Inflammatory bowel diseases (IBD)

Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract of which the cause is not fully clear. Researchers' current opinion is that the IBD is caused by a combination of hereditary and environmental factors. The two major types of IBD are Crohn's disease en ulcerative colitis. IBD patients may suffer from chronic abdominal pain, (bloody) diarrhoea, weight loss and sometimes anaemia. Patients are diagnosed with IBD at a relatively early age, which may cause educational delay and job absenteeism or incapacity for work at a later age. The number of new cases has risen in the Netherlands in the past few years, like in other European countries. Both Crohn's diseas and ulcerative colitis are characterized by active periods of inflammation (relapses) alternated with periods of remission. Therefore most IBD patients need to use maintenance drugs and will sometimes undergo surgery. Medical treatment consists of anti-inflammatory and immunosuppressive drugs. Apart from inflammation in the gastrointestinal tract, patients often have an extraintestinal manifestations of IBD such as: inflammation of the skin, eyes, joints and biliary tract. Crohn's disease may also co-occur with fistulas. Fistulas are abnormal communications of the intestines with for instance the skin next to the anus. The patients' quality of life could be much improved by better individual targeting of medical treatment. More insight in the aetiology of the disease, the effectiveness of drugs, and the cost-effectiveness of the treatment will improve the care for all IBD patients and restrict the economic loss (job absenteeism and cost of treatment) in the future.

Inflammatory bowel diseases outpatient clinic
A major spearhead for the IBD-group in Erasmus MC is excellent patient care for this often disabling, chronic disease. This is why a dedicated IBD outpatient (5 half-days a week) aimed at high-quality care is available, this includesa specialized preconception and pregnancy out-patient clinic for IBD patients. The IBD-unit is staffed by a team of two senior physicians of the department of Gastroenterology and Hepatology, two gastroenterologists in training (supervised by the senior physicians) and one IBD-nurse. As IBD patients regularly have to undergo examinations of the intestinal tract, these examinations are usually performed within the IBD-endoscopy program under supervision of the IBD-senior physicians.Apart from the care for adult patients, the IBD-group participates in the transition program for adolescents (14-18 years) suffering from IBD (de Luchtbrug - overhead bridge). In cooperation with the paediatric gastroenterology department the adolescents in this program are prepared for transfer to adult care.

IBD-patients information day
Every year the department organizes a public information day, in close partnership with the Dutch Crohn and Colitis Ulcerosa Association (CCUVN) and the hospitals in the region.
Ongoing scientific research Erasmus MC IBD-group:
Apart from industry-initiated, large-scale studies into the effectiveness of new drugs, self-initiated research is aimed at good stratification of patients into risk groups. This is aimed at better prediction of the disease course in an individual patient and establishing the effect of specific medication in this individual patient. The final goal is to enhance the patient's quality of life, which in general will be lower than normal, as best as possible. For an up to date overview of the different research possibilities please contact us. For a summary of current non-pharmaceutical research see below.

Drug research
ADAFI study: effect of combination of anti-TNF with ciproxin on the healing of fistulas in Crohn's disease: enrolment closed.Effect of the development of antibodies against infliximab and against adalimumab on the effectiveness of adalimumab.
Effect of anti-TNF/ MTX/azathioprine on the effectiveness of glucocorticoids.

Female and IBD: this study aims to assess possible differences between males and females with IBD with regard to quality of life, hereditariness and the influence of hormones on disease activity. This project also pays special attention to fertility and pregnancy issues.

The following studies are being conducted in the laboratory of the department of Gastroenterology and Hepatology
Carcinogenesis and IBD
- study into predictive methods in IBD-related CRC.
- study into the influence of bile acid salts on the development of CRC in IBD.

Molecular immunological mechanisms of IBD: including the role of apoptosis of the immune-competent cells in the IBD pathogenesis and its clinical application for diagnostic procedures and therapy.

Cooperation in the Netherlands
A unique initiative was launched in the Netherlands, in which gastroenterologists of the eight university centres with specific interest in IBD joined forces in the fields of research, education and patient information; it was named ‘Initiative on Crohn Colitis' (ICC). One of the results of this cooperation is the so-called Parelsnoer (Pearl chain) project. This project aims to build a Biobank infrastructure providing for the registration of data on the clinical course, as well as the storage and analysis of body material, in a standardized manner for eight patient groups in all centres.

Several ICC-initiated studies
• Crohn and Bone: effect of treatment with alendronate on the bone mass of patients with Crohn's disease.
• Anti-CD3 therapy: medication for the treatment of patients with severely active Crohn's disease.
• Azathioprine and its influence on pregnancy and child.
• Intestinal cancer in patients with inflammatory bowel disease.

Patient information
Close ties are maintained with the Crohn Colitis Ulcerosa Association (CCUVN) in the Netherlands. An information day for IBD-patients is organized yearly, in cooperation with the CCUVN.