MDNews - Cleveland-Akron-Canton

Surgical Interventions for IBD When a patient’s symptoms have pro- gressed to the point that IBD controls much of their life, and medication is not sufficient to keep these symptoms in check, surgery is the next option. “Sometimes, it becomes a quality of life issue,” says Dr. Stein, who recounts the story of a female IBD patient with two young children. “This woman had to know where every single bathroom was between her home and her children’s school. She could not leave the house without knowing that. When your life is ruled by where the bathrooms are, or when you stop participat- ing in the things you used to enjoy because you worry about making it to the bathroom, it is time to think about surgery.” About 20 percent of patients with Hazel Veloso, MD, is one of six female IBD specialists at UH. and anemia IBD patients are also at higher risk for colon cancer. Often, the first-line treatment is medication. As a gastroen- terologist with a special interest in IBD, Dr. Awais helps patients navigate the sometimes complex process of finding the best medication for their particular problems. “Generally, drugs for IBD fit into three categories — anti-inflammatory medications such as 5-aminosalicylic acid (5-ASA), immunomodulators such as methotrexate, and biologics such as Remicade,” says Dr. Awais. “We may also use steroids for a short period of time. We wish it were possible to predict which patients will respond to which medications, but there is still a lot of trial and error.” She explains that 5-ASA is typically used for milder forms of IBD while Remicade and other biologics are used for more severe cases. For patients who do not respond to standard drug therapies, UH offers access to a number of ongoing clinical trials. Among the newest IBD trials at UH is a study of placenta-derived stem cells for Crohn’s disease; patients will be recruited for this study starting this summer. UH researchers are also studying the effect of chondroitin sulfate on mild Crohn’s disease, and Remicade is being tested as a way to prevent the return of Crohn’s after surgery. For ulcerative colitis, the asthma drug anrukinzumab is now in Phase II clinical trials at UH. The hospital also hopes to institute a new study of methotrexate for ulcerative colitis. “We take a very individualized approach to care. Every case is different,” Dr. Awais explains. ulcerative colitis and up to 50 percent of those with Crohn’s disease will eventu- ally need surgery. UH Digestive Health Institute’s team of colorectal surgeons offers short- and long-term management for the complications of Crohn’s and ulcerative colitis, including pelvic and perianal sepsis, fistulas, small and large bowel resection and colostomy placement and repair. Many procedures are performed using minimally invasive techniques. For those with ulcerative colitis, the good news is that surgery can usually cure the disease. “If we cannot control the symptoms any other way, we can pretty much end the intestinal manifestations of ulcerative colitis by removing the colon,” says Dr. Stein. “So, although patients may still have systemic issues such as skin, UH DIGESTIVE HEALTH INSTITUTE LOCATIONS MEDICAL CENTERS UH Ahuja Medical Center UH Bedford Medical Center UH Case Medical Center UH Conneaut Medical Center UH Geauga Medical Center UH Geneva Medical Center UH Richmond Medical Center HEALTH CENTERS UH Bainbridge Health Center UH Chagrin Highlands Health Center 16 | Cleveland-Akron-Canton MD NEWS  MDNEWS.COM  JULY-AUGUST 2011 UH Chesterland Health Center UH Concord Health Center UH Hudson Health Center UH Landerbrook Health Center UH Madison Health Center UH Mentor Health Center UH University Suburban Health Center UH Twinsburg Health Center UH Westlake Health Center For more information or to refer a patient, call 1-866-UH4-CARE (1-866-844-2273). PHOTO © JOE SMITHBERGER, SMITHBERGER PHOTOGRAPHY, NORTH CANTON

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