Leading Edge Developments in the Diagnosis of IBD

" Hello I'm between -- to welcome the webcast leading edge developments in the diagnosis and treatment of inflammatory bowel disease. This program's being sponsored by the crohn's and Hawaii is foundation of America. Will be divided webcam into two parts and will begin with a look at what's new in the diagnosis. Of crohn's disease and ulcer to collect. Joining me are me leading -- especially. Doctor Edward reluctance on the Mayo clinic in Rochester Minnesota. Doctor Scott plugging it from the University of Pittsburgh school of medicine and doctor -- Bangkok. Is that pediatric specialist at the mount Sinai school of medicine here in New York. There's a great deal of research taking place on the genetics at ITT. Rejected begin this webcast with a look at some of the important science has been carried out with partial funding by EC. Our door start with a family that clearly carries a genetic predisposition. To twenty."

" Every week Lisa -- it makes a long trip to the University of Chicago hospital. For an infusion of the medicine Rick --"

" I have crohn's disease and I -- father Basil Collette as my mom was pregnant with these I had a brother who had -- that he's. What about email from my mom's side of the family at one point or another had and and at inflammatory I'll deserter."

" What we currently understand that the strongest risk factor for an individual retirement aren't out of games. Is either to be child who are inflammatory bowel disease. And then secondly -- sibling somebody as a result. His father Robert Jacobs -- his first -- both -- root of -- a young man. -- We it was just -- it was an inch and seven -- You know her -- her about a year dobbs and went symptoms three year 2000. Wouldn't collide later again and it was a -- it was better not that. I had to have surgery. They got sick in January 2000. In the degree where was unable to work -- great -- The latest known as -- inflammatory bowel. And came as one of those surprise and life in print -- should not have been."

" I actually was diagnosed with crohn's disease just recently. And I can. For many years. Some sort of problems stomach pain diarrhea and not an ulcer."

" Marilu Jacob like Bob now too is doing well. In her -- medication is keeping her under control. The real -- tragedy Stanley was what happened to the Jacobson's son Brian. The story starts with a doctor with a Jacobs said he was quick to to miss a diagnosis of crohn's disease."

" eighteen. Anemic and and and diarrhea for quite awhile and the pediatrician kept saying. It was his first year college she's not adjusting. They can -- it got around person the person that was do you think yes I'm -- I don't know I absolutely not."

" Over the next year's Bryant and -- got worse in the summer of 1992. When Brian what you -- underwent surgery. Things do warm downhill. On -- post up he was taking. Mir and doses of immune suppressant drugs. And they compromised immune from. Aren't you literally in my heart surgery. At the -- of the idea of -- and that a certain current. Can alter a record number. Families like to Jacobs provided. A genetically. IBT from the time crone was first against. When -- called crohn's disease her crimes by pearl -- and Oppenheimer and others in 1932. They were already seen that some family had more than one person in the family a similar set of symptoms and problems. Evidence for a genetic link -- comes also from two other observations. Prevalence varies according to ethnic background. And risk increases when an identical twin to the Junichiro. Reese -- at the University of Chicago led a team that made a mile -- in the hunt for a genetic link to IBT. In the summer of two out and the team found that many patients with crown. Mutations in the gene called nod to."

" And would get one copy of those. Building it was -- mutations that increase your risk of developing. About two -- over the general population. If you Kerry to copy not contained in your chance to -- constantly think it's twenty to forty --"

" In the Jacob's family the first diagnosed and -- be the among the two children came and -- was ten."

" They never let anything stand -- her way what you want to do something and I inning with number one thing."

" I was very effect acting as an anonymous how well a few times that spring. And I had my solo effort -- an eye out and penitent and however a number that I had a lot of Christine doesn't have any -- the right take my fellow I was skiing and I can't deny it but I'll. And you know at that time everybody in the world that I email account -- and they cannot finish that and we hadn't -- next and if I wasn't. But because I love that probably would have been able to concentrate -- for awhile world."

" Together with ticket to get through that as seen at Hollywood -- for the next."

" Judy chose research helps explain just what may go wrong in the intestines had crohn's patients like Lisa."

