Do I really need that test?

Medical testing for diagnosis and disease monitoring become sort of a routine part of a Crohn's patient's life.  These tests run the gamut from less-invasive blood and stool tests and diagnostic imaging to invasive colonoscopies.  I am particularly interested in the research on appropriate clinical testing for Crohn's activity, for both the personal reason of balking every time my gastroenterologist recommends another colonoscopy, and because I think the "right" amount of testing is an extremely complicated issue for any doctor and patient to work out.  The reasons for this are muti-fold... sometimes the incentives for testing are not in the right place, the tort* culture of medicine in the US makes it so that missing a diagnosis or complication is a major concern for physicians, and personal anecdotes and experience heavily influence human decisions (and doctors are not immune to this fact).  This is not to say that physicians just order tests all willy-nilly.  Most doctors are well aware of the costs associated with over testing... both the indirect costs of inflating health care expenditures and the direct costs to the patient of potentially identifying "incidentalomas" (An incidentaloma is essentially a made-up term to describe some test finding that would have never caused any problems for the patient, but because it is discovered by a clinical test, it necessitates even more testing and evaluation... e.g., a benign mass that is identified by MR imaging.).  Also, despite the fact that evidence-based medicine* is the ideal for practice, every patient situation is unique, and controlled research studies cannot possibly address every scenario, which sometimes makes it hard for the clinician to make decisions solely on research conclusions.

A note to keep in mind...

For the record, it was difficult to find research the topic of testing indications during Crohn's management.  I found many articles on standard-of-care* guidelines for Crohn's treatments, but as for recommendations and indications for testing, there was shockingly little.  From the standpoint of controlling health care costs, this is fairly problematic... many doctors could be ordering unnecessary tests and driving up costs, simply because there's limited to no data to show that those tests are unnecessary... the research just isn't there.  That being said, I will review what publications I could find on the matter, and I will continue to follow the literature on this issue for updates.

Testing at the time of diagnosis

The diagnosis of Crohn's disease usually relies on the results from a number of different tests... including endoscopy, biopsy, blood, and diagnostic imaging results (Mowat et al. 2011).  The key finding for Crohn's diagnosis is generally a specific pattern of inflammation on endoscopy and biopsy, which distinguish it from other forms of inflammatory bowel disease ("skip lesions" and "granulomatous" inflammation... I will discuss these in detail in future posts), and the rest of the test results support the clinical picture, establish a baseline for disease activity at the time of diagnosis, and determine whether any complications are present.

Other situations when testing is (absolutely) necessary

I qualify "absolutely" because I struggle with saying that anything is ever definitive or true in all cases, but there are other situations in which testing definitely meets criteria for being the standard of care for Crohn's management.  When there is a dramatic change in Crohn's symptoms that is suggestive of an acute complication... for example, a sudden uptick in pain or blood loss or a striking decrease in frequency of bowel movements (BMs)... diagnostic testing, which will depend on the symptoms, is warranted.  As an aside, using the term BM always makes me think of one of Tina Fey's hilarious quotes from 30 Rock: "Boy, is anybody else BMing like a rock star?".  I think Crohn's patients should use this phrase gratuitously whenever their GI symptoms are in check.

Screening and surveillance colonoscopies are also recommended for patients following diagnosis, due to the increased risk of colon cancer in patients with Crohn's.  Friedman and colleagues followed 259 patients with Crohn's colitis for nearly 17 years, and found that 7% of these individuals had pre-cancerous or cancerous lesions on colonoscopy at some point over the evaluation period (Friedman et al. 2008).  In another study from Sweden, Crohn's patients were found to be at 2.5x increased risk of colon cancer compared with the general population, and that risk increased to 5.6x if the disease involvement was restricted to the colon (Ekbom et al. 1990).

