New Johns Hopkins Center Treats Those With Mysterious But Controlled Stomach Diseases
Meredith Berlin, 33, of Rockville, Md., was only 9 when she began experiencing recurrent bouts of excruciating stomach pains.
“The pain would be so uncomfortable that lying in bed was about all I could do when my symptoms were bad,” she says.
Meredith’s mother took her to the doctor. The diagnosis? Ulcerative colitis (UC).
Today, approximately 700,000 Americans suffer from the malady, a chronic autoimmune disease that causes inflammation of the colon and can occur at any age. Symptoms include rectal bleeding, abdominal pain, cramping and diarrhea. The causes of UC are still not fully understood, but contributing factors may include genetic and environmental factors, immune system problems, intestinal bacteria or perhaps food allergies.
But as Meredith discovered, there is a novel treatment for the debilitating disease and other diseases that mimic ulcerative colitis. One such option, using a drug called infliximab (Remicade), treats cases of ulcerative colitis and Crohn’s disease that have not responded well to traditional therapies, according to Mary L. Harris, M.D., associate professor of gastroenterology and director of the Johns Hopkins Infusion Center at Johns Hopkins at Green Spring Station in Lutherville, Md. The center operates as part of the Division of Gastroenterology at The Johns Hopkins Hospital.
“Anti-inflammatory medications are normally the first course of treatment for ulcerative colitis, but, unfortunately this has not been helpful for many. Other types of treatments that are used include steroids and immunomodulator agents,” Harris says. “But for patients who haven’t responded well to those therapies, treatment with infliximab can be helpful. This drug modulates a patient’s immune system, which may increase risk of certain infections, so safety is a concern. Patients really have to balance the risks and the benefits of this course of treatment.”
Most intravenous infusions are completed in approximately two hours, with an additional 30 minutes of observation prior to discharge. Side effects of the treatment can include chills, headache, nausea and difficulty breathing. For this reason, Harris adds, a Hopkins physician is always present during the infusion with ready access to emergency drugs.
“We’ve had some patients with cases of ulcerative colitis who have taken the drug and now say this is the best they’ve ever felt in their life,” says Harris.
Harris, who has treated Meredith for 18 months, says women should wait until their ulcerative colitis is in remission before becoming pregnant. “Having the disease in remission at the time of conception is key. If they have active disease when they become pregnant, there is a chance of the symptoms getting worse. Patients will be treated to control their symptoms as much as possible,” says Harris.
There have been reports of ulcerative colitis starting during pregnancy, but the disease does not become worse just because of when it occurred. “Women with ulcerative colitis have about the same chance as women without it of having a healthy child,” adds Harris.
Even if a previous pregnancy was complicated by ulcerative colitis, it doesn’t necessarily mean the next one will be. “If you do experience difficulties during one pregnancy, that doesn’t mean future pregnancies will be difficult,” states Harris.
Harris encourages women with ulcerative colitis who are pregnant or who plan to become pregnant to speak to their gastroenterologist or obstetrician. “The one thing to keep in mind is that every case is different, and every pregnancy is different, as well,” she says.
Today, Meredith, who is expecting her third child in early 2008, is leading a fully active life. With infliximab, her condition is in remission, and if there is a recurrence, it can often be more easily managed.
“In my view, it’s much better to have ulcerative colitis now than 20 years ago,” says Meredith. “I am shooting for the future and planning.”
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John M. Lazarou