April 27, 2025 • 29 mins
04/27/25
The Healthy Matters Podcast
S04_E14 - Gut Check: Understanding Crohn's Disease
With Special Guest: Dr. Jason Eckmann, MD
We've all had a stomach bug at some point in our lives, and it's probably safe to say that every one of us would rather skip the next one. But for millions worldwide with a Crohn's Disease diagnosis (AKA Crohn Disease), that stomach issue is much like the condition they live with every day of their lives. Crohn's is a chronic condition, and whether you’re newly diagnosed, supporting someone who is, or just curious about what this condition is all about, in this episode, we'll break it down in a helpful way that’s easy to understand.
A diagnosis of this condition can be scary, and it's certainly one that comes with its own set of physical and emotional challenges. Thankfully, on this show we'll be joined by Dr. Jason Eckmann, MD, a Gastroenterologist at Hennepin Healthcare, and someone who's helped countless patients navigate this condition and continue on with their lives. From symptoms, to diagnosis, to treatments and what the future might hold for those with Crohn's, there's a lot to talk about - and we've got just the expert to walk us through it. We hope you'll join us.
Here's a link to the Chron's & Colitis Foundation mentioned in the show.
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 2 (00:19):
Hey everybody, and welcome to episode 14 of the
Healthy Matters podcast. I'myour host, Dr. David Hilton,
and thank you for tuning intoday. So let me ask you this,
have you ever heard someonemention Crohn's Disease and
thought, wait, is that thatstomach thing or is that IBS?
Is it IBD? Well, don't worry,you're not alone today. We're
(00:39):
tackling what Crohn's diseaseis, how it affects people, what
causes it, and what treatmentslook like in real life To help
us make sense of it, I amjoined by Dr. Jason Ekman . He
is a gastroenterologist inHennepin Healthcare right here
in downtown Minneapolis, and hespecializes in diagnosing and
treating conditions like thisone, and he's helped countless
(00:59):
patients navigate life withCrohn's disease. So, Jason,
welcome to the podcast.
Speaker 3 (01:03):
Thank you very much for having me. Great to
Speaker 2 (01:05):
Have you here. So start with the basics, if you
would, in the most basic terms,what is Crohn's disease?
Speaker 3 (01:11):
Yeah. So at its most basic, Crohn's disease is a
condition where the bodyattacks the lining of the
intestines leading toinflammation.
Speaker 2 (01:17):
So why is that a problem?
Speaker 3 (01:18):
Well, it's a problem because inflammation leads to a
lot of really uncomfortablesymptoms that can really affect
your quality of life.
Speaker 2 (01:24):
Okay. So inflammation in your bowel, is
it then with Crohn's disease,inflammatory bowel disease? Is
it the same thing? Crohn's
Speaker 3 (01:31):
Disease is a type of inflammatory bowel disease.
Ulcerative colitis would be theother main camp.
Speaker 2 (01:36):
Okay. So we're not gonna talk tons about
ulcerative colitis today, butcan you summarize how they're
different?
Speaker 3 (01:43):
Sure. So ulcerative colitis by definition is
inflammation of the colon. Socolitis means inflamed colon.
Crohn disease can involve thecolon, but it can also involve
anywhere else in thegastrointestinal system,
anywhere from the mouth to theanus.
Speaker 2 (01:56):
Okay. So we're gonna be talking about a specific
kind of inflammatory boweldisease, Crohn's disease today.
Paint a picture for us. If Iwere to visualize what does
inflammation of the bowel walllook like? What is what and why
is that a problem? Sure.
Speaker 3 (02:11):
So just like we have skin on the outside of our
body, and that skin can beinflamed and have rashes and
bruises and cuts , uh, so tothe inside of our intestines
has a skin, if you will, aswell, called mucosa. And so
when that skin gets inflamedand the inside of your
intestines, it leads to thepain and the discomfort and
everything else we'll talkabout with, with Crohn's
Speaker 2 (02:32):
Disease. And there's lots of causes of that, right.
Of inflammation, not ofCrohn's, but I mean absolutely.
You can have lots of reasons.
Your intestinal wall can beinflamed.
Speaker 3 (02:39):
Sure. Anywhere from infections to to foods you eat
to conditions like inflammatorybowel disease .
Speaker 2 (02:45):
Okay. So let's talk about causes. Who gets Crohn's
disease and, and why?
Speaker 3 (02:49):
So anybody can get Crohn's disease, but uh, the
most common people we see thatin is patients aged about 15 to
30 years old. Oh , that'syoung. It is young, yeah. And
so we actually bridge with our,our colleagues in, in the
pediatric population as well.
But, but again, anybody can getit. And we also see a second
peak later in life, sort ofbetween the ages of 50 and 80
as well, for reasons that wedon't quite fully understand.
Speaker 2 (03:12):
Do we know why people get it?
Speaker 3 (03:13):
So that's a complicated question. Uh, you
know, it's, it's not just onespecific thing. So there's
definitely a genetic component.
Uh, we do see that people witha family history, especially in
parents or siblings , uh, aremore likely to get Crohn's
disease than people withoutthat. But that being said,
people without a family historycan certainly get Crohn's
disease as well. And thenthere's also likely a , an
(03:34):
environmental component, if youwill. So , uh, things that
we're exposed to, like certaininfections potentially , um,
ingestions , uh, other sorts ofillnesses can lead to, to
Crohn's disease as well . What
Speaker 2 (03:46):
About diet? Does that affect It doesn't cause
it,
Speaker 3 (03:48):
It doesn't cause it , uh, so diet may play a role .
