The Inflammatory Bowel Disease (IBD) Center at Penn State Health Milton S. Hershey Medical Center is one of only a small handful of such centers in the U.S. providing nationally-recognized care to patients suffering from IBD and other related disorders, including Crohn’s disease and ulcerative colitis. Walter A. Koltun, M.D., FACS, FASCRS, chief, division of colon and rectal surgery, and director of the IBD Center, says, “This past spring, since the doors to the new IBD Center opened, physicians specializing in IBD treatment work collaboratively to bring the full spectrum of IBD care under one roof. This dramatically streamlines care for patients with IBD, so that all or most of their needs are coordinated and provided in a single setting.” Continue reading
Tag Archives: IBD
The majority of variants of uncertain significance (VUS) end up being normal polymorphisms that are not linked to increased cancer risk. Rarely, a VUS is later reclassified as a pathogenic variant that would then inform medical management recommendations. In these cases, patients with the reclassified VUS are contacted for follow-up consultation, sometimes years after the gene test was performed.
The presence of a newly identified pathogenic variant can also raise difficulties for advising patients. The result may be found in a gene for which we do not yet appreciate the full spectrum of cancers and the lifetime risks associated with these cancers, and screening recommendations are not necessarily developed. Continue reading
Structured Transition from Pediatric to Adult IBD Care Increases Patient Retention, May Improve Outcomes
For adolescent patients with inflammatory bowel disease (IBD) at Penn State Hershey Medical Center, a quarterly pediatric-to-adult care transition clinic has dramatically improved follow-up rates in the adult clinic, reducing no-shows to less than one percent.
“The structured transition program makes the process smoother and addresses the biggest problems that patients and parents encounter when the patient reaches 18 years-of-age,” says Emmanuelle Williams, M.D., assistant professor, Penn State Hershey Gastroenterology and Hepatology, and associate director, Penn State Hershey IBD Center. Together with Tolulope Falaiye, M.D., Penn State Hershey Pediatric Gastroenterology, Penn State Hershey Children’s Hospital, Williams has led the development of the successful program.
The process of transition begins around the age of 12. Transfer to adult care occurs at age 18. A specialized IBD nurse navigator is assigned to follow patients throughout the multi-year transition process. Older adolescents with IBD, under the care of pediatric gastroenterology, complete the Transition Readiness Assessment Questionnaire (TRAQ). At age 18, patients identified as ‘transition-ready’ are presented at a transition conference and have their first adult care visit held in the pediatric clinic location. Their former gastroenterologist performs introductions and is present the day of transfer. Continue reading
The pediatric gastroenterology program at Penn State Milton S. Hershey Medical Center, Penn State Hershey Children’s Hospital, will begin enrolling its first patients into the Improve Care Now (ICN) network in the first quarter of 2014, making it the only hospital in central and western Pennsylvania—and just the second in the state—to become part of this internationally recognized program. ICN is a network of more than fifty pediatric gastroenterology divisions throughout the United States, Canada, and Great Britain focused on the health of children with inflammatory bowel disease (IBD), which includes patients with Crohn’s disease and ulcerative colitis. The network will celebrate its tenth anniversary later this year.
“Improving the quality of care for pediatric patients suffering from IBD always has been our goal,” said Marc E. Schaefer, M.D., M.P.H., Penn State Hershey’s physician leader for the ICN program. “By joining forces with Improve Care Now, our physicians and nurse practitioners have access to medical data to help us treat these children even more effectively.”
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 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.”