" What unique about the intestinal. Over any other organs or tissues in the body is that it's disposed of very high. Bacteria remain within the -- So that constant interplay out of balance. Right amount of information. He spoke these icons are accurate how to limit that information. Is what he thinks he'd understanding -- seasonal like."

" not approach -- and help individual likely we're on the environment and turned on pulled inflammatory reaction. And then it has turned off and a number of all the way in people with abnormal not -- pro team and they can't implement and that may be turned on when it shouldn't speak or one. Turned on it doesn't know how to turn off."

" The genetics of -- Is very much on a -- it's a mind. She got married in the fall 2000. And she and her husband are planning a --"

" I'd always known and had a feeling found that as a little girl or diagnose the cronies that. It would be a strong possibility that one or more of my older than it had the current especially after they had other developing it as well."

" What about lead being tested forty abnormal not to have her purse and like Lisa. What about her child her because caring and not mutation just not sure that you're going to get and that conversely not every patient has not you we don't think that the -- and an individual -- cabinet had not. Is going to be useful in predicting he -- Doctors say there may be some value however interesting or not inpatient likely are already done right. The testing may help determine what's subtype that -- agent -- And treatment decisions might be adjusted accordingly. They were not through abnormalities are more likely through. Have to -- and science labs are bought and -- I'm not only him. And the big theater that he and being more structuring our current -- to. Better than inflammatory. -- And it did and they were not terminal are more likely have a younger age of onset of the there's also the possibility that knowledge about genetic factors BT may lead to prevent or cure. But those goals remain -- and depend on great deal more."

" We don't really understand at this point in time what it would prevent -- because he snake tail. But it's a genetic -- agent accused of additional scenes with identifying. Sensitive individuals hybrid. We can then start thinking about potential which is really what Stanley some patient care about it. And so it -- unidentified disease it's early stages you start identifying the earliest -- don't want to cause he. Then we can start thinking about the big work like prevention work."

" Robert Jacobs and we suggest at least some genetic component crohn's disease. And should be chosen work shows that one -- may play a role. Doctor -- let's begin our discussion with -- what about all -- took collider has anyone seen been identified with jeans."

" Per day like not you have not yet been identified and that collided however we clearly you know and that he's like the ones that doctor -- reporting that led to the identification or not they'll. That there is a genetic they could collide as well right now genetically or how to on the Al. And any other genes that are going predispose inflammatory about the I think what interest thing. Is that some of these genes seem to be linked with brown he's. Sounds seem to dealing with a critical eye and some impact may -- in common between both disorders. Suggesting a common genetic link that may -- including. Of the battle so I think over the next few years we're going to be hearing about many different genes. In both that predispose a developing a crown and the for the -- To the ankle let me ask you to elaborate. On what the use of tossed into the not to gene might -- Regina has been one of the most exciting development and they're very recent development only going back for described in the U2 and one. And I think we don't know all -- four nations. To date what we've really looked at the possibly a tactic that different kinds of crimes it's important to remember the crime he. Michael Klein is spectrum and that they are different that stations and the severity and more on the early and have been found is that -- be not to gene associated with -- the terminal and the other thing that's been around it means that you're not teaching and so it with and developed narrowing of intent and strictures and these can be and what period complicate and it is initial. In -- and that not to associate that with narrow restrictions. Hold true that might be a way of trying to prevent them in the future."

" So really it would be more useful in the treatment of crohn's disease -- the diagnosis -- so far we've only looked at the."

" Sorry diagnosed with -- no one has looked at the pro active in the -- there are other tech ticket on the -- and that passion. So there might be implications and missiles on -- remember that this is probably only one of many genes that could could control crown he. Its own seasonal idea where a single -- on to -- a probable that -- probably would have -- hundred years -- when you are pediatric -- so what what are the implications -- does not -- for a four children who like -- to -- we're very excited about that because and pediatric and we -- family and it's a very typical scenario or any parent to come to a with a child. And parent has on these are also quite worried that the child with with gas and can. And very often. We have Donald and children that means one out of every six -- have abdominal pain and and nothing behind it. So we would very much appreciate it we had a test that could be screened or at least it too late apparent fears that -- test it would have to be done now this has not been done yet. But something went looking for okay thank you doctor then call to plug -- let me ask you."