We have yet to identify aspecific food or a specific
food group that is the cause.
But certainly there's apossibility that something that
we ingest helps to precipitatethe inflammation. So
Speaker 2 (04:02):
How common is it?
Speaker 3 (04:03):
It is something we see pretty frequently in our
clinic. So estimates I've seenrecently estimate between , uh,
half to a million people in theUnited States have Crohn's
disease. Upwards of seven or 8million people across the globe
have inflammatory boweldisease, which again, is that
combination of Crohn's diseaseand ulcerative colitis, but
it's definitely out there.
Speaker 2 (04:22):
So that's a lot,
Speaker 3 (04:23):
A lot of
Speaker 2 (04:24):
People. Yeah. This isn't, I wouldn't call rare.
It's maybe not, you know, superduper common. It's not like
high blood pressure, but thisis not a rare disorder. You see
it all the time. I , I see itin my clinic, in , in a primary
care practice. Yeah . And I ,and listeners, what I do when I
do see it is send , I send itto guys like , uh, Dr. Ekman
before I move on to like, whatdoes it look like, signs and
symptoms, what , why the wordCrohn's disease and , okay.
(04:45):
Listeners, nobody can spell iteither. So if you don't know
how to spell it , uh, I got ,it's C-R-O-H-N, Crohn . It must
be some guy.
Speaker 3 (04:55):
It is exactly that.
Some guy who, who firstdescribed this sort of
constellation of, ofinflammation throughout the
intestines and, and it actuallyis Crohn disease. Oh,
Speaker 2 (05:05):
It's Crohn . I've been saying Crohn's the whole
time. And I've been, and
Speaker 3 (05:08):
You'll hear me say Crohn's disease as well, but it
, it really, if , if you lookin the literature, it is
C-R-O-H-N disease.
Speaker 2 (05:14):
No. Apostrophe. Yes . Okay . Well , okay. I'm, I've
been doing this for 25 yearsand I, I think I've been
getting that wrong.
Speaker 3 (05:20):
You know, it's not just his disease, it's all of
our disease . It's
Speaker 2 (05:23):
All of our disease.
It's just like Lyme disease.
It's Lyme, it's not Lyme since, so it's the same as the true
for Crohn , and it isC-R-O-H-N. And if there's
anything in a medicalliterature or medical document
in a chart that's misspelledmore often than Crohn's
disease, I don't know what itis . Okay. So now that we've
tackled that before we get moveon from that , uh, we're always
naming things after, usuallysome guy from 50 years ago, a
(05:46):
hundred years ago, 150 yearsago. So we're kind of getting
away from that in, in medicalscience. So I wonder what it'll
be called in the future, butright now it's still Crohn's
disease. Okay. Symptoms. Whenpatients come to see you, what,
what are they telling youthey're experiencing?
Speaker 3 (06:00):
So most commonly we see patients come in with
abdominal pain and, and , andlongstanding diarrhea. So
lasting several weeks. Uh, thediarrhea is frequently bloody,
but it's not always weightloss, nausea, vomiting, fever,
often seen as well. And tocomplicate things even further,
people have symptoms outside oftheir GI system. So , uh, skin
(06:20):
rashes, eye problems, jointpain can all be associated with
Crohn's disease as well.
Speaker 2 (06:25):
And so those could be caused by lots of things.
Speaker 3 (06:27):
Uh , that's what makes it so challenging to
diagnose. Uh, how
Speaker 2 (06:29):
Often do you see what, what sounded like more
serious symptoms? Fever, bloodydiarrhea. Because I think
there's a lot of listenersright now who are going, well,
yeah, I got loose stools, Ihave diarrhea all the time, but
probably fewer are saying,yeah, and emol , I've got a
fever and I got weight loss,and I got blood in my stool.
How often do you see those?
Speaker 3 (06:48):
So they're, they're probably the more commonly seen
in patients with Crohn disease.
You know, patients who haveloose stools or, or mild
abdominal pain for otherreasons could have Crohn's
disease, but more likely otherconditions leading to that. Uh,
but I'd say the majority ofpatients with Crohn disease
have at least one or more ofthose more severe symptoms.
Speaker 2 (07:05):
So when should somebody seek attention,
particularly from a specialistlike you ? Because I'm just
trying to imagine peoplelistening to this and how many
people are saying, yeah, I haveloose stools. I do, I have 'em
almost all the time. Whenshould they come see somebody?
Speaker 3 (07:21):
Well, if , if you're having loose stools almost all
the time, I , you shouldprobably come see us. And , and
again, it may be chrome , itmay be something different,
but, but certainly worthtalking to us. You know, we've
all experienced short-livedsymptoms, you know, nausea,
vomiting, abdominal pain,diarrhea, and, you know, nine
times outta 10, that's a GIbug. Food poisoning, something
like that lasts for a few days,passes on its own. But you
(07:42):
know, if these symptoms startto last 2, 3, 4 more weeks ,
uh, maybe you start losingweight, you start to see that
blood in your stool, at thatpoint, you should start
thinking more about a chronicdisease like Crohn disease. To
be honest, severe complicationscan develop from ignoring these
symptoms. And so it's, it'sreally important to get on top
of them early.
