THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 549.4 Guest: Dr. Stephen Targan, Head of Cedar Sinai Inflammatory Bowel Disorder Center, Los Angeles, CA Topic: Crohn's Disease Producer/Host: Steve Girard

NEMA: A talk with Dr. Stephen Targan, head of the Inflammatory Bowel Disease Center at Cedar Sinai Medical Center in Los Angeles,will help us learn about Crohn's disease.....

TARGAN: Crohn's disease is a chronic, intestinal disorder where there is a chronic inflammation through the entire gastrointestinal tract. Patients who have this display several symptoms, which include: abdominal discomfort and pain, chronic, unrelenting diarrhea...all the way to having fevers, a tremendous amount of weight loss. There's a large spectrum of symptoms, from very benign to those patients who are continually in and out of the hospital.

NEMA: Does it come quickly, or does it have a gradual onset...?

TARGAN: The vast majority of patients who have this, it's something that develops slowly over time. And it's very intermittent, so patients may have symptoms for weeks at a time, and then they disappear, but then they may come back weeks to months later.

NEMA: Is there a known cause...and does the way we take care of ourselves...diet, stress, exercise...play a role in the onset and progression of the disease...?

TARGAN: There's nothing actually proven...but there's an enormous amount of scientific discoveries occurred over the last year and a half, and it suggests that there's a genetic predisposition to this disease, and that the idea is that the intestines are overreacting to the local environment. In fact, the over reactivity may be to the normal bacteria that live in symbiosis with us all our lives. And that may relate to how sometimes people will get more severe or improved, depending upon sometimes what they eat.

NEMA: How are Crohn's patients treated?

TARGAN: Crohn's disease, since it does affect all of the gastrointestinal tract, and surgery indeed is not curative, but is usually used to times for complications like when a patient has a bowel obstruction, and that area has to be removed...or medicines become ineffective and the patient has to have that part of his intestine that's involved removed. But, in general, patients are treated certainly sometimes with antibiotics, but today trying to bring this overactive local immune system that's overreacting back into the normal range, and drugs that will decrease the activity of the immune system, drugs that will inhibit protein and things that cause inflammation are used. Things like 5-aminosalicylic acid products, or 5-asa's, corticosteroids, immunosuppressants or immunomodulators, which directly, but broadly inhibit the immune system. And there's some very recent, very exciting treatments that have emerged from biotechnology.

NEMA: Can you look down the road and see what might develop from that...?

TARGAN: In the advent of this new technology...which has sort of created antibodies that inhibit or bind up these proteins that cause this inflammation....we have been able to treat very, very sick patients with this disease, and they have dramatically responded and gone into remission for great lengths of time. And there's many, many additional new drugs that are going to be created and then tried over the next couple of years.

NEMA: Dr. Stephen Targan of the Inflammatory Bowel Disease Center at Cedar Sinai Medical Center in Los Angeles...if you need more information, call the Crohn's and Colitis Foundation of America at 800-343-3637. I'm Steve Girard.