" Wind -- this has been commercially available and onto -- Well word has it that -- will probably see."

" Not to available -- commercial source within the next year. It would be very soon it will be very and on the market."

" Thank you doctor Levy prior to the webcast we've been soliciting email questions to our website. One question comes from Pristina in Virginia. But Taylor -- suckers for -- stomach -- and -- he -- may be crohn's disease but her doctors hadn't been able to find anything wrong. Doctor -- this crap is a good way to starter discussion about how doctors and they diagnosed -- dealing with two rounds of the ways that I'd be doing is like."

" IBB is not always a straightforward -- now expect most studies suggest that as a percentage of patients. Might have sent him for months or even years prior to diagnose. The foundation of any good diagnosed -- remains a good history and physical examination by the position following bet. -- will lead to certain blood that's. For example a complete blood count on a -- blood count you'll be looking at hemoglobin looking signs of Anemia you might also look at the white blood cell count the white blood cell count elevated -- could be an indication of inflammation in the body. Other terror that are important are sediment retention rate Percy reactive protein these are also indicator of implement it also -- that's right. Sometimes. Certain. In sections within the colon or small battle might mimic. The symptoms of inflammatory -- seems so indication -- symptoms or a flare. Of symptoms and a patient with existing employment rebel disease. -- order stool test to exclude certain infections like Salmonella. Or -- load factor or extradite him to."

" So it's important to rule that out absolutely -- Doctor Lofton has given a very good overview of how I BD is diagnosed today. While sitting in recent research led to any new diagnostic tools. As stock."

" Let me well there's. -- a blood -- they're now commercially available that because there's been a very exciting read or that. I didn't name in some way shape -- help with a diet and ironically the Al east. These there what we were hurt to -- a logic. And what your logic that's and that's again the simple blood and the tests that are performed give us an indirect way of measuring in the blood. Meet immune activation may be going on dean and I'd be -- antibody tests on rant about these part of your own body's immune response. What's interesting about the -- and we can detect in the blood. Immune response is so added there have been activation occurring bacteria that normally live in all of aren't. And in people who don't have an article about the things we did not -- being asked about the because the immune system in the -- is not acted in responding to the bacteria in inflammatory bowel disease we see evidence -- immune activation. TV bacteria that normally should just be airing. Be happy -- and not causing planetary changes. These tests. Are known -- anti neutral hillside last week and about what we call and there's another one anti Accra my certainly here in the body which we call Scott. And here's another one called anti aren't yet again I think the important thing about the is we can -- and a black and they give us evidence of immune activate and specifically in patients with inflammatory about."

" Figures specifically looking for those three antibodies that you mentioned correct and can't -- how how valuable are the heroes diagnose it ask you mr. Clinton."

" There and doing. But they're not always as valuable and is willing we need them to -- Are there very good. Tour of screening population. But if you're talking to an individual patient taking a good history and doing a good physical and like that a -- Indicated. This has become a super a couple of times. Are there are cases have been hunkered down as he where you can differentiate between Clinton and -- And keeping our 10% of all cases for that category and -- And we sometimes look to those trying to determine the fact is that he blood tests are only useful and after 2% of those case."

" So they're useful tool but not an old case is that you have to be very careful about the use that the fearsome. Well what about. Imaging technology -- used in the -- our -- well ultimately when we make a diagnosis of inflammatory bowel disease where interest it isn't what are you in cash into the music back how severe is it that helps us make our decisions on how to better manager patient. So there are a couple of 110 that we can -- and many many years now. On the first group is what we would -- be at great and and and I patients may be familiar with what we call small bowel series. And the attack aware that they will go into may have radiologists office. I'm and they would drink any. About the court of any white chalky substance called Barry. Actor can assuming that Marion I didn't out of the radiologist will. -- put them underneath X ray machine and as the battery goes through the not ballot will take repeated series of pictures. And we can use this to visualize the part of the Molly and that expected with crohn's disease. On the other -- that patience. Are all familiar with usually. -- help diagnose. Both these and alternate -- Kaleidoscope is essentially a camera where were able to actually. Take a look at -- large intestine and sometimes you know did our own and then I take pictures and importantly take buyout of areas that look like they're expected with inflammatory bowel disease. And has that and we'll tell you before you go in for a colonoscopy. Which has done with and nations that would that we make -- comfortable as possible for our patients. They need to take a preparation and the day before usually the queen being -- out so we can do our job in seeing how what we're looking at make diagnose as best we can."

