GASTROENTEROLOGY
INFLAMMATORY BOWEL DISEASE THERAPY IN 2015
By Dr Charles Murray
Over the last few years we have seen real changes in the understanding and treatment of inflammatory bowel diseases (IBD). As the incidence of both Crohn’s disease and Ulcerative Colitis (UC) continue to rise, so too has our understanding of some of the pathophysiological mechanisms that underlie them and, through this, the development of more targeted therapies. As important as the advancements in new therapies has been the development of more structured management, a national IBD audit, the creation of a national IBD registry and the publication of national IBD standards. All of these developments promote a multidisciplinary approach to management and encourage standardisation of excellent care in all hospital settings. In order to really excel in IBD care, the patient needs to be central to all treatment decisions. Information is key, and fortunately, in addition to discussing with their doctor or specialist nurse, there are excellent organisations such as Crohn’s and Colitis UK which can provide accurate and up-to-date information, while offering networking and support. Clinically, patients with IBD will need the input of multiple specialists, including: dieticians, gastroenterologists, surgeons, radiologists, IBD specialist nurses and psychological input, where needed. We have moved from a clearly symptom based approach to demonstrating that there is
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often a clear mismatch between symptom burden and extent of disease (particularly in Crohn’s disease). This is important because we now know that early intervention and aiming for mucosal healing is an effective strategy to preventing complications in the long term.
In order to really excel in IBD care, the patient needs to be central to all treatment decisions Fortunately, at the GI Unit at The Wellington Hospital, we are perfectly placed to provide the type of personalised care that is associated with the best outcomes. Our JAG accredited Endoscopy Centre provides stateof-the-art endoscopic imaging and therapy. This includes a large and active video capsule endoscopy unit, which can now provide video capsule colonoscopy. The radiology department provides high quality imaging, including advances in MRI small bowel imaging and small bowel ultrasound. We work closely with our excellent colorectal surgeons who are experts in advanced laparoscopic surgery, and importantly are experienced in the management of IBD patients and bowel sparing surgery.
Last, but of course, not least, are our gastroenterologists, who are experts in the management of these complex conditions and are at the cutting-edge of new therapies. Greater knowledge of the genetics and immunology of IBD, the microbiome and the multiple points in the inflammatory process at which we can intervene has not as yet led to a cure, but the treatments are increasingly effective. Anti-tumour Necrosis Factor biologics, such as inflximab and adalimumab, are now used frequently by physicians with a vast experience of them. More recently, the integrin monoclonal antibodies, such as vedolizumab, have come into clinic practice and offer alternative and effective interventions in conditions in which surgery was previously the only other option. Multiple other targets are in the pipeline and there are multiple new therapies are on the horizon. In summary, therefore, the treatment of IBD in 2015 is evolving all the time, with new treatments in development, more understanding of the pathophysiology of these complex diseases, and by working in a multidisciplinary way we can move towards truly personalised care in the future. To find out more about Dr Charles Murray, please visit: www.thewellingtongiunit.com