Optimal Management of Biologics in Crohn’s Disease - Episode 1

Overview of Crohn’s Disease

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Bincy P. Abraham, MD, MS, AGAF, FACG, and Jennifer Seminerio, MD, provide insight on the pathophysiology of Crohn’s Disease (CD), associated risk factors, and diagnosis of disease.

David P. Hudesman, MD: Hello and welcome to this HCP live® peer exchange titled 'Optimal Management of Biologics in Crohn's Disease'. I am Dr David Hudesman, the Co-Director of the Inflammatory Bowel Disease Center at the NYU Langone Health, in New York City, New York. Joining me today in this discussion, are my esteemed colleagues.

Miguel Regueiro, MD, AGAF, FACG, FACP: I'm Dr Miguel Regueiro. I'm Professor and Chair of Digestive Disease and Surgery Institute at Cleveland Clinic, in Cleveland, Ohio.

Jennifer Seminerio, MD: And I'm Dr Jennifer Seminerio. I'm an Assistant Professor of Medicine and the Director of Inflammatory Bowel Disease at USF Health in Tampa, Florida.

David P. Hudesman, MD: Our discussion today focuses on the optimal management of Crohn's Disease, with a focus on current treatment landscape and the role of biologics therapy. Welcome everyone and let's get started. Dr Abraham, why don't we first just discuss briefly about pathophysiology of Crohn's disease and how you would explain that to your patient?

Bincy P. Abraham, MD, MS, AGAF, FACG: Pathophysiology of Crohn's disease can vary based on the individual that gets diagnosed. For example, someone who has a significant family history, there may be a significant genetic component to their pathophysiology of developing Crohn's. On the other hand, a lot of the patients that we're seeing currently did not have any family history, I'd like to call it 'de novo Crohn's disease' essentially. It could be related to environmental factors. For example, infections that they have and that causes a chronic immune activation of their GI tract that causes that chronic inflammation in Chron's disease. It can vary depending on the patient, their prior risk factors. The other component of it is diet. We think it may play a huge role. Because what we eat affects our microbiome and we know that the microbiome affects the immune cells and its interaction in the GI tract. It can also lead to chronic inflammation.

David P. Hudesman, MD: Right. Thanks. Dr Seminerio, maybe you could comment on the age of diagnosis, ethnicities, and race and how that's changed.

Jennifer Seminerio, MD: As we follow along with epidemiologic studies, one thing that we've noticed is there's different populations now that we're seeing high rates of it, even within the United States and Europe, we're still on an epidemiologic rise of the disease and we haven't reached an equilibrium state. Where we're seeing the largest rises in disease diagnosis is in the pediatric population, first generation migrants to the United States are particularly susceptible. But honestly, we can see this disease diagnosed in any age group. And that may be based on the severity of the disease, and they had it for longer than the period at which we diagnosed it. And it may just be based on ability to get entwined in the healthcare system and get the proper exposure to the doctors necessary to diagnose it. Specifically, within the female population, one of the things that we have talked about is that females, in general, have a later age of diagnosis which may be related to confounding interests why the doctor's seeing them, such as, saying that they may have IBS before they're properly being given the therapeutic and diagnostic options to investigate other disease states. Other than that, we're seeing it in different ethnicities in different age brackets. And one thing I always say about this disease is it is the least prejudiced disease that we've seen out there, doesn't care what age, race, gender, or sexuality you are. It will affect anybody at any time.

David P. Hudesman, MD: No, I think that's a great point and something when we're seeing patients in our office. I think in the past, we would think, "OK. Caucasian European descent." And if it's somebody, let's say, from Southeast Asia, like, "OK, maybe it's an infection or something else." And now, we really should be thinking about this with anybody presenting with some of these common GI symptoms.

Transcript edited for clarity