" Okay we're talking about imaging technology so doctor Loftus is there anything new in engine technology you can. For the first one is potentially a modification of minority existing technology this called AT and choreography in a modification of a cat scans many patients already have had the experience of going -- You lay on a flat table and go through an imaging machine that looks like a big -- harbor tunnel. And the difference from the patient's point of view is that instead of drinking a contrast dye which many patients can't drink because the taste. They drink lots and lots of water instead and the idea to stand up to -- as much as possible. So that when radiologists take images and these images are cross sections are like that really abdomen and the radiologist can focus. On the thickness of the bowel wall of the bickered about water the more signs of inflammation. In a -- and a better they're the radiologist has given intravenous contrast aren't the same time. And the radio it's looking for -- early enhancement contract and -- and I'll walk so the radiologist -- Now Walt thickening or contrast enhancement. That's an indication of how wallet on me."

" OK well doctor Plavix are there any other new developments in imaging technology. Well there is a task it is wide clinical use and and this is so what we -- nuclear -- And what he's doing is are we actually take white blood cells which are sending -- inflammatory cells from a patient and we get -- We we treat -- literally innocuous low level amount of radiation and then we actually get itself back in the pension. And -- white blood cells will do what white blood cells to do and find areas in the body where inflammation occurs. In the setting of inflammatory bowel disease that the test that and then by taking X ray pictures. We can see where these radioactive labeled white cells light -- may give us some information and about where there's inclination. And -- although this past isn't widely clinically used people are evaluating where it -- and the diagnosed and."

" About it okay. Well doctor -- as we've been speaking about the leading edge developments and imaging technology and I know you've got something pretty state of the art to show us. Along those lines but it got. Well this is called a wireless video. That compete. -- it is the words it's a little it's like it gets the camera tell people like to call and in this. The clear and here contain small video. Which takes images about our second. So what this and tell you the patient goes into the and I asked to be patient. Wears this sort of respect -- any -- And then swallow the camera -- And this will transmit images of the fact -- any act as a tumbles down through the -- to take pictures for about eight hours. The patient can go about their usual daily activities they don't have to wait in there and -- be -- the hospital but can go about. They come back after eight hours and they give that Fannie peck peck and then those images are transmitted or downloaded to a computer. For the position -- to visualize them. And then this capsule will be -- greeted. Either later that -- or perhaps a couple of days later this fantastical click something from the movie. What's right it's almost like that's fantastic. Boy had the advantage of it is that it. Awhile access to the inner lining of the -- in areas where we've never been able to reach at least and a and a predictable way. If you think about it -- only look at the upper part of the monitor and colonoscopy only looks at the very very bottom of smart and and allows a image. The rest of -- and perhaps. Will be able to diagnose milder approach to news that don't show up on some of the conventional. -- the advantage of this it really gives you that middle portion. Exactly I'm going to ask that question how the people react with the idea of swallowing the little camera camps. I'm surprisingly well its its larger than your average still but most people can slow it down with a little bit of liquid and there are some theoretical concerns that perhaps an official with crohn's disease. If there's narrowing of the -- that we know about we might not be so excited about doing the test because that put her in the capsule might get stuck. But and that's. It would be early studies suggest that that's not a significant problem. Do you see this system being used more widely in the future a future of diagnosis all I think so I think various modifications will come down on the -- but I I think this is going to be. This is going to play more and more important role in -- of a variety of the United he's not just -- thank you doctor."

" this doctor Levy inducted Bangkok we appreciate information you've been hearing with the well that wraps up the first segment and I looked at leading edge development in the diagnosis and treatment by the date. In part two we'll look at head at promising research in medical therapy for IBT and we'll discuss the latest techniques and surgery. Thanks for joining us I'm -- incorrect."

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