The Crohn's & Colitis Foundation of America recommendations for colonoscopic cancer surveillance are as follows (Farraye et al. 2010):

• Patients with Crohn's disease with major colonic involvement (at least 1/3 of the colon) should have a screening colonoscopy at 8-10 years after disease onset (from start of symptoms... not diagnosis).
• The details of the second recommendation are somewhat complicated and confusing... but basically, if there are no pre-cancerous or cancerous lesions detected on the aforementioned screening colonoscopy, then surveillance colonoscopies should be done every 1-2 years.

Following up for therapeutic response

As for testing to monitor response to therapy, I thought I'd seek answers from clinical trial end points... i.e. what measures do clinical trials use to evaluate the efficacy of therapy?  Many trials use activity scores, such as the Crohn's Disease Activity Index* (CDAI) or Inflammatory Bowel Disease Questionnaire* (IBDQ), in order to measure patients' symptoms before and after therapy (Colombel et al. 2007., Feagan et al. 2008.).  These trials measured response as a decrease in the CDAI (by greater than or equal to 70 points) or as remission by CDAI (score less than or equal to 150).  C-reactive protein (CRP... see my previous post for a more detailed explanation on this blood marker) were also measured from patients in these trials, but this test was not used as an end point to evaluate drug response.  Currently, there isn't a clear precedent for using more invasive testing for monitoring response to therapy, but recommendations for endoscopic disease monitoring are contested (Rameshshanker and Arebi. 2012).

Concluding thoughts

While the gastoenterologist is going to be the expert, and, thus, the most informed person when it comes to making decisions about clinical testing, it is perfectly valid as a patient to have a discussion with your GI doc about his/her reasons for ordering that test and if it's absolutely necessary.  Generally, the litmus test for whether or not a clinical test is needed is based on the question, "Will the results of this test change the patient managment?".  If the answer is "no", then the test shouldn't be done, but if it is "yes" or "potentially", the test is often warranted.  But there are situations in which even this litmus test breaks down... what if a similar answer can be provided by a less-invasive test or just by watchful symptom evaluation over time?  Often things are not clear cut, and the patient and clinician should reach a mutually agreed upon decision for management.

Bibliography:

Colombel et al. (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology 132:52-65.

Ekbom et al. (1990) Increased risk of large-bowel cancer in Crohn's disease with colonic involvement. Lancet 336:357-359.

Farraye et al. (2010) AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 138:746-774.

Feagan et al. (2008) Treatment of active Crohn's disease with MLN0002, a humanized antibody to the alpha4beta7 integrin. Clinical Gastroenterology and Hepatology 6:1370-1377.

Friedman et al. (2008) Screening and surveillance colonoscopy in chronic crohn's colitis: results of a surveillance program spanning 25 years. Clinical Gastroenterology and Hepatology 6:993-998.

Mowat et al. (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60:571-607.

Rameshshanker and Arebi. (2012) Endoscopy in inflammatory bowel disease when and why. World Journal of Gastrointestinal Endoscopy 4:201-211.

*Some more thorough terminology explanations:

Crohn's Disease Activity Index (CDAI): The CDAI is essentially a way to more-or-less objectively rate the activity of Crohn's disease and is used as a tool for research investigations.  Most clinical trials to evaluate Crohn's therapies will use the CDAI to determine efficacy.  Several symptomatic factors are included into the CDAI computation, including number of stools per day, presence of complications, and general well-being.

Evidence-based medicine: The application of evidence obtained from scientific investigations to clinical decision making.  The goal of evidence-based medicine is to allow a clinician to make decisions about a particular testing or treatment strategy based on controlled studies in large populations instead of purely on personal experience, which can often be biased.  Evidence from controlled investigations can more accurately inform practice about the benefits and harms of a particular clinical strategy, and leads to may recommendations for standard-of-care (see below) practice.

Inflammatory Bowel Disease Questionnaire (IBDQ): This is a questionnaire for IBD activity that incorporates questions to assess the impact that the disease has on quality-of-life factors, such as social and emotional effects.  IBDQ scores generally correlate well with CDAI scores.