Speaker 2 (08:00):
I was gonna ask you about that. Is there a , is
there a benefit to finding outabout it earlier in the course?
Speaker 3 (08:06):
Absolutely. So as that inflammation progresses
throughout the gastrointestinalsystem, we see things like
fistulas, which are abnormalconnections between loops of
bowel. We see strictures, whichis essentially scar tissue ,
tissue , uh, leading tonarrowing of the intestines. We
can see perforations or holesin the intestine. And, and that
longstanding inflammation caneven lead to colon cancer in
(08:26):
some situations. So, so someearly is
Speaker 2 (08:28):
Better, some fairly unsavory things that can happen
later in the disease.
Absolutely . So how do youdiagnose Crohn's disease?
Speaker 3 (08:35):
So it's really a combination of a lot of things.
You know, first we'll see youin clinic with the symptoms
that we've talked about. We'lloften get lab tests on that
day. We'll do a physicalexamination as well, and then
see if we can get a sense forwhere that abdominal pain might
be coming from. The next stepis typically a scope, so a
colonoscopy, maybe an upperendoscopy depending on your
symptoms. This allows us tolook directly the , on the
(08:57):
inside of your intestines and,and see what's involved. And
even take samples to confirmthe diagnosis. And we'll often
obtain an image imaging studyas well, something like a CT
scan or an MRI to help get anidea both of, of where the ,
the Crohn's disease isinvolving your system, as well
as any complications that we'vetalked about.
Speaker 2 (09:15):
So you're the guy at the control end of that
colonoscopy. You're, you've gotthe controls in your hand,
you've got the machine, you'vegot your video monitor. All the
rest of us are at the businessend. We're at the other end of
the colonoscopy. Could you giveus the insider's take on what
does Crohn disease look likewhen you're in there versus
what a normal colon looks like?
(09:37):
What are you looking for?
Speaker 3 (09:39):
Yeah, so again, going back to that analogy that
I, I talked about earlier withthe , the rash on your skin.
You know , uh, normal lookingskin is quite smooth and
healthy appearing. Same withthe inside of your intestines.
Uh, we see a very smooth, shinyhealth appearing mucosa when
patients have Crohn's disease.
We see a lot of redness,irritation, we can see very
(09:59):
deep ulcers. And all of thesethings are , uh, a strong sign
that something wrong is goingon. So
Speaker 2 (10:04):
You can visualize it and see this doesn't look
normal,
Speaker 3 (10:07):
Can definitely tell it doesn't look normal. I can't
guarantee a hundred percentjust looking at it that it's
Crohn's disease, but I cancertainly get to the point
where I can take samples and,and confirm the diagnosis.
Speaker 2 (10:17):
So when you're taking a sample or a biopsy of
someone's intestinal wall, howdo you do that? 'cause I, I've,
I've talked to a lot of peoplesaying what they're gonna ,
he's gonna take a chunk outtamy, you know, it's not a chunk
, but what do you , howdo you do that?
Speaker 3 (10:30):
Yeah, so we have what's called a working channel
in our camera. So it's, it's areally long flexible tube that
we use to visualize inside theintestine,
Speaker 2 (10:38):
Long being the key word .
Speaker 3 (10:39):
Yep . Long and soft.
It , uh, you know , okay,
Speaker 2 (10:41):
It's soft and flexible
Speaker 3 (10:42):
. Um , and
we can, and we can put this
very, very small , uh,instrument called the forceps,
which is essentially a, amicroscopic tweezers that'll
take like a millimeter sampleout of the intestines. You
can't feel it, you won't noticethat it's gone, but it gives us
enough information to get thediagnosis.
Speaker 2 (10:58):
And then you send that little, you pull it
through the , your, your scopeback out and you put it in a
jar or whatever, and you sendit off to a lab. And that's how
you can make the definitivediagnosis.
Speaker 3 (11:06):
Exactly. We ask for, for help from our friends in
the pathology lab to, to tellus what we saw.
Speaker 2 (11:11):
Okay. So that's the diagnosis. We're talking to Dr.
Jason Ekman. He is agastroenterologist and we're
diving into Crohn's Disease.
And right now we're gonna takea short break now that we have
the foundation of what Crohndisease really is, when we come
back, we're gonna discuss whatit's like to live with Crohn's
Disease and what treatments areavailable. And I'm here to tell
you there's a lot moretreatments than there used to
(11:32):
be. I'm gonna ask Jason whatthe future looks like for
Crohn's disease and what peopleneed to know who are living
with Crohn's disease. So stickaround, we'll be right back
Speaker 4 (11:43):
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(12:04):
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Hennepin Healthcare is here foryou and here for life.
Speaker 2 (12:21):
And we're back talking with Dr. Jason Ekman
about Crohn's disease, one ofthe inflammatory bowel
diseases. He is agastroenterologist at Hennepin
Healthcare. Dr. Ackman , let'stalk a little bit about the
impacts on people's daily life.
Can you share with us what youhear from patients about how
their Crohn's disease canaffect their daily life?
