Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) is associated with an increased risk of thromboembolism. Andrew Tinsley M.D., M.S., associate director of clinical research and quality at Penn State Hershey Medical Center’s Inflammatory Bowel Disease Center explains, “While thromboembolic events are rare, they can be potentially life-threatening. Until one of your patients experiences one of these disease-related complications, or perhaps even dies from one, it’s difficult to appreciate how important of an issue this is.” The risk of thrombosis in the hospital can be significantly reduced with the use of daily medications such as heparin.
As a member of the Crohn’s and Colitis Foundation of America’s Quality of Care Committee, Tinsley is one of the first physicians to conduct research to explore the current state of thromboembolism prevention in hospitalized inflammatory bowel disease (IBD) patients. An initial nationwide survey of gastroenterologists was published by Tinsley and colleagues, and suggested that many providers were not routinely giving heparin for thromboembolism prophylaxis. Following on from this study, Tinsley recently looked at the actual rates of heparin use for preventing thrombosis in patients admitted with ulcerative colitis (UC). His findings, which recently appeared in the Journal of Crohn’s and Colitis, revealed that only around 50 percent of inpatients with active UC received prophylactic anti-thrombotic medication. Furthermore, when the medications were ordered, medical patients failed to receive one-third of their doses. Continue reading
Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are chronic conditions that typically emerge early in life and exact a heavy and costly burden of disability and illness over time. In 1998, physicians and researchers at Penn State Milton S. Hershey Medical Center and Penn State College of Medicine made a long-term commitment to investigating the causes of IBD as a means toward identifying novel therapeutic targets and improving patient care. This has involved establishing and growing the area’s first IBD-dedicated BioBank. Today, the IBD BioBank consists of three inter-related components: an IBD patient registry that characterizes the clinical factors that define subcategories of IBD; a DNA bank derived from patient leukocytes immortalized by viral transformation; and an IBD tissue library, harvested at the time of surgery.
Walter Koltun, M.D.
Walter A. Koltun, M.D., explains, “Because about 25 percent of patients with IBD have a family history of the disease, a crucial starting point for the IBD BioBank was to establish a patient registry to gather medical and demographic data not only from IBD patients but also their family members. Since beginning this work in 1998, we now have nearly 1,400 patients, some with three generations of family members entered into the registry. This is a powerful tool for investigating not only the genetic basis of the disease but also environmental, microbiological and epigenetic IBD risk factors.”
For patients with inflammatory bowel disease (IBD), surgery is often necessary to manage symptoms and address disease-related complications. Such surgery is particularly common for patients with stricturing or fistulizing Crohn’s disease, patients with ulcerative colitis whose disease is not adequately managed with medication, and those with precancerous lesions. Surgical interventions vary according to the disease. Because Crohn’s disease can involve any segment of the gastrointestinal tract, surgical intervention is unlikely to be curative and is reserved to treat the complications of the disease such as obstruction or fistuli. As Walter Koltun, M.D., explains, “Excessive or repeated resection can potentially leave a Crohn’s patient with crippling short bowel syndrome and so alternate surgical therapies are performed such as stricturplasty, which overcomes the obstruction but minimizes resection.”