Standard of care: A medical treatment guideline that specifies the appropriate testing or treatment based on scientific evidence and the consensus of medical professionals.

Tort: Tort law is a type of jurisdiction that deals with situations in which one person's actions have unfairly caused another individual to suffer loss or harm... so that the harmed individual can recover his/her loss.  Applied to the health care field, tort law generally comes into play in the form of medical malpractice (where a doctor's negligence has caused a patient harm, and the patient or patient's family aims to recoup the costs of that harm).  Claims for medical malpractice must establish all four elements of the tort of negligence in order to be successful.

Team Challenge Progress: Week of 8.19 to 8.25

Thank you to my awesome donors for the week!  I continue to be amazingly humbled and awestruck by your generosity, and I am > 45% of the way toward reaching my goal of $2,700 to support Crohn's research.  Check out the progress bar on my fundraising page!

Here's my donor honor roll for 8.19 to 8.25 (in alphabetical order by surname):

• Anonymous donor
• Christopher Barrett
• Kathleen Barrett
• Nathaniel Ginder
• Sarah Gutbrod
• Brian Holzem
• Nancy Holzem
• Lena Loewenstine
• Sarah Richards
• Allie Roisman
• Emily Roisman
• Keri Walton

I would also like to give special recognition to the week's top donors... Brian Holzem and Nancy Holzem... and also an anonymous donor!

Training progress update... and an exciting day for me

At this point, I am continuing my daily runs for general fitness, and I have logged another 36 miles in the past week.  I also made a major breakthrough for my future training... I ran yesterday morning!  This probably does not sound like that momentous of an event to most of you, but due to my disease activity, I had pretty much given up running in the morning.  So, basically, I am continuing to improve on my current medicines (so much so my doctor has recommended starting to taper down the predinsone).  Amazing!  I had to stop during the run a couple of times, but nothing like past experiences.  Now, the next step will be doing some running outdoors (as opposed to on a treadmill... where facilities are always nearby).  This is all very good news for my ability to complete, and maybe actually perform well, during my half marathon in December.

Probiotics and Crohn's

Probiotics* are wildly popular right now, and certainly an advertising boon for the food and nutritional industries.  For example, I was just at my local Whole Foods and happened to notice the very conspicuous, colorful “Probiotics” sign over the yogurt case… I don’t even remember there being an equivalent sign indicating what they were actually selling, i.e. “Yogurt” (for the record, I am a frequent consumer of Whole Foods yogurt because I think it’s delicious).  Research seems to suggest that gut bacteria are undoubtedly important for health and wellbeing, and the extent to which they interact with and regulate human physiology is only starting to be understood.  This is a really exciting current field of research, known as the Human Microbiome Project (HMP), which is a multiinstuitional consortium (i.e. large group of researchers across the country) funded by the National Institutes of Health* (NIH) focused on understanding all of the places where bacteria live in us, all of the types of bugs, and how they impact our lives.  However, there is less clear evidence at this point of the direct health benefits of probiotics… in general and for inflammatory bowel disease (IBD), including Crohn's.

Before I launch into the specific scientific investigations with this blog post, I want to highlight my general theme with a transcription from NPR’s Science Friday, which I find particularly illustrative on the state of gut bacterial research.  This was taken from an interview with Dr. Jeffery Gordon, one of the leaders of the HMP (and I am happy to say is on the faculty Washington University in St. Louis... where I am in training), who has published work on the impact of yogurt bacteria on the gut microbiome.

John Dankosky: Jeffrey Gordon, do you eat yogurt every day?

Dr. Jeffery Gordon: I don't eat a yogurt every day, but I do eat yogurt intermittently.

John Dankosky: OK, and it has any health benefits for you?

Dr. Jeffery Gordon: Um, not noticable, but I enjoy the experience.

The bottom line is basically that gut bacteria do matter, but we don't really understand their importance yet.  So go ahead and enjoy your yogurt because it is a tasty, nutritious snack, but don't expect it to cure what ails you... for now at least.