Speaker 3 (12:40):
Yeah, you know, it's, it's a disease that
really has wide ranging effectson, on all facets of life. Can
be difficult to go to work, toschool, to socialize, raise a
family, just deal with, withbasic life, with a lot of the
symptoms we've talked about.
For example, eating out or evenin a eating in at at home can
be challenging when you havenausea, when you're worried
that that next meal is gonnasend you a run into the
(13:02):
bathroom. So patients areconstantly vigilant of where
the nearest bathroom is, howquickly they can get there, and
a lot of logistical challengeslike that. So, you know, both
these physical and emotionalsymptoms really wear you down
with time.
Speaker 2 (13:14):
Is there much pain associated with it?
Speaker 3 (13:17):
Absolutely. Uh , again, physical and emotional,
right? But , uh, you know,abdominal pain, that
inflammation really can, canmake your, your stomach hurt
quite a bit.
Speaker 2 (13:25):
So what advice do you give people? Uh , we're
gonna get into some of thetreatments to actually relieve
these symptoms, but it's notcurable really.
Speaker 3 (13:32):
That's correct. It is not curable from the sense
that in the traditional sense ,cancer can be cured in certain
C circumstances. It's a chronicdisease, you live with it the
rest of your life, but like yousaid, we will get more into to
, to medications and, andtreatment options. But we do
have good options there.
Speaker 2 (13:45):
Yeah, there's some really good options. Now. There
can be, actually my patientshave said kind of life changing
for them. What advice do yougive people though, while
you're getting 'em into sometreatments with the hope for
some better results in thefuture? What kind of , of , uh,
what advice do you tell people?
Speaker 3 (14:00):
Uh , you know, I think it's, it's important to
be pragmatic. So if you'reliving with Crohn's Disease,
you know, taking that trip upto the boundary waters for a
week or an international flightmay not be , oh my goodness,
you know, the best decision ifyour symptoms aren't under
great control. Um, but once youget on the right medications,
stay on the right medications,most patients can leave
essentially pretty normallives, maybe working around
their medication schedule. But, but otherwise they do quite
(14:22):
well. So I really stress theimportance of getting on and
staying on the rightmedications.
Speaker 2 (14:26):
So you mentioned earlier there are some
long-term potentialcomplications, particularly
with untreated Crohn's disease,and some of those were, were
fairly significant. Does thedisease, if, if, if it
progresses lead to a shorterlife expectancy? In other
words, is it a life-threateningillness?
Speaker 3 (14:42):
It can be a life-threatening illness. And,
and certainly we, we seepatients in the hospital with,
with very severe symptoms that,that are , are in a
life-threatening situation.
There are patients with verysevere disease that probably
have , uh, a slight decrease intheir life expectancy. But most
patients, again, when they geton the right medications and
stay on those medications , uh,they live very normal lives
(15:04):
that , uh, shouldn't reallysignificantly decrease their
life expectancy.
Speaker 2 (15:06):
So that's, that's hopeful. Mm-hmm .
Um , what about some of theother complications you talked
about in our first half of theshow? You mentioned things like
fistulas and increased coloncancer risk . Could you say a
little bit more about that? I'mgonna imagine that lots of
people don't really know what afistula is.
Speaker 3 (15:23):
Yeah. So a a fistula is basically develops when you
have a lot of inflammation andit hooks up or, or connects
loops of bowel that shouldn'tbe connected and bypasses large
amounts of the intestine, whichcan lead to, to problems with
absorption of nutrients. Hencethat weight loss we talked
about and some of the othersymptoms
Speaker 2 (15:42):
And fistulas can be fixed or is that just like a ,
something you live with?
Speaker 3 (15:46):
No fistulas can be fixed sometimes just treating
with the right medications andreducing that inflammation
allows those to close up. Um,but sometimes surgery is needed
as well.
Speaker 2 (15:54):
Okay. Let's get into some of the treatments. So
starting out with , uh,immediate treatments for
symptom relief. And then let'sget a little bit more into the
long-term medications that areavailable now for treating it.
Sure.
Speaker 3 (16:08):
That's, and that's a great , um, distinction to
make. You know, we use thingscalled steroids, which , uh,
are different than maybe thesteroids you think about for
bodybuilding, but these arevery potent anti-inflammatory
medications that act veryquickly and are very effective
for almost all patients thatreally reducing that
inflammation and therefore thesymptoms right
Speaker 2 (16:26):
Away. Yeah. So these are corticosteroids, they're
powerful anti-inflammatories.
I've talked about steroids alot on the show and I'm never
referring to the bodybuildertype listeners. , we're
always talking about the Sothey're aware. Yeah . Well, I
don't know if they're aware. Ialways say it if we're not
talking about what you mightthink, but I have said on the
show Yeah , steroids, they kindof cure what ails you . Yeah .
Because they're ananti-inflammatory and they sort
(16:47):
of calm everything downregardless of where the
inflammation is. So does thathelp in people's symptoms when
they take Absolutely.
Prednisone or something
Speaker 3 (16:54):
Similar ? Yeah, exactly. You know, patients
within a few days to a weekfeel typically much, much
better. The downside , whichyou may have talked about on
the show previously, as well aswell,
Speaker 2 (17:02):
Tell us what they are 'cause I haven't lately .
