2. Sponsors

3. Crohn’s & Colitis Foundation of America Our Mission: To cure Crohn’s disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases

4. CCFA Programs and Services Information Resource Center (IRC) –Accessible via 888.694.8872 and www.ccfa.org Community website: www.ccfacommunity.org Teen website: www.ucandcrohns.org Education –Chapter programs –Teleconferences

5. CCFA Programs and Services Support groups Online resources Camp Oasis –Children with inflammatory bowel diseases (IBD) enjoy a safe and supportive camp community

6. “Take Steps” –Held locally –Join the walk for a cure Fund research Raise awareness Be heard Change lives –www.cctakesteps.org CCFA Signature Events

7. “Team Challenge” –Endurance training program to run or walk a half marathon at an exciting destination –Help the Foundation raise crucial funds to find a cure –16 weeks of professional training as part of a team –“Challenge yourself to change a life!” –www.ccteamchallenge.org CCFA Signature Events

8. IBD Research: CCFA’s Commitment Invested approximately $150 million in research and funded more than 1,100 grants New initiative: Challenges in IBD Research –Strategic research plan –Understand causes and disease processes of IBD –Identify faster, more effective methods of diagnosis and treatment –Sponsors scientific workshops and training programs to provide guidance on how to perform good clinical studies

9. Understanding Inflammatory Bowel Diseases (IBD): What Every Patient Needs to Know

10. Today’s Objectives Define IBD, its potential causes and diagnosis Discuss management and treatment Highlight special populations Review latest research Answer questions

11. What Is IBD? Comprises Crohn’s disease (CD) and ulcerative colitis (UC) –Overlapping symptoms and complications Crohn’s disease can affect any area of the gastrointestinal (GI) tract, including the small intestine and colon UC affects only the colon An estimated 1.4 million Americans live with IBD 30,000 new cases diagnosed each year

12. What Are the Potential Causes of IBD? Genetic Predisposition 20%–25% of patients have a close relative with IBD Immune System Abnormalities An inappropriate reaction by the body’s immune system Environmental Factors Infections, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diet, smoking

13. Indeterminate colitis 10%–15% The Spectrum of IBD CROHN’S DISEASE –Patchy inflammation –Mouth to anus involvement –Full-thickness inflammation –Variable involvement –Fistulas –Abscesses –Strictures –Extraintestinal manifestations –Increased risk of cancer ULCERATIVE COLITIS –Continuous inflammation –Colon only –Superficial inflammation –Variable involvement –Increased risk of cancer –Extraintestinal manifestations

14. Understanding Complications of Crohn’s Disease Intestinal obstruction Abscess Fistula Stricture Colorectal cancer Obstruction Fistula

15. Understanding Complications of Ulcerative Colitis Anemia from blood loss Perforation (rupture) of the bowel Colorectal cancer Toxic megacolon Perforation

16. Recognizing Symptoms of IBD Flares Diarrhea –Often increased from usual course of disease –Rectal bleeding Abdominal pain or cramping Low-grade fever Fatigue Extraintestinal manifestations –Joint pain/swelling –Eye inflammation –Skin lesions –Mouth ulcers

17. Diagnosis

18. Diagnosing IBD

19. Normal colon on colonoscopyUC on colonoscopyCD on colonoscopy

20. Management & Treatment of IBD

21. Comprehensive IBD Management Control symptoms Treat inflammation Treat complications Provide emotional support Prevent cancer Improve quality of life Replenish nutritional deficits Minimize treatment toxicity Maintain remission IBD Management Goals

22. Understanding Treatment Options Prescription medications Over-the-counter agents Complementary and alternative therapies Surgery

23. Prescription Medications ClassAgents 5-ASA Agents Balsalazide (Colazal ® ) Mesalamine formulations – Delayed release tablets (Lialda ®, Asacol ®, Asacol HD ® ) – Controlled release tablets (Pentasa ® ) – Extended release capsules (Apriso™) – Rectal suspension (Rowasa ® ) – Rectal suppository (Canasa ® ) Olsalazine (Dipentum ® ); Sulfasalazine (Azulfidine ® ) Corticosteroids Adrenocorticotropic hormone Budesonide (Entocort ® ) Hydrocortisone (Cortenema ®, Cortifoam ® ) Methylprednisolone (Medrol ® ) Prednisone Antibiotics Ciprofloxacin (Cipro ® ) Metronidazole (Flagyl ® ) Rifaximin (Xifaxin ® )

24. Prescription Medications ClassAgents Immunologic Agents Azathioprine (Imuran ®, Azasan ® ) Cyclosporine (Neoral ® ) 6-Mercaptopurine (Purinethol ® ) Methotrexate Tacrolimus (Prograf ® ) Biologic Agents Adalimumab (Humira ® ) Certolizumab pegol (Cimzia ® ) Infliximab (Remicade ® ) Natalizumab (Tysabri ® )

25. Over-the-Counter (OTC) Agents Address only specific symptoms –Antidiarrheal agents –Laxatives –Pain relievers Important to discuss with physician before taking any OTC medications

26. Complementary & Alternative Therapies: Probiotics “Good” bacteria that restore balance to the enteric microbiota-bacteria in the intestines May be helpful in aiding recovery of the intestine and maintaining remission Important to discuss with physician before initiating treatment

27. Complementary & Alternative Therapies: Supplements Fish oil supplements containing omega-3 fatty acids –May reduce pain and inflammation when added to standard therapy –Clinical trial results are inconsistent –No clear recommendation Natural aloe supplement –Works within intestines to break down impacted food to cleanse the bowel –Many formulations can actually be harmful to the bowel Alternative therapies should not replace prescription medications

28. Surgery in IBD Crohn’s Disease –Strictureplasty –Resection of small intestinal segment –Colectomy (partial or complete) –Proctocolectomy Unlike UC, CD cannot be cured with surgery Ulcerative Colitis –Proctocolectomy (removal of the colon and rectum) With ileostomy Restorative (ileoanal or J pouch) Disease is “cured” once the colon is removed

29. Understanding the Importance of Diet & Nutrition in Managing IBD Causes of nutritional deficits –Decreased intake (no desire to eat) –Active disease Protein and fluid loss –Decreased absorption of nutrients (when small intestine is affected by CD) Fat Vitamins Small intestine

30. Understanding the Importance of Diet & Nutrition in Managing IBD Create a food journal –Eliminate problematic foods Strive for a well-balanced, healthy diet based on –Hydration –Electrolyte balance –Continual adequate nutrient intake

31. IBD in Special Populations

32. Understanding IBD in Children & Adolescents Special considerations –Ability to swallow capsules or tablets –Side effects of drug therapy Risks of long-term corticosteroid use Emotional/social concerns –Adherence –Growth failure and need for nutritional supplementation –Emotional well-being

33. Understanding IBD in Pregnant Women Special considerations –IBD should be controlled before considering pregnancy –Remain on most prescribed medications –Well-balanced diet with vitamins, including folic acid –Ongoing communication between obstetrician and gastroenterologist

34. IBD Research

35. Genetics –Several genes linked to both CD and UC –Large genome-wide studies continue Biologic markers –Measurable substances that may help characterize disease Clinical trials –Better understand disease –Develop novel therapies

36. IBD Research: Agents on the Horizon Antibiotics –Rifaximin (Xifaxan ® ) Steroids with new delivery systems, such as COLAL-PRED ® Hormone –Teduglutide Mesenchymal stem therapy

37. Living Well With IBD Be compliant with medications Understand your disease and possible complications Schedule follow-up appointments Maintain a well-balanced diet Establish a support system Empower yourself with information Follow “Helpful Tips” handout

38. Questions & Answers