New Ap­proach to Care for In­flam­ma­tory Bowel Disease Pa­tients

Wellness Update - - Esophageal Cancer -

Ap­prox­i­mately 1.4-mil­lion peo­ple in the United States are af­fected by in­flam­ma­tory bowel disease (IBD), a group of chronic dis­eases of the colon and small in­tes­tine gen­er­ally fall­ing into the cat­e­gories of ul­cer­a­tive coli­tis and Crohn's disease. The ill­nesses tend to be di­ag­nosed in child­hood or young adult­hood, and are char­ac­ter­ized by pe­ri­ods of re­mis­sion fol­lowed by flare-ups of symp­toms that can in­clude ab­dom­i­nal pain and cramp­ing, di­ar­rhea, rec­tal bleed­ing, vom­it­ing and weight loss.

"On the out­side, you wouldn't know that some­one has IBD," says Daniel Hommes, M.D., Ph.D., head of UCLA's Cen­ter for In­flam­ma­tory Bowel Dis­eases. "But on the in­side, it's very de­struc­tive. A sig­nif­i­cant num­ber of pa­tients re­quire fre­quent toi­let vis­its and have prob­lems with pain. Ca­reers and re­la­tion­ships can be af­fected. The drugs that are avail­able come with side ef­fects and are in­ef­fec­tive in about 20 per­cent of pa­tients, who end up need­ing ex­per­i­men­tal ther­apy or surgery."

Dr. Hommes be­lieves the tra­di­tional ap­proach to as­sist­ing pa­tients with IBD has left much to be de­sired, and so the Cen­ter is im­ple­ment­ing a new ap­proach to chronic-disease man­age­ment. Play­ing off the con­cepts of in­tel­li­gence quo­tient (IQ) and emo­tional in­tel­li­gence quo­tient (EQ), the cen­ter is track­ing each pa­tient's value quo­tient (VQ), a mea­sure that in­cor­po­rates the an­nual bur­den of the pa­tient's disease (in­clud­ing fac­tors such as disease ac­tiv­ity, com­pli­ca­tions, med­i­ca­tion side ef­fects and hos­pi­tal­iza­tions); qual­ity of life; and work pro­duc­tiv­ity. Each year, an in­di­vid­ual pa­tient's VQ will be an­a­lyzed by the cen­ter's pro­fes­sional staff to de­ter­mine fac­tors that in­flu­ence the score and to de­vise a plan for the year ahead. "It is our mis­sion to an­nu­ally im­prove each in­di­vid­ual VQ," Dr. Hommes says. The cen­ter's ap­proach to con­trol­ling pa­tients' disease is two-pronged. The first in­volves the devel­op­ment of new treat­ments. Pa­tients who don't im­prove with stan­dard med­i­ca­tions can par­tic­i­pate in state-of-the-art IBD re­search through a clin­i­cal-tri­als pro­gram and a stem-cell-treat­ment pro­gram. Dr. Hommes has been a leader in both au­tol­o­gous hematopoi­etic stem-cell trans­plan­ta­tion (us­ing pa­tients' own stem cells, drawn from blood) and mes­enchy­mal-stem-cell ther­apy - us­ing cells with the ca­pa­bil­ity of dif­fer­en­ti­at­ing into a va­ri­ety of cell types as a strat­egy for con­trol­ling in­flam­ma­tion.

The other part of the ap­proach cen­ters around the ac­tive role pa­tients play in their care. An on­line-ed­u­ca­tion pro­gram em­pow­ers pa­tients by teach­ing them about the disease, treat­ments, home care and their in­di­vid­ual case. The cen­ter is also de­vel­op­ing home­care de­vices, in­clud­ing biochips for clin­i­cal test­ing. To en­sure close mon­i­tor­ing of their disease, pa­tients are in­vited to pe­ri­od­i­cally trans­mit re­sults of self-ad­min­is­tered tests as well as in­for­ma­tion on their symp­toms, qual­ity of life, and work pro­duc­tiv­ity.

Dr. Hommes be­lieves the cen­ter's ap­proach can serve as a model for other chronic dis­eases.David Zir­ing, M.D., di­rec­tor of the UCLA Pe­di­atric IBD Cen­ter - part of the Cen­ter for In­flam­ma­tory Bowel Dis­eases - says the value-based ap­proach is also ben­e­fi­cial for chil­dren with IBD. "They will en­joy a seam­less tran­si­tion from ado­les­cent to adult care, will be able to par­tic­i­pate in ground­break­ing clin­i­cal tri­als of new drugs, and for those in whom con­ven­tional ther­a­pies have failed, will be given the op­por­tu­nity to par­tic­i­pate in new stem-cell-ther­apy reg­i­mens," Dr. Zir­ing says. "Like Dr. Hommes, I strive to pro­vide holis­tic care to my pa­tients and their fam­i­lies, in­clud­ing not only main­tain­ing disease re­mis­sion, but also op­ti­miz­ing qual­ity of life and school per­for­mance."

For more in­for­ma­tion go to: www.gas­tro.ucla.edu/ibd -This in­for­ma­tion pro­vided courtesy of UCLA Health Sys­tems

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