also works closely with Subra Kugathasan, MD, Medical Director of the Pediatric IBD Program at Children's Hospital of Wisconsin.

Dr. Binion concluded, "Although Crohn's disease and ulcerative colitis are serious health issues, our improved ability to help patients with better drugs and new insights into clinical management make these conditions very manageable. Our goal is to devise a unique treatment strategy for each patient to help them achieve excellent quality of life and durable remission."

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.