Colon & Rectal Surgery at the University of Louisville -- Patient Information

"Work in Progress" Newsletter

Unlocking the Mysteries of Inflammatory Bowel Disease & Colorectal Cancer

Imagine that you could have a simple blood test to determine if you are at risk for Crohn's disease, ulcerative colitis (collectively known as inflammatory bowel disease, or IBD), or colon cancer.

Now imagine that doctors could replace or repair genes to prevent the disease from occurring.

Finally, imagine that future generations of your family may never have to experience the pain and anguish that these digestive diseases wrought.

Well, you don't have to imagine because the University of Louisville Section of Colon and Rectal Surgery is involved in research that aims to make the realities of these digestive disorders a thing of the past.

"This is an exciting time in the field of digestive disease research. However, investigators face some hurdles vital to the basic understanding of these maladies. With those answers, scientists may be able to improve the quality of life for patients and their families by making these disorders preventable, more manageable, or curable," explained Susan Galandiuk, M.D., associate professor of surgery at the University of Louisville.

Challenges In Research
So, where are we now and what lies ahead as researchers begin to unlock the mysteries of IBD and colorectal cancer? Dr. Galandiuk had the following comments:

What are the greatest challenges facing researchers of these digestive diseases?
First, physicians need to be able to accurately distinguish between Crohn's disease and ulcerative colitis. Even now, doctors often have a very difficult time in diagnosing Crohn's disease and ulcerative colitis.

Medical treatments for Crohn's disease and ulcerative colitis are similar. Yet, the surgical treatments for these two diseases are very different. Because of the difficulty that physicians have in telling the two ailments apart, patients may undergo surgery for ulcerative colitis while they, in reality, have Crohn's disease. Sadly, many patients develop complications due to this.

And the other obstacle?
Presently, there is no way to predict which patients with Crohn's disease will develop a recurrence after surgery. Identification of these patients would allow us to put them on preventative medication after surgery.

How can we detect patients at risk of developing colorectal cancer earlier?
The current method of detection and screening using colonoscopy, is invaluable as a diagnostic tool. However, it has not significantly improved the stage at which cancers have been diagnosed over the past 10 years. Many patients who are diagnosed with cancer are well past the stage for it to be cured. It is our hope that we will be able to develop a blood test to identify patients who are at risk of getting colorectal cancer years before it forms in the colon.

If we are able to predict patients at risk of getting colon cancer, can we place them on some type of medication that would prevent these cancers from occurring?
Possibly, while numerous studies have already shown an association between regular use of calcium or aspirin with a lower risk of developing colon cancer, additional studies are needed to better understand the relationship.

Can we determine which cancer patients will develop spread or recurrence of that cancer?
If we were able to predict this, only these patients would be given preventative chemotherapy and radiation treatments, which can both have a lot of side effects.

What can we expect to find out about gastrointestinal illnesses and future treatments in the new millennium?
I believe that, in the coming years, we will witness the dawn of new medications to treat these ailments. Just look at the progress medicine has made to date.

The 5-ASA products (i.e., Pentasa®, Asacol®, Dipentum®, Colazal®, Canasa®, and Rowasa®), which were developed in the 1980s and 1990s, continue to help many patients with ulcerative colitis and Crohn's disease. A new 5-ASA drug, LIALDA™ (mesalamine) with MMX® technology, is the first and only once-daily oral formulation of mesalamine approved by the U.S. Food and Drug Administration (FDA) in 2007 for the induction of remission in patients with active, mild to moderate ulcerative colitis.

Some patients with mild to moderate active Crohn's disease may have the option of taking budesonide (Entocort EC®), a steroid that acts topically in the gut, which was approved by the FDA in 2001.

Breakthrough biologic drugs include infliximab (Remicade®) and adalimumab (Humira®). Both medications inhibit tumor necrosis factor-alpha (TNF-alpha)—a protein involved in the inflammatory process. Remicade was FDA approved specifically for the treatment of Crohn's disease in 1998, and in September 2005, it was approved for the treatment of ulcerative colitis.

Humira is an anti-TNF alpha medication approved in 2007 for the induction and maintenance of remission in adults with moderately to severely active Crohn's disease who have lost their response to conventional therapies or who are intolerant of Remicade.

Additional biologic medicines are in the pipeline for both types of inflammatory bowel disease.

As I mentioned, calcium and aspirin have shown signs of prevention for colon cancer, which need to be studied further.

This is only the beginning. In the future, as genetic research progresses, it may play a major role in how we diagnose and treat these disorders.

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