By David T. Rubin, MD, as told to Camille Noe Pagán
When I started medical school at the University of Chicago, my grandmother told me to go see Joseph Kirsner, a gastroenterologist there who had treated her for Crohn’s disease. If you can believe it, I didn’t even know what Crohn’s disease was at the time. But I still went to see Dr. Kirsner, who was a pioneer in the field. He was 80 then and still seeing patients. We hit it off, and every few months he’d call me to his office. Our talks piqued my interest in GI health, and I decided to become a gastroenterologist too.
Today, I work as a clinician (meaning I see patients) and a researcher. I also oversee the GI division of the University of Chicago, which has one of the largest inflammatory bowel disease (IBD) centers in the country, if not the world. My work is almost entirely focused on IBD, which includes Crohn’s disease and ulcerative colitis.
I absolutely love my job. Dr. Kirsner taught me that all research needs to come back to the patient. And I really see myself first and foremost as a physician who treats patients. That helps me make better decisions about the research projects I’m pursuing. For example, I recently conducted a study where people with Crohn’s wore Fitbits to track their sleep and physical activity to see if there was a connection between lifestyle habits like lack of sleep and Crohn’s flare-ups.
When I first started practicing, someone came up to me after a lecture and said, “You didn’t mention a cure.” At that point in my career, it hadn’t even occurred to me. Now it’s so obvious. We don’t have a cure yet, and there’s no telling how far it is. But it’s something we in the scientific community are actively talking about. I’d like to see it in my lifetime … but it isn’t clear if that’ll happen.
And while there isn’t a cure for Crohn’s yet, we’ve come a long way in how we assess and treat it. Treatment used to involve trying a new medicine or therapy and waiting to see if it made you feel better. Now experts know that isn’t the best approach. Yes, we want people with Crohn’s to feel good, but that improvement doesn’t mean the disease is turned off. It’s crucial to get inflammation under control, too, and to get the disease under control. Otherwise, Crohn’s disease can cause permanent damage. So now we measure inflammatory markers in blood and stool. When possible, we also perform colonoscopies [a scope test to examine the colon, a.k.a. the large intestine, and rectum] to see if the disease is really under control.
The good news is, there are many newer therapies for Crohn’s and they’re very safe and often very effective. For example, we have some new therapies that only work if you have inflammation; otherwise, they don’t affect your body. If you have Crohn’s disease, you shouldn’t be ”saving” the strongest therapies for later. Use them now to get your disease under control! This is such an exciting time in Crohn’s research. New treatments are being developed as we speak. Two years from now, there will be something even better available to you.
Some of the treatments just around the corner include a new class of oral therapies. These are medications made of small molecules so you can take them by mouth rather than getting an infusion. The future of Crohn’s treatment will also include at-home drug and disease monitoring. At-home stool tests, which are already available in Europe and Canada, will soon be available in the U.S. There’s also an at-home finger prick test in the works that will help you check your inflammation levels and how your medications are affecting your disease. That may make treatment more accessible and effective for more people. That’s important, because not everyone lives near or can get to a gastroenterologist or major medical center regularly.
Researchers are also looking into how to manipulate the microbiome -- that is, modify the balance of the intestines -- to treat IBD. Right now, scientists are looking at different bacteria that may be anti-inflammatory and would help ease Crohn’s-related inflammation. Another thing we’re working on is identifying biomarkers that show which patients benefit from particular treatments. That would save time and money and lead to better health outcomes. Researchers are even creating devices such as wearable biosensors to measure spit, saliva, perspiration, and other things to monitor inflammation and give clues on when someone with IBD is going to have symptoms.
With so many advances on the horizon, the future of Crohn’s disease is very bright. But for now, I can’t stress this enough: the vast majority of people with Crohn’s disease should be in remission and living unrestricted lives. It used to be that the disease was considered unpredictable and made it hard to do everyday activities, like work without running to the bathroom every hour. That’s not the case anymore. If you’re having symptoms, see a specialist so you can begin to look for a treatment plan that doesn’t just control your symptoms but gets your disease under control, too, so that you can live your life.
David T. Rubin, MD, the Joseph B. Kirsner Professor of Medicine; chief, Section of Gastroenterology, Hepatology, & Nutrition; and co-director, Digestive Diseases Center, University of Chicago Medicine.