Microbes in the normal human gut

Due to research conducted largely through the HMP, and with the help of generous "specimen" donations from study participants, we now have a great deal of knowledge about the bacterial composition of the human gastrointestinal (GI) tract.  The colonization of the gut starts after birth, when our initially sterile (germ free) GI systems become progressively populated with a dense bacterial community.  There are thought to be approximately 100 trillion bacteria in the average human gut, many of which live in the colon, and hundreds of different bacterial species make up this complex ecosystem (Jonkers et al. 2012).

So, some of you out there may be wondering why we have all of these bugs living within us, especially given that we generally associate bacteria with infection and disease.  It is somewhat counterintuitive to our knowledge that these bacteria are actually beneficial for us, and we have developed a symbiotic relationship (i.e. coexistence in which both organisms benefit) by hosting their residence in our GI tracts.  Microbes in the gut seem to be particularly important for the development of the normal immune system response of the GI tract, which is crucial for our health given that we encounter many pathogens in the gut after eating them (Jonkers et al. 2012).  In addition, colonization by "good" bacteria may actually help defend against pathogens.

Gut microbial alterations in Crohn's patients

I mentioned in my previous Crohn's 101 blog post that there is evidence that microbes in the gut are involved  in producing the overaggressive inflammation of IBD.  There is also research suggesting that the types of bacteria residing in the intestines of Crohn's patients are different from and less diverse than in individuals without the disease (Jonkers et al. 2012).  And, despite that there are fewer types of bacteria comprising the gut microbiome in patients with IBD, the overall counts of bacteria seem to be higher when compared with normal individuals.  There also may be a relationship between bacterial counts and IBD activity, with greater counts in active disease, but this has not been confirmed in all studies.

Probiotics as therapy for Crohn's?

It is estimated that up to 50% of patients with IBD have attempted to use probiotics for their disease, either at the recommendation of a physician or as self-prescribed alternative therapy (Mack. 2011)... and I myself fall into this ~50%.  But does the research support that probiotics are actually beneficial for Crohn's disease?  Digging into the studies that have evaluated probiotics as a therapy for Crohn's, the conclusions at the moment are similar to those for probiotic use in general... currently there seems to be no clear benefit of probiotics for induction or maintenance of remission, or for the management of post-operative Crohn's disease (Jonkers et al. 2012.; Mack. 2011).  Many of the studies have evaluated the potential effects of probiotics in several different ways... with endoscopic activity, serologic markers (i.e. blood tests such as for C-reactive protein*), and/or Crohn's disease activity scores.  There were several different types of bacteria tested individually in many of these studies, but only a couple of the investigations attempted using several strains of bugs mixed together at the same time.  Despite these somewhat disappointing results thus far, it does seem that there hasn't been enough research into the matter, and the reported studies have only involved relatively small numbers of patients... meaning that small benefits (or harms) of probiotic therapy would be difficult to detect.

So what do we know that probiotics actually do?

For the answer to this question, I actually return to research conducted by the laboratory of Dr. Jeffery Gordon.  In one study, they sampled GI bacterial content of genetically identical twins, and then had the twins start eating  a commercially available yogurt with live, active cultures for a certain window of time (McNulty et al. 2011).  Then the twins were instructed to stop eating the yogurt. Surprisingly, they found that the consumption of the probiotic bacteria in yogurt did not alter the normal gut bacterial communities.  But this doesn't mean the probiotic bacteria didn't have an important effect... the changes that did happen as a result of yogurt consumption were actually in how the colonizing bacteria processed certain types of nutrients.  Basically, the strains of bacteria in the yogurt were able to somehow communicate with the normal gut microbes, telling the gut bacteria to alter their own digestion of other products that we consume (yes, the bacteria in our gut break down a lot of the things in our food that we don't digest).  In particular, these probiotics improved how our resident microbes processed polysaccharides (a type of carbohydrate), and, thus, the products of polysaccharide break down could be more available to the human host.  However, the implications of this finding seem unclear at the moment.