Speaker 3 (17:03):
Sure, yeah. So , um, there's a lot of side effects
that can arise from takinglong-term steroids. Things like
diabetes, things like poorsleep, weight gain, and
immunosuppression, meaning ,uh, increased risk of
infection. Yeah .
Speaker 2 (17:14):
You really don't wanna be on steroids if you can
help it. That's true for yourwhole life. But that's kind of
what we had for the longesttime. Right . Yeah. And then we
had some other things you , yougave enemas and this, that and
the other thing. What are someof the other symptomatic relief
things people can take?
Speaker 3 (17:28):
Uh , from a symptom standpoint? You know, we can
take pain medications likeTylenol , uh, which, which can
help to some degree . We cantake antidiarrhea medications
like Loperamide or Imodium ,uh, but those are really sort
of a bandaid approach. You're ,you're helping with the
symptoms, but you're notdirectly affecting the
underlying disease.
Speaker 2 (17:45):
Right. It doesn't get at the causes at all. Okay.
So let's talk about what's comeout in the last 5, 10, 15 years
and there's now what I wouldprobably venture to say is the
mainstay of treatment ofCrohn's disease, the biologics,
what I refer to as biologics.
Could you talk about those?
Speaker 3 (18:01):
Sure. I think, you know , maybe before we move on
to the biologics , uh, we, wehad and still have a class of
medications calledimmunomodulators, which were
very common for, for decades,and they're still used to some
degree. Um, these decreasedinflammation very effectively
and can be used longer term .
Um, but , uh, you know, theytend to have a bit more side
effects and need more frequentmonitoring, and that's where
(18:24):
the advent of, of thesebiologic medications has really
been helpful.
Speaker 2 (18:27):
Yeah, thanks for that reminder, because I, I
skipped over a whole class ofmedicines there, these immune
modulators. What are some ofthose?
Speaker 3 (18:33):
So azathioprine is probably the most common one
you'll hear about. Um, there'sone called six Mercaptopurine,
another one calledmethotrexate. Um, all are , are
quite effective medications fora lot of patients. But, but
again, with some of thelong-term side effects, we've,
I think are, are moving awayfrom those and more towards the
biologics.
Speaker 2 (18:51):
If your physician does recommend azathioprine or
six mp , those are stillaccepted treatments?
Speaker 3 (18:56):
Absolutely. I still use them. Uh , and sometimes I
use them in combination withothers, sometimes on their own.
But , uh, they are still veryacceptable
Speaker 2 (19:03):
Treatments and those have been around a long
Speaker 3 (19:04):
Time. They have been for a lot of different
diseases.
Speaker 2 (19:06):
Yeah. People might be familiar with those from a
variety of things. Mm-hmm. So the biologics
that I alluded to earlier,these are the most modern, for
lack of a better word,treatments. Tell , talk to us
about those. Yeah,
Speaker 3 (19:18):
Absolutely. These, these really have become the
mainstay of treatment over thepast couple decades probably.
Um, and these target, theinflammatory cascade we call
it. So basically the process ofinflammation within the body,
they're very effective, they'rebetter tolerated , uh, than ,
and some of the othermedications we've talked about,
the downside to a lot of themis that they're often given
(19:39):
through the vein, sointravenously or
subcutaneously, meaning underthe skin, which can be a bit of
a hassle for some people, butYeah .
Speaker 2 (19:46):
You're not just taking the daily pill.
Speaker 3 (19:46):
Correct. Um, but, but they are so effective , uh,
and , and they work so wellthat patients tend to be okay
with dealing with thatinconvenience.
Speaker 2 (19:54):
How often do you have to do that or , I know it
varies. It does
Speaker 3 (19:57):
Vary,
Speaker 2 (19:57):
But it's not every
Speaker 3 (19:58):
Day. It's not every day . So usually it's anywhere
between every two weeks toevery eight
Speaker 2 (20:02):
Weeks. There's another downside to the
biologics is that you can'tpronounce any of 'em . That's
true.
Speaker 3 (20:07):
But ,
thankfully the pharmaceutical
companies have come up withcatchy names that we can say
easily . I know,
Speaker 2 (20:12):
And I , and I will tell listeners , um, uh, I have
a , an issue with advertisingof medications, but if you're
watching TV and you see some ofthese medications with all
these bizarre names, if youlook kind of closely at the, at
the generic name that theysometimes put on the screen, it
usually ends in an AB or an ib. There are too many syllables
(20:33):
and there's too many consonantsin there, but those are the
medications we're talkingabout. Exactly. And , and
they're, they're, they'reasking you to go ask your
doctor if such and such isright for you. That's kind of
what the biologics are. Butthat cynical side, put that
aside, they're highlyeffective,
Speaker 3 (20:49):
They're very effective. And, and sometimes
we try one and maybe it doesn'twork, but you can almost always
find a different one that worksin a different way that'll,
that'll work for a patient.
Speaker 2 (20:57):
What types of side effects might people get? You
said they're fairly welltolerated, probably a lot fewer
side effects than say,prednisone and the steroids.
Speaker 3 (21:05):
Definitely. So the most common are, are mild
infusion or injectionreactions. Uh, more serious
side effects would be , uh,infection. It does suppress the
immune system. And so you're ata slightly increased risk for
things like, you know, coldsor, or other mild infections
like that. There are , uh, somemuch lower risk of things like
developing skin cancer orlymphoma, but those are
(21:28):
incredibly rare and, and , uh,something we can keep an eye
out for before they hit.
