Artist Tom Humberstone has created an engaging personal account of the Crohn's experience in his comic Everything You Never Wanted to Know About Crohn's Disease. It's a great resource to explain the effects of Crohn's to family and friends, instead of the dry list of medical symptoms from most medical sites.
A small trial has found that capsule endoscopies after surgery are better tolerated and produce better results than regular colonscopies. This was reported in Gastrointestinal Endoscopy (full article for subscribers only), with more details freely viewable at Medpage Today.
Given that patients preferred the preparation and procedure surrounding swallowing a small camera, and that the results were significantly more accurate than with the traditional camera on the end of a flexible tube, I expect to see further progress on making this standard soon.
The Los Angeles Times has a good description of how two of the latest Crohn's medications operate:
Cimzia is also a TNF blocker, but unlike the others it contains only part of the antibody -- the portion that recognizes TNF. The rest of the antibody -- the part that can induce its own immune response -- is replaced with a compound called PEG.
This PEG tail stabilizes the drug, allowing it to stay in the patient's body much longer[...].
That means patients would only require treatment every other month, as opposed to every other week with Humira.
During inflammation, infection-fighting white blood cells of the immune system cruise through capillaries, searching for infection. When tissues are infected, they put out signals to slow down the blood cells and coax them to enter the tissue. [...]
Tysabri binds to those exit signs -- blocking them from recognition by the immune cells that are causing the Crohn's. So the white blood cells keep on moving, and the course of inflammation is stopped.
The Sydney Morning Herald reports, as predicted, that Infliximab will be available on the Pharmaceutical Benefits Scheme (PBS) from October for the treatment of Crohn's disease. Prior to this patients would have to pay the thousands of dollars themselves, or be one of the lucky few paid for by a hospital.
The Daily Telegraph reports that Humira has been approved for the treatment of Crohn's disease in Australia. However, until it is listed on the Pharmaceutical Benefits Scheme (if it ever is), its cost of $16,000 per month will be prohibitive for many people.
From the unlikely source of a new player in pharmaceuticals, Asia's largest company Hutchison, comes news of an alternative to the usual Crohn's medicines. The Independent reports that initial trials of a compound found in traditional Chinese medicine have found it to be as effective as the more common treatments in Ulcerative Colitis, and is expected to be similarly effective in Crohn's. The story is in their business section, so it's a bit sparse on details, but it's definitely an area to keep an eye on. (Image from PoYang)
A great editorial in the Annals of Internal Medicine discusses how the the two current anti-TNF treatments, infliximab and adalimumab, are not living up to their initial promise.
The article examines the latest research into the effectiveness of these antibodies, and notes that responses to infliximab lessen over time. It adds that people who have stopped responding to infliximab will then not respond as well as other people to adalimumab, and they ponder whether the infliximab has changed the underlying nature of the Crohn's disease.
I thoroughly recommend this as required reading for Crohn's patients who are considering starting on an anti-TNF regime.
A Belgian study has found that PET/CT is 100% successful in diagnosing active Crohn's disease. PET, or Positron emission tomography, involves injecting the patient with a radioisotope, and watching for its decay. CT, Computed Tomography, is where multiple x-rays are taken in quick succession, and a computer combines them to form a 3D image. When referred to as PET/CT it indicates that the two procedures are done at the same time, using one integrated machine, which allows the results from each to be correlated.
Regarding the use of PET/CT for Crohn's investigation, the researcher noted:
"The big advantage of PET/CT is that it is noninvasive, simple, fast and without any side effects. There was no preparation for the patients, except that they fasted for six hours. Each study took less than 20 minutes," said Hustinx. "If the PET/CT is positive, the doctor should confirm the results using endoscopy. If the PET/CT is negative, there would be no need for the endoscopy—given the high negative predictive value of the technique," he added.
When the results of research are reported in three separate BBC reports you can tell it's important. Firstly, the BBC reported an overview:
A major advance in understanding the genetics behind several of the world's most common diseases has been reported.
The landmark Wellcome Trust study analysed DNA from the blood of 17,000 people to find genetic differences.
...
One of the most exciting finds was a previously unknown gene common to type 1 diabetes and Crohn's disease, a type of inflammatory bowel disorder, suggesting that they share similar biological pathways.
The team also unexpectedly found a process known as autophagy - a process of clearing bacteria from within cells - is important in the development of Crohn's disease.
Dr Miles Parkes, consultant gastroenterologist at Addenbrooke's Hospital and the University of Cambridge said: "The study has substantially advanced our understanding of what causes Crohn's disease.
"There is a lot of follow-up work required to fully understand the impact of the genetic associations that we have identified. However they have already provided some major leads regarding possible new treatment options."
For example in Crohn's disease, the team did not expect to find that autophagy - a process of removing unwanted bacteria from within cells - was an important factor.
They now plan to study this further to find out if it is associated with specific bacteria and there are treatments available which effect autophagy that researchers can investigate for use in Crohn's disease.
An emerging theme from molecular genetic studies of CD is the importance of defects in autophagy and the processing of phagocytosed bacteria. A number of other specific components within innate and adaptive immune pathways are also highlighted.
...IRGM (immunity-related guanosine triphosphatase; the human homologue of the mouse Irgm/Lrg47), the strongest signal being at rs1000113 (P = 5.1 times 10-8). IRGM encodes a GTP-binding protein which induces autophagy and is involved in elimination of intracellular bacteria, including Mycobacterium tuberculosis67. Reduced function and/or activity of this gene would be expected to lead to persistence of intracellular bacteria, consistent with existing models of CD pathogenesis57 and the recent ATG16L1 association64 (see above).This is extremely interesting when you review my earlier blog entry about a possible Crohn's vaccine, which operated on exactly that bacteria.
Tests on a new form of treatment called extracorporeal photopheresis have been announced.
Results from an international multi-center Phase II clinical trial suggest that extracorporeal photopheresis (ECP) may be effective in treating patients with clinically active (OR symptomatic) Crohn's disease who cannot tolerate or are refractory to immunosuppressants and/or anti-TNF agents.
A 50% response rate after 3 months of ECP treatment was noted in the study, using standard disease activity criteria, as presented this afternoon at a scientific research session of Digestive Disease Week (DDW). The majority of patients who responded to ECP therapy had a notable improvement in their disease symptoms and signs after only six weeks of treatment.
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