Concluding thoughts

While there isn't evidence to support the use of probiotics for Crohn's therapy, there isn't evidence of harm from their consumption either.  So, if you are going to enjoy that yogurt anyway, and you accept that there may or may not be some benefit to your gut... then go ahead and have those probiotics.  However, it's probably not worth paying an extra $25 (or whatever) for that bottle of pure, encapsulated bacilli based on what we currently know.  But, in general, I don't think the research community has definitively answered the question yet of whether certain kinds of supplemental bacteria could be beneficial for general health and/or Crohn's disease, so it will be worth keeping an eye on further developments in this arena.

Bibliography:

Jonkers et al. (2012) Probiotics in the Management of Inflammatory Bowel Disease; A Systematic Review of Intervention Studies in Adult Patients. Drugs 72:803-823.

Mack. (2011) Probiotics in Inflammatory Bowel Diseases and Associated Conditions. Nutrients 3:245-264.

McNulty et al. (2011) The Impact of a Consortium of Fermented Milk Strains on the Gut Microbiome of Gnotobiotic Mice and Monozygotic Twins. Science Translational Medicine 3:106ra106.

*A few specific terminology explanations:

C-reactive protein (CRP): This is a protein that is made in the liver in response to inflammation and then gets released into and circulates within the blood.  Because CRP levels are elevated during inflammation, the concentration can be measured as a test for active Crohn's disease.  But this test is not specific for Crohn's disease activity, because CRP can be made in response to other kinds of inflammation, including infection or cardiovascular disease.  Also, it's worth noting that some patients can still have active Crohn's disease (confirmed endoscopic inflammation) with normal CRP levels.

National Institutes of Health (NIH): The NIH is an agency of the US Department of Health and Human Services that is responsible for directing and funding biomedical research in the US.  The NIH has an Intramural Research Program, in which research is conducted at the "headquarters" in Bethesda, Maryland, and an Extramural Research Program, which funds research at many academic and medical institutions across the country.  There are 27 different sub-institutes of the NIH, each with their own focus in biomedical research, such as cancer, cardiovascular disease, or aging.

Probiotics: This term essentially refers to microorganisms that are thought to be beneficial to the host in which they live.  These microorganisms are most commonly certain types of "good" bacteria, but there are also types of probiotic yeast.  Probiotics are usually administered (or consumed) as a component of fermented foods, such as yogurt, but can also be packaged as nutritional supplements.

Team Challenge Progress: Week of 8.13 to 8.18

Thank you all for helping kick start my CCFA Team Challenge fundraising!  It has been a great first week, and thanks to your extreme generosity, I am about a quarter of the way to attaining my goal of raising $2,700 to support Crohn's research.  Check out the progress bar on my fundraising page!

This week's donor honor roll (in alphabetical order by surname):

• Kate Coates-Hensley
• Tim Cooper
• Jane Glasser
• John Glasser
• Joshua Glasser
• Matt Glasser
• Jane Hagner
• Paul Hess
• Kassandra Holzem
• Katherine Holzem (have to support my own mission)
• Kyle Holzem

I would also like to give special recognition to the week's top donors... Paul Hess, Joshua Glasser, and Jane Hagner!

Training progress update

I have not yet set or started a formal training program for the half marathon, because I will probably use a roughly 12-week program... meaning I need to start in sometime in September.  However, I have been continuing my normal day-to-day runs for general fitness, and this past week I logged a total of 36.5 miles, and although I have not been keeping detailed track, I would estimate my comfortable, average pace to be somewhere in the ballpark of 9 minutes per mile... not too shabby for me.  My running endurance, and the frequency with which I need to make stops, have improved with my current medication regimen, so I hope things continue to get better with regard to my Crohn's symptoms this fall.