Speaker 2 (21:33):
So these more advanced medications, are they
treating symptoms or are theyactually doing anything to the
underlying disease process?
Speaker 3 (21:41):
So they're doing both, you know, by addressing
the underlying inflammation anddisease process , uh, patients
will also feel better.
Speaker 2 (21:48):
Does it affect the, the long-term course of the
disease or don't we know that?
So in other words, are yougonna be the, a different
person 20 or 30 years down theroad because you took these
now?
Speaker 3 (21:59):
Probably. So, as I think I alluded to earlier, if
you don't treat disease earlyon, the disease can progress.
That inflammation leads to allthese complications we talked
about. So by getting on thatmedication early, and again,
I'll stress it, staying on thatmedication, even if you're
feeling well , uh, thatprevents flare-ups of your
disease, inflammation comingback and, and can hopefully
(22:20):
reduce the likelihood thatthese complications arise.
Speaker 2 (22:23):
You alluded to surgery earlier. Uh, and
patients do ask me that a lot.
Is there a surgery for this?
What do you say to that?
Speaker 3 (22:30):
A lot of patients end up needing surgery , uh,
for Crohn's disease. What
Speaker 2 (22:34):
Do they do? So
Speaker 3 (22:34):
What they typically do in these situations, we, we
do surgery for one of tworeasons. One is we can't find a
medication that is effectivelytreating the inflammation. And
in those circumstances, we cantry to remove that area of the
intestines that are inflamed.
The challenge there though isthat Crohn's disease can affect
anywhere within the intestines.
So we take that area out, it'sa little bit like whack-a-mole,
you know, it can pop up againstsomewhere else in the bowel.
(22:56):
Right.
Speaker 2 (22:56):
You said mouth to anus. Right. How do you know
what to take out? You can'ttake, can't take it all
Speaker 3 (23:00):
.
Speaker 2 (23:01):
Yeah , you can't take all that out.
Speaker 3 (23:02):
Yeah. So you take out the area that you know is
causing the problem now and,and then you hope that you can
get a patient on a medicationand, and prevent it from
flaring up elsewhere. The otherreason we would do surgery is
developing any of thosecomplications we talked about
earlier. So the fistulas, thestrictures, the perforations ,
uh, we do surgery then to, toremove those areas that are
problematic.
Speaker 2 (23:22):
I do wanna go back briefly to ulcerative colitis,
the other big inflammatorybowel disease because isn't
surgery a little morestraightforward in that case?
Speaker 3 (23:31):
It is. We, we often approach it in a similar way,
meaning if there's been acomplication or if we can't get
your symptoms under controlwith medications, we, we pursue
surgery, but as I talked aboutearlier with colitis, meaning
colon, by definition,ulcerative colitis only affects
the colon. So, so
Speaker 2 (23:46):
You know where it is a little bit better,
Speaker 3 (23:48):
We can essentially cure ulcerative colitis by
fully removing the colon withsurgery if need be. So
Speaker 2 (23:54):
Back to Crohn's disease, is there a certain
place in your GI tract frommouth to anus, the whole thing?
Is there a place where it'smost common?
Speaker 3 (24:03):
It's most commonly seen at the very end of the
small intestine, which iscalled the ileum, and then the
very first part of the colon,which is called the cecum . And
so ileocecal Crohn's is themost common , uh, way we see
it, but
Speaker 2 (24:15):
Right at the farthest end of what you can
see with a colonoscope, right?
Correct. So you can see it inthat place. Yep .
Speaker 3 (24:21):
Probably three quarters or more of the time we
can find Crohn's in that area.
Uh , and then elsewhere in thecolon or the small intestine is
a little bit harder to, to findthere.
Speaker 2 (24:29):
How does one find it in the 20 foot long small
intestine ? You can'tput a scope in there
Speaker 3 (24:34):
That, that is true, thankfully. For, for my job and
for patients. Can you
Speaker 2 (24:37):
Imagine that the five foot long Yeah . Scope .
They use it for thecolonoscopies long enough?
Speaker 3 (24:42):
Yeah. Long but not that long. Yeah . So , uh, what
we do is either use imaging, sothe CT scans the MRIs that I
talked about earlier, or wehave something called video
capsule endoscopy or colloquial, uh, the pill cam , which is
essentially a , a large pillthat people swallow with a
camera in it that takespictures every, every couple
seconds , uh, and traverses thewhole length of the intestines
(25:04):
and can give us some goodpictures of, of what's going
on.
Speaker 2 (25:06):
People ask me a lot about the, the camera that you
swallow mm-hmm .
That's what you're talkingabout, right ?
Speaker 3 (25:11):
Pill cam . Exactly.
Yeah.
Speaker 2 (25:13):
Um, and that must be a heck of a deal to look at
those pictures. You gothundreds, thousands of pictures
of the inside of someone'sintestines. They must all start
to kind of look alike.
Speaker 3 (25:22):
That's not the most exciting part of our job. Do
you
Speaker 2 (25:24):
Read those?
Speaker 3 (25:26):
Uh, thankfully I do.
