Inflammatory Bowel Disease: Not Curable, But Treatable

Dr. Adam Cheifetz is an expert at putting himself in his patients’ shoes and understanding exactly what they are going through. Why? Because he not only directs the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, he also lives with a form of the disease himself.

As a medical resident on overnight call nearly 20 years ago, Cheifetz, concerned about the severe abdominal pain he was experiencing, had an X-ray taken that showed an obstruction of the small intestine. After several similar episodes, he was diagnosed with Crohn’s disease.

Today, Cheifetz combines his personal experience, professional knowledge and ongoing research to help individuals with IBD manage their disease and enhance their quality of life. The winner of the 2015 New England Chapter of the Crohn’s and Colitis Foundation of America Humanitarian of the Year Award, Cheifetz says, “Although IBD is a chronic disease, it is treatable.”

Crohn’s Disease and Ulcerative Colitis

IBD is a broad term that describes conditions in which the gastrointestinal (GI) tract is inflamed due to an abnormal immune response, causing pain and a variety of other symptoms. Crohn’s disease and ulcerative colitis are the two main forms of IBD.

Crohn’s disease is chronic disorder characterized by inflammation anywhere along the GI tract that can lead to symptoms such as abdominal pain, nausea, vomiting, diarrhea, intestinal bleeding, and weight loss. The most commonly affected area is the where the small intestine and the colon meet.

“The symptoms of Crohn’s disease can be similar to the symptoms of other diseases,” Cheifetz says. “A history and physical exam, as well as additional testing such as imaging tests, blood tests, and endoscopic exams with a biopsy of the tissue, are some of the tools used to make an accurate diagnosis.”

Ulcerative colitis is characterized by chronic inflammation of the colon (large intestine) accompanied, in severe cases, by ulcers in the lining of the colon. It typically presents with rectal bleeding and diarrhea. The most accurate way to diagnose ulcerative colitis is by examining the colon with a fiber-optic endoscope inserted into the rectum. A sigmoidoscopy examines the lower third of the colon; a colonoscopy examines the full colon.

Crohn's disease and ulcerative colitis are most often diagnosed in people in their 20s and 30s, although it can develop at any age, in both children and adults.

Physicians and Patients Partner to Manage IBD

“Physicians and patients should work together to develop a treatment plan, with goals of controlling the symptoms and the inflammation, getting the patient feeling back to normal, keeping them feeling normal, and minimizing medication side effects,” Cheifetz says.

Since 1997, when Cheifetz was first diagnosed, powerful new medications called biologics have been developed to treat IBD. Biologics are therapies made from living organisms that work by blocking the action of specific proteins or receptors of inflammation. They are designed to help restore the body’s ability to fight the disease.

“Twenty years ago, achieving a partial response to medications or being dependent on steroids was often the norm,” says Cheifetz. “There are currently six biologic therapies approved for the treatment of IBD. Their availability has had a huge impact on the treatment of IBD and other immune-mediated diseases. We now discuss complete clinical remission and even healing the intestines so there is no inflammation. I tell my patients that my goal is to get them feeling so well that they forget they have IBD.”

The key to success with all medications is taking them as prescribed. Not taking medications as prescribed can lead to flares of the disease.

Looking to the Future

Cheifetz is researching how to use these newer medications even more effectively. He is deeply committed to research aimed at improving treatment options, and is currently focusing on the use of therapeutic drug monitoring to optimize anti-inflammatory therapies to treat patients diagnosed with IBD. He and his colleagues were the first to show improved outcomes with proactive therapeutic drug monitoring with two medications (infliximab and adalimumab) when compared to the standard of care