BATTLING INFLAMMATORY BOWEL DISEASE
Condition might not be well known, but it affects 300,000 Canadians
As diseases go, inflammatory bowel disease does not have the impact or gravitas of cancer, say, or heart disease. But it affects 300,000 Canadians, some of them profoundly. “It can cause lifelong suffering — and it can be quite debilitating,” said Dr. Ernest Seidman, a Montreal gastroenterologist who has devoted his life to treating people with IBD and to IBD research.
For reasons that are not clear, Canada has the world’s highest incidence of Crohn’s disease, one of two major forms of IBD. “People like me are trying to figure it out,” he said.
Crohn’s is a disease of the developed world and it was thought to be genetic. “But we have people who moved their families here from various countries around the globe — countries where it is nearly non-existent. Something in the environment makes them prone to get Crohn’s.”
Seidman, 63, holds the Canada Research Chair in Immune-Mediated Gastrointestinal Disorders and the Bruce Kaufman Endowed Chair in IBD at McGill University, where he is professor of medicine and pediatrics. He treats pediatric patients at the Montreal Children’s Hospital of the McGill University Health Centre and adults at the Montreal General Hospital, where he is director of the new McGill IBD Centre of Excellence. The centre is the first stand-alone IBD clinic in North America. Building it was part of what attracted Seidman to McGill in 2004 from Hôpital Ste-Justine.
Crohn’s is usually diagnosed between the ages of 12 and 35 and affects people, to varying degrees, all their lives. Symptoms include abdominal pain and diarrhea, sometimes bloody, fever and weight loss. The course of the disease is unpredictable, so people can be well one day and sick the next.
Symptoms range from mild to severe; those who are severely affected can be too weak to go to school or work. “The cost to society of inflammatory bowel disease is extremely high,” Seidman said. Its incidence is increasing and, for reasons unknown, the age of onset is dropping.
Crohn’s can affect any part of the gastrointestinal tract; the other major form of IBD, ulcerative colitis, is restricted to the large bowel — the colon — and rectum. Both are autoimmune diseases, which means that the body’s own immune system attacks parts of the digestive system.
It is common for people with Crohn’s disease to need surgery to remove sections of their bowel that become obstructed — but the surgery is not a cure: The disease always returns. Ulcerative colitis can be cured by removing the large bowel — but then the patient is faced with the prospect of a colostomy bag or construction of an internal pouch to hold waste. As well, a long-standing inflammation of the large intestine is associated with an elevated risk of colon cancer.
The prevention of cancer is one of the subjects being studied in Seidman’s lab: His Canada Research Chair pays half his salary to protect his time devoted to teaching and research. Another is trying to determine whether someone in whom IBD is diagnosed will develop a mild or severe form of the disease. Also being studied is the role of Vitamin D in inflammatory bowel disease. “I think it is extremely important for people with IBD to take vitamin D — 2,000 units a day,” he said.
Because his practice is limited to IBD and he treats both children and adults, Seidman is able to offer continuity of care to patients and their families. He has known some of his patients for more than two decades and finds it gratifying to see them grow up and do well. “I see them succeeding in their schooling and starting their careers. They can have a normal life.”
With proper treatment, most people with IBD can go into remission. “I am really motivated for my patients’ benefit,” he said.
There’s another thing Seidman does: help to raise money. He’s part of a committee that organizes an annual fundraiser for the McGill Inflammatory Bowel Disease Research Group; among other things, the group raises funds to help pay a portion of the salaries of specialized nurses at the Montreal General and the Jewish General hospitals and a child psychologist at the Montreal Children’s. “My role is primarily to seek assistance from our pharmaceutical partners who want to give back,” he said.
He does it because it is necessary, but “all things being equal, we shouldn’t be in this position ... Patient care should not be funded by soft funds and corporate goodwill.”