Not yet, but I'm sure it'scoming down the pipeline
Speaker 2 (25:29):
For me. ,
I'll bet you guys fight over
who gets to look at thousandsof pictures of the inside of
someone's intestines. Notexactly as good as looking at
someone's vacation photos. Hey. Right. Okay. I would like to
, um, before I let you go, talka little bit about the future.
What might be down the roadthat you're aware of, either in
research, new medications , uh,what does the future look like
(25:50):
for people living with Crohn'sdisease?
Speaker 3 (25:52):
Yeah, so, you know, as you alluded to, not too long
ago, we only had a fewmedications available to us.
And, and now it seems likeevery few months or every year
we have a new medication. Everyfew years we have, you know, a
new class of medications thatwe can use to, to help treat
patients, which is, which isreally exciting. It's a very
active area of research. And Ithink the genetic component as
(26:12):
well is probably gonna comeinto to play quite a bit more
where we're able to identifycertain medications that will
be more effective for certainpeople depending on their
genetic makeup. So
Speaker 2 (26:22):
A little less trial and error. Hey, try this, see
if it works, and then trysomething else. See if it
works. I'm , I'm being a little, uh, flippant about it, but
sometimes we have to trymedicine. See if it works for
you.
Speaker 3 (26:32):
Exactly. You never know who's gonna respond to
which medication.
Speaker 2 (26:35):
Right. And wouldn't that be great if we knew ahead
of time, hey, the genetic typethat you have, this is the
medication that might work with, that's exciting. Exactly. So
that's actually quiteencouraging. Mm-hmm
. What otherresources are available for
people , uh, living withinflammatory bowel disease?
Speaker 3 (26:49):
You know, I think a , a great resource is the
Crohn's and Colitis Foundation.
Uh, people may already be awareof that, but they're probably
the largest organization ofboth experts and patients , uh,
who are involved in, in Crohn'sdisease and ulcerative colitis.
There are a lot of greatresources on their website ,
uh, ranging from just goodinformation about the disease
as well as community resourcesget togethers and, and , uh,
(27:12):
crowdsourcing of, of differenttechniques and approaches to
dealing with life withinflammatory bowel disease. And
Speaker 2 (27:17):
Listeners, we'll put a link to those in our show
notes, so be sure to checkthose out. Dr. Jason Ekman,
what would you leave listeners,if you had a bit of advice to
leave about this topic, whatwould that be?
Speaker 3 (27:30):
So I think one important thing is, is really
listening to your body andlistening to your symptoms. As
we've talked about, I thinkseveral times already, you
know, we don't wanna leaveCrohn's Disease undiagnosed and
untreated for a long time. Theother thing is, is , you know,
Crohn is a scary disease. And,and you hear people like me
today saying, well, we don'tfully understand it. And , and
(27:51):
that can sound very scary tosomebody diagnosed with Crohn's
disease, but I just reallywanna reiterate that we have
great medications and so if ,if you come to see us in clinic
and we make this diagnosis, we,we really can help you.
Speaker 2 (28:02):
Thank you for that.
I personally have sent peopleto the gastroenterologist at
Hennepin Healthcare, includingDr. Eckman with some kind of
scary symptoms. They haddiarrhea for ages or losing
weight. They're in pain. Anddue to the expert treatments
available and the expertisethat's available, their lives
were actually changed for thebetter. There is a lot of hope
on the future and thetreatments available for you if
(28:24):
you're living with Crohn'sDisease. And this is a friendly
reminder. If you're havingsymptoms, you'll know you don't
know what they are. Please doseek help. Go to your primary
care physician or otherclinician, go to a
gastroenterologist. There ishelp available for you. Jason,
thanks for being on the showtoday.
Speaker 3 (28:39):
Thanks for having me.
Speaker 2 (28:40):
It's been a great conversation about Crohn
Disease and listeners, I hopeyou've picked up some
information that's useful toyou. And I want to thank you
for joining us for the podcast,and I hope you'll join us in
two weeks time when we dropanother episode. And in the
meantime, be healthy and bewell.
Speaker 1 (28:56):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(29:18):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(29:40):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 2 (00:19):
Hey everybody, and welcome to episode 14 of the
Healthy Matters podcast. I'myour host, Dr. David Hilton,
and thank you for tuning intoday. So let me ask you this,
have you ever heard someonemention Crohn's Disease and
thought, wait, is that thatstomach thing or is that IBS?
Is it IBD? Well, don't worry,you're not alone today. We're
(00:39):
tackling what Crohn's diseaseis, how it affects people, what
causes it, and what treatmentslook like in real life To help
us make sense of it, I amjoined by Dr. Jason Ekman . He
is a gastroenterologist inHennepin Healthcare right here
in downtown Minneapolis, and hespecializes in diagnosing and
treating conditions like thisone, and he's helped countless
(00:59):
patients navigate life withCrohn's disease. So, Jason,
welcome to the podcast.
Speaker 3 (01:03):
Thank you very much for having me. Great to
Speaker 2 (01:05):
Have you here. So start with the basics, if you
would, in the most basic terms,what is Crohn's disease?
Speaker 3 (01:11):
Yeah. So at its most basic, Crohn's disease is a
condition where the bodyattacks the lining of the
intestines leading toinflammation.
Speaker 2 (01:17):
So why is that a problem?
Speaker 3 (01:18):
Well, it's a problem because inflammation leads to a
lot of really uncomfortablesymptoms that can really affect
your quality of life.
