Bench to Bedside:
Seeing Crohn’s clearly:
U-M research may help bowel disease sufferers avoid unnecessary surgery
Crohn’s disease is a form of inflammatory bowel disease so debilitating at times that patients may choose to drop out of college, hesitate to take risks, or decide to not have children simply because they don’t know when they’re going to get sick again.
The condition is often diagnosed in young people between the ages of 15 and 25 and brings pain, vomiting, nausea and other unpleasant symptoms caused by uncontrolled inflammation of the intestine.
Current therapy is effective at treating the inflammation, but over time damage to the intestine causes scarring, narrowing or even blockages. Patients may come back to the hospital multiple times in a given year and, until now, clinicians were unable to determine whether symptoms were caused by inflammation or by a blockage that requires surgery. Typically, a physician might prescribe steroids in hope that the problem is inflammatory; the same patient may be back in six months only to have surgery after all.
Peter Higgins, M.D., Ph.D., assistant professor in the Department of Internal Medicine explains, “There was no way for us to determine whether a patient was experiencing inflammation versus scarring. It would be great to figure out what is going on at the blockage so that patients can get the right course of treatment immediately.”
Higgins knew of research being conducted by Jonathan Rubin, M.D., Ph.D., professor in the Department of Radiology, which uses ultrasound technology to determine whether blood clots in the leg are hard (old) or soft (new). Higgins suspected ultrasound might also be able to tell whether a patient with Crohn’s disease has a hard, fibrotic intestine: an indication that surgery is probable. Alternatively, a patient with a soft intestine could be treated accordingly for inflammation and not undergo the pain and recovery of surgery.
Higgins began with a study on rats with intestinal fibrosis. When the ultrasound was pressed on the abdominal wall, a hard intestine resisted compression. A soft intestine did not. “In the instances of resisted compression, those rats had a lot of fibrosis and scarring,” he says.
With such positive results, Higgins studied seven patients with Crohn’s disease who underwent an ultrasound procedure. Again, a normal bowel compressed. An abnormal bowel was hard.
“Now we have a better picture of what’s happening,” Higgins says. “We can save patients the discomforts of unpleasant procedures in emergency situations and months of treatment and possible steroid side effects if surgery is a better option.”
Because ultrasound allows us to reproducibly find differences between scarred segments of the intestine and normal intestine, Higgins plans to do a large-scale study with patients who come to the hospital with intestinal problems and monitor their progress over the next year.
“If we’re able to use ultrasound to make better predictions on Crohn’s treatment, patients will ultimately benefit. We know the technology works; now we need to make sure it’s an accurate predictor,” Higgins says.
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