Team Challenge Kick-off Party

This upcoming week, the St. Louis Team Challenge group will have it's Kick-off Party for the Las Vegas half marathon.  It will be held Wedneday, August 22 at 7:00 pm at the Forest Park Visitor's Center Learning Lab.  I mention this to let you know it's not too late to sign up to be a Team Challenge participant for Las Vegas.  Go here for more details.

Support my CCFA Team Challenge fundraising and advocacy and win!

I am offering some incentive to my supporters... check out my Team Challenge fundraising page for more details.

Thanks for visiting.

My Team Challenge fundraising page is live!

Please support Crohn's disease research and make a donation toward my Team Challenge fundraising goal by clicking here.

Thank you for your generous support!!

Crohn's 101

Before getting into the extensive scientific literature on Crohn's, I thought it would be appropriate to start off with a basic explanation of the disease.  Crohn's disease is one of the two most common forms of inflammatory bowel disease (IBD), with ulcerative colitis being the other, in which the patient's immune system inappropriately attacks the gastrointestinal (GI) tract.  Many symptoms and manifestations can result from this immune system-mediated destruction of the gut, including weight loss, nutrient malabsorption, and, the ever unpleasant, diarrhea. For many Crohn's patients, damage to the intestines can become so severe that a portion of the gut will have to be surgically removed... thankfully something that I have not had to experience yet.

The pathogenesis (i.e. cause) of Crohn's is not completely understood, although there are many prevailing theories.  First and foremost, Crohn's, like most chronic diseases, is extremely complex... there is no single cause that can be identified in most or probably all cases.  Genetic, environmental, immune system, and microbiological (bacterial) factors are all important to varying degrees.  In fact, the most widely accepted hypothesis of the disease incorporates all of these elements... i.e. Crohn's (and IBD in general) is essentially an abnormal overreaction of the immune system to gut bacteria in individuals predisposed to the disease for genetic and environmental reasons.  So, now that that's (hopefully) clear, I will discuss the scientific support for each of these contributing elements individually.

Genes & Crohn's

Some of the best evidence of a genetic component for the disease is the fact that it tends to run in families.  If one sibling has Crohn's, the chances of other siblings developing the disease are 30 times greater than for an unrelated person.  Several studies have also found particular genes to be mutated, or screwed up, in Crohn's disease (Balfour Sartor. 2006).  Interestingly, many of the identified genes seem to serve an important function for determining the GI and immune system responses to foreign material, such as bacteria or other pathogens.

Environmental factors

Although genetic background is important, it is clear that environment also plays a role.  While the disease does cluster in families, studies of identical twins (i.e. two individuals with the exact same set of genes) show about a 50:50 split.  In 50% of cases where one twin suffers from Crohn's, so will the other twin, but in the other half of cases, the other twin will live free of the disease (Balfour Sartor. 2006).  Also, favoring an environmental trigger is the fact that the prevalence of IBD increased in North America and Europe in the latter half of the 20th century, and IBD is becoming more common in other countries that are adopting a more Western lifestyle.

Immune system overactivity

Fundamentally, Crohn's is an autoimmune disorder, in which the immune system goes rogue and attacks the host (patient) as opposed to just fighting off foreign invaders like it should.  Thus, some degree of immune system malfunction is clearly part of the disease pathogenesis.  Broadly speaking, there are two main arms of the immune system... the innate immune system, which is important for quick and nonspecific responses to infection, and the acquired immune system, which fights the more specific infectious battles and is the reason why you can clear an infection more quickly the second time around versus the first time.  In Crohn's disease, both the innate and acquired immune systems are thought to be overactive.

The innate immune system.  Macrophages (a word that translates essentially to "large eaters" because these cells gobble up large particles that your body wants to get rid of) are cells of the innate immune system, which are found in abnormally high numbers in the intestines of Crohn's patients (Balfour Sartor. 2006).  Also, in response to activation of the innate immune system, many molecular signals get produced by the body, and these molecules, which are more specifically called cytokines, are elevated in active Crohn's disease.  These cytokines help serve to keep the immune system going, and, thus, newer medications for Crohn's disease are designed to inhibit these molecules... for example, the TNF inhibitors.

