“Crohn’s disease is a form of inflammation in the intestine which can lead to very unpleasant symptoms of abdominal pain, diarrhoea, sometimes faecal incontinence, weight loss and fatigue. It particularly affects young adults at a time in life crucial to educational achievement, career progression and formation of adult identity and relationships, often making it challenging to earn a living and/or raise a family,” explains Dr Ailsa Hart
, one of the Consultant Gastroenterologists within the Gastroenterology and Hepatology team
at The Physicians' Clinic.
One of the first-line treatments for Crohn's disease involves using steroids to reduce inflammation and to damp down the immune response that is active throughout the gut. Unfortunately, many patients become dependent on steroids or resistant to the effects of steroids. A goal for patients with IBD is to achieve a steroid-free remission, in view of the long term side effects of corticosteroids. Many of the current therapies available to treat Crohn’s disease help to achieve this goal.
The new research on steroid resistance in Crohn's disease
“This month sees the publication of some exciting new research work identifying a possible key to drug resistance in Crohn’s Disease,” reports Dr Hart.
The study was published in the Journal of Experimental Medicine in the online advance issue on January 6th 2014. It is authored by a group of researchers from the renowned Scripps Research Institute
in Florida, USA, and outlines their research in patients with Crohn's disease.
The disease is known to involve an abnormal immune response and the group identified a subtype of white blood cells, called Th17 cells that are much more common in the guts of people with Crohn's disease compared to people with healthy guts. Some people with Crohn's had 10 times the number of Th17 cells.
“The key property of these cells is that they are completely unaffected by steroids, so the treatment that is being given to patients is not able to restrict them. The cells appear to encourage the inflammatory process, making the condition worse, despite increasing doses of steroids,” explains Dr Hart.
This knowledge doesn't help patients in the short-term but understanding more about the complex events that happen in the gut of someone with Crohn's disease will lead to improved treatment strategies in the future.
Crohn's disease management at The Physicians' Clinic
The Physicians' Clinic has a 6-strong team of expert gastroenterologists and hepatologists, including Dr Hart, and they have many years of experience managing Crohn's disease and ulcerative colitis, the other main inflammatory bowel disease.
“Prompt diagnosis is crucial to limiting the impact of this disease and can lead to better outcomes. Here we perform blood and stool tests, endoscopy examinations and imaging of the gut, combining analysis of the findings with clinical examination and listening to come to a clear diagnosis.”
“Treatment is then started and the array of medical therapies now available not only improves the unpleasant symptoms of the disease, but can also heal the gut mucosa. Such therapies include thiopurine drugs (azathioprine and 6-mercaptopurine, methotrexate and anti-TNF drugs).”
“The Gastroenterology and Hepatology team at The Physicians Clinic use the latest evidence-based and optimal medical therapies, but they also adopt a holistic approach, recognising the significant psychological burden that Crohn's disease can have.”