An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Crohn’s disease: Managing an incurable public health problem

High school years should be highlighted by laughter and happy memories.

Yet Michael Artigues remembers being 16 and suffering from excruciating stomach pain that caused a dramatic weight loss of 40 pounds and a hospitalization that left a blurred memory of many pain killers.

Vanessa Franco was continually exhausted in high school, suffering from constant diarrhea and recurrent abdominal cramps. 

Michael and Vanessa’s painful journey eventually led them to a diagnosis of Crohn’s disease. 

Michael and Vanessa share another common bond: They consider Atilla Ertan, M.D., a “magician” for effectively managing their disease for more than two decades. Ertan is director of the Ertan Digestive Disease Center of Excellence at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann-Texas Medical Center.

Crohn’s disease is a chronic inflammatory disease without a medical or surgical cure, and it affects upward of 780,000 people in the U.S.  While this disease is more prevalent among adolescents and young adults between the ages of 15 and 35, it can strike men and woman equally at any age. Ashkenazi Jews and Caucasians develop Crohn’s disease at a higher rate than other ethnicities.

Crohn’s is among a group of conditions known as inflammatory bowel disease (IBD).  “We consider Crohn’s a significant public health problem because of its debilitating nature,” explains Ertan, professor in the Division of Gastroenterology, Hepatology and Nutrition at McGovern Medical School at UTHealth. “The goal of medical management is to reduce the inflammation that triggers signs and symptoms. The successful induction therapy improves long-term prognosis by limiting complications, hospitalizations and the need for surgery. After induction therapy, it is crucial to arrange a long-term effective and safe maintenance therapy to achieve a deep remission.”  

Ertan, who has achieved national and international recognition in gastroenterology, says there are promising new treatment agents for Crohn’s patients.  “Innovative treatment options are available and clinical studies are underway at UTHealth to determine their efficacy and safety,” he says.

“Crohn’s disease is different from ulcerative colitis, another type of IBD,” explains Andrew W. DuPont, M.D., director of clinical investigation in gastroenterology and the Inflammatory Bowel Disease Program at McGovern Medical School. “While the symptoms are similar, the areas affected in the gastrointestinal (GI) tract are different.”

Crohn’s typically affects the end of the small bowel and the beginning of the colon, but it could affect any part of the GI tract, as well as the thickness of the bowel wall.  Ulcerative colitis is limited to the innermost lining of the colon.

Contributing factors

The cause of Crohn’s disease is unknown but some factors may contribute to it:

  • Immune system problems: Our immune system can usually be counted on to defend our body from harmful elements, such as bacteria. Harmless bacteria, which aid in digestion, are normally protected from this attack. When these helpful bacteria are attacked by mistake, inflammation occurs and becomes chronic.
  • Genetics: Crohn’s tends to run in families. If you, or a close relative, have the disease, the odds increase that your family members will develop it.
  • Environment: Crohn’s is more common in developed countries, in urban areas and in northern climates.

Factors that may aggravate the disease are stress, cigarette smoke and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and naproxen.

Managing Crohn’s disease

There is significant progress in the management of Crohn’s disease, especially in recent years.

“We have over 3,000 patients with IBD in our center, and we not only look for long-term remissions, we do everything possible to avoid complications, hospitalizations and surgical intervention,” Ertan notes. “We customize treatments for each patient and our goal is to relieve the symptoms, reduce inflammation and enable the intestinal tissue to heal so the patient can enjoy lengthy periods of remission with a quality of life.”

The role of diet and nutrition are also emphasized. “Focusing on a patient’s diet may help reduce inflammation and promote healing,” says DuPont, a physician with the Ertan Digestive Disease Center of Excellence. “We recommend foods that are preferable and those to avoid.” If the patient is lactose-intolerant, dairy products should be avoided. Gluten-free foods may also be recommended.

“It’s important to talk with your doctor and to make sure you receive accurate information about treatment options,” DuPont explains. “Unfortunately, there is inaccurate information on the internet that causes confusion and fear about treatment options.”

Lifestyle adjustments

Michael eventually discovered that changing his lifestyle prolonged remissions. “A light bulb went off in my head, and I realized I had to give 100 percent toward a clean lifestyle,” he says. “That means no smoking, no drinking and eat healthy foods.”

In January 2015 Michael had a serious flare-up of the disease. “We successfully managed Crohn’s for many years but Dr. Ertan determined it was time for a surgical resection of my strictured small bowel. That decision saved my life,” he says.

Michael is thankful his life turned around.  “It’s unbelievable how well I am now,“ he says. “My advice for anyone with these symptoms is to find a specialist, follow their advice and commit to a healthy lifestyle.”

Vanessa considers Ertan “a blessing in my life” since 1993 because she finally found a doctor to manage her Crohn’s disease.  

Like Michael, Vanessa had a series of remissions and flare-ups.

“Crohn's can be very embarrassing,” she admits.  “I may look normal on the outside but often don’t feel well on the inside. People don’t understand what you feel on the inside. You are frequently bloated or tired and you may have no choice but to leave social gatherings early.”

To better manage Crohn’s, Vanessa made adjustments to her career and instead of continuing as a school registered nurse, her current job allows her to work at home where she can better manage her Crohn’s disease.

“We always tell our patients to be hopeful,” Ertan emphasizes. “We have more effective and safe new agents to manage Crohn’s disease, either commercially available or in research trials.”

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