The acquired immune system.  As for the acquired immune system side of the matter, Crohn's disease certainly involves an excessive response of CD4 T cells, which are a kind of white blood cell that helps regulate immune responses.  Crohn's patients may have more of these cells in their guts, and blocking these T cells has been shown to prevent or reverse immune system-mediated damage (Kucharzik et al. 2006).

Gut bacterial (microbial) involvement

Some of the most convincing evidence that gut bacteria (neat factoid... there are more bacterial cells that live in your gut than there are cells in the rest of your body) are involved in the pathogenesis of Crohn's disease comes from animals free of gut bacteria.  Basically, if you prevent an animal from ever having GI bacteria, that animal will not get colitis (colitis = colonic inflammation), and many animal models of colitis will respond to antibiotics and probiotics (Balfour Sartor. 2006).  Unfortunately for Crohn's patients, response to antibiotics or probiotics has been more variable in humans.  Currently, it is thought that IBD may be caused by a bacterial imbalance in the gut... with "bad" bacteria outnumbering "good" bacteria... thus, several studies have been conducted to better understand which specific species of bacteria are more problematic for the development of GI inflammation.

Concluding thoughts

Many studies conducted to date have helped us better understand the causes and evolution of Crohn's disease, only some of which I have highlighted above, and these investigations have lead to the development of improved therapies for Crohn's patients.  Due to the exceeding complexity of human physiology, there is a lot more research that still needs to be done.  Hopefully, continued research progress will lead to better, more specific therapeutic options and ways to prevent... or potentially even cure... this disease.

Bibilography:

Balfour Sartor R. (2006) Mechanisms of Disease: pathogenesis of Crohn's disease and ulcerative colitis. Nature Clinical Practice Gastroenterology and Hepatology 3:390-407.

Kucharzik T et al. (2006) Recent Understanding of IBD Pathogenesis: Implications for Future Therapies. Inflammatory Bowel Diseases 12:1068-1083.

Despite the fact that wikipedia is not yet a widely accepted academic source, I have not met a medical student who didn't depend on it for their studying livelihood.  While the Crohn's-related entries on wikipedia will not go into as much depth as I intend to do, I strongly recommend reading the wikipedia page on Crohn's (http://en.wikipedia.org/wiki/Crohn%27s_disease) for a basic knowledge of the disease causes and symptoms.

Specifically, I run for Crohn's research.  I have signed up to participate in and raise money for the Crohn's and Colitis Foundation of America (CCFA) Team Challenge Las Vegas Rock 'n' Roll Half Marathon.  The race is December 2, 2012 and happens on the Las Vegas strip in the evening... couldn't think of a better place to stay entertained while hauling 13.1 miles.  I have the goal of raising $2,700 by November 14, 2012 to support research for better treatments for this disease.

So why do I run for Crohn's research?  I was diagnosed with Crohn's about 15 months ago, and the disease had probably been active, at a low level, for several years prior to my diagnosis.  Now, despite medical care and trials of several immunosuppressive drugs, my disease continues to worsen.  My doctor and I haven't found the right therapy (or cocktail of agents) yet to slow down or halt my disease.  More, and better, therapeutic options are needed for Crohn's and colitis sufferers out there like me.

In addition to my fundraising for the CCFA Team Challenge, I wanted to create this blog for a few reasons.  I want to use it to thank those individuals who support my effort and fundraising goals and provide updates on my fundraising and training progress.  Also, after grappling with figuring out what Crohn's will mean for my life, I have decided that I want to be a greater advocate for Crohn's and colitis research.  As a student pursuing both my medical degree and Ph.D. in biomedical engineering, I think my background gives me a valuable perspective on Crohn's-related research.  I hope to digest some of the advances in the basic and clinical sciences for Crohn's and colitis, and share them in a broken-down, readable fashion.

Thanks for reading, and I will post again as soon as my Team Challenge fundraising page goes live.