Part 1: Diagnosis and Managem... Video Transcript

Participants

Bettina Gregory , Arthur Heller MD, Robert Tepper MD

Summary

Crohn's disease and ulcerative colitis -- together known as Inflammatory Bowel Disease, or IBD -- affect as many as a million Americans. Just what are these conditions? What are their causes? How are they treated? For answers to these questions and more, watch this special Webcast brought to you exclusively by the Crohn's and Colitis Foundation of America.

Webcast Transcript

BETTINA GREGORY, Psy.D.: Hello. I'm Bettina Gregory. Welcome to our webcast on nutrition and inflammatory bowel disease. This program is sponsored by the Crohn's and Colitis Foundation of America. We're dividing this webcast into three parts, and we'd like to begin with an overview of inflammatory bowel disease, or IBD.

Joining us is Dr. Arthur Heller, a gastroenterologist of Weill-Cornell Medical College, and Dr. Robert Tepper, who is Co-Chair of the Medical Advisory Committee of CCFA's Long Island chapter, and he's also a gastroenterologist in private practice. Thank you both for taking part in this program. Dr. Tepper, let's start with you, and let's start at the very beginning. What is IBD?

ROBERT TEPPER, MD: IBD is a general term describing a number of chronic inflammatory conditions of the gastrointestinal tract. That encompasses the mouth, esophagus, stomach, small and large intestines, rectum and anus. The two most common conditions are ulcerative colitis and Crohn's disease. Because they have several similarities, they're grouped under the umbrella term IBD.

BETTINA GREGORY, Psy.D.: What are the similarities, Dr. Heller, and the differences between ulcerative colitis and Crohn's disease?

ARTHUR HELLER, MD: Ulcerative colitis is a disease that starts in the rectum, the lowest-most part of the colon, and in a continuous manner can work its way up to a varying degree in the colon. Crohn's disease can affect the gut anywhere from lips to anus, often in a skip pattern, a segmental pattern.

Ulcerative colitis affects inflammation of only the superficial lining cells of the colon, whereas Crohn's disease involves inflammation of the full thickness of the gut. Because of that, some of the complications will be different. Crohn's disease can cause scarring, stricturing, narrowing, whereas ulcerative colitis typically does not. Crohn's disease can cause fistulas -- that's an abnormal connection from a loop of gut to some other organ or the outside world. Ulcerative colitis typically does not. Both of them can be associated with inflammation outside of the gut, and the type of inflammation under the microscope can look different.

BETTINA GREGORY, Psy.D.: Dr. Tepper, what are the causes of IBD?

ROBERT TEPPER, MD: No one knows the specific cause. Currently, the most attractive theory is that in a genetically predisposed person there is some environmental trigger that causes an abnormal immune response. Of the factors involved, there are certainly genetic factors. We know this because of patients who have IBD, in 15% of them, they will be able to identify a first-degree relative, a parent, child or sibling, who also has the disease. Secondly, we know that identical twins are more likely to both have the condition than non-identical twins. We know that there are certain ethnic groups, such as Ashkenazi Jews, who are more likely to have the condition than others. And finally, there's been a recent discovery of a gene called the nod-2 gene, which is twice as likely to occur in Crohn's patients than in patients who do not have the disease.

There are also environmental factors. Researchers have tried to find for a number of years a particular infectious agent, but there has been no specific agent that has been implicated as the cause of the condition. There are psychosocial issues -- stress, anxiety, depression -- which we do not believe are the cause of the disease, but certainly can modify the course of the disease and the response to therapy.