Speaker 2 (01:24):
Okay. So inflammation in your bowel, is
it then with Crohn's disease,inflammatory bowel disease? Is
it the same thing? Crohn's
Speaker 3 (01:31):
Disease is a type of inflammatory bowel disease.
Ulcerative colitis would be theother main camp.
Speaker 2 (01:36):
Okay. So we're not gonna talk tons about
ulcerative colitis today, butcan you summarize how they're
different?
Speaker 3 (01:43):
Sure. So ulcerative colitis by definition is
inflammation of the colon. Socolitis means inflamed colon.
Crohn disease can involve thecolon, but it can also involve
anywhere else in thegastrointestinal system,
anywhere from the mouth to theanus.
Speaker 2 (01:56):
Okay. So we're gonna be talking about a specific
kind of inflammatory boweldisease, Crohn's disease today.
Paint a picture for us. If Iwere to visualize what does
inflammation of the bowel walllook like? What is what and why
is that a problem? Sure.
Speaker 3 (02:11):
So just like we have skin on the outside of our
body, and that skin can beinflamed and have rashes and
bruises and cuts , uh, so tothe inside of our intestines
has a skin, if you will, aswell, called mucosa. And so
when that skin gets inflamedand the inside of your
intestines, it leads to thepain and the discomfort and
everything else we'll talkabout with, with Crohn's
Speaker 2 (02:32):
Disease. And there's lots of causes of that, right.
Of inflammation, not ofCrohn's, but I mean absolutely.
You can have lots of reasons.
Your intestinal wall can beinflamed.
Speaker 3 (02:39):
Sure. Anywhere from infections to to foods you eat
to conditions like inflammatorybowel disease .
Speaker 2 (02:45):
Okay. So let's talk about causes. Who gets Crohn's
disease and, and why?
Speaker 3 (02:49):
So anybody can get Crohn's disease, but uh, the
most common people we see thatin is patients aged about 15 to
30 years old. Oh , that'syoung. It is young, yeah. And
so we actually bridge with our,our colleagues in, in the
pediatric population as well.
But, but again, anybody can getit. And we also see a second
peak later in life, sort ofbetween the ages of 50 and 80
as well, for reasons that wedon't quite fully understand.
Speaker 2 (03:12):
Do we know why people get it?
Speaker 3 (03:13):
So that's a complicated question. Uh, you
know, it's, it's not just onespecific thing. So there's
definitely a genetic component.
Uh, we do see that people witha family history, especially in
parents or siblings , uh, aremore likely to get Crohn's
disease than people withoutthat. But that being said,
people without a family historycan certainly get Crohn's
disease as well. And thenthere's also likely a , an
(03:34):
environmental component, if youwill. So , uh, things that
we're exposed to, like certaininfections potentially , um,
ingestions , uh, other sorts ofillnesses can lead to, to
Crohn's disease as well . What
Speaker 2 (03:46):
About diet? Does that affect It doesn't cause
it,
Speaker 3 (03:48):
It doesn't cause it , uh, so diet may play a role .
We have yet to identify aspecific food or a specific
food group that is the cause.
But certainly there's apossibility that something that
we ingest helps to precipitatethe inflammation. So
Speaker 2 (04:02):
How common is it?
Speaker 3 (04:03):
It is something we see pretty frequently in our
clinic. So estimates I've seenrecently estimate between , uh,
half to a million people in theUnited States have Crohn's
disease. Upwards of seven or 8million people across the globe
have inflammatory boweldisease, which again, is that
combination of Crohn's diseaseand ulcerative colitis, but
it's definitely out there.
Speaker 2 (04:22):
So that's a lot,
Speaker 3 (04:23):
A lot of
Speaker 2 (04:24):
People. Yeah. This isn't, I wouldn't call rare.
It's maybe not, you know, superduper common. It's not like
high blood pressure, but thisis not a rare disorder. You see
it all the time. I , I see itin my clinic, in , in a primary
care practice. Yeah . And I ,and listeners, what I do when I
do see it is send , I send itto guys like , uh, Dr. Ekman
before I move on to like, whatdoes it look like, signs and
symptoms, what , why the wordCrohn's disease and , okay.
(04:45):
Listeners, nobody can spell iteither. So if you don't know
how to spell it , uh, I got ,it's C-R-O-H-N, Crohn . It must
be some guy.
Speaker 3 (04:55):
It is exactly that.
Some guy who, who firstdescribed this sort of
constellation of, ofinflammation throughout the
intestines and, and it actuallyis Crohn disease. Oh,
Speaker 2 (05:05):
It's Crohn . I've been saying Crohn's the whole
time. And I've been, and
Speaker 3 (05:08):
You'll hear me say Crohn's disease as well, but it
, it really, if , if you lookin the literature, it is
C-R-O-H-N disease.
Speaker 2 (05:14):
No. Apostrophe. Yes . Okay . Well , okay. I'm, I've
been doing this for 25 yearsand I, I think I've been
getting that wrong.
Speaker 3 (05:20):
You know, it's not just his disease, it's all of
our disease . It's
Speaker 2 (05:23):
All of our disease.
It's just like Lyme disease.
It's Lyme, it's not Lyme since, so it's the same as the true
for Crohn , and it isC-R-O-H-N. And if there's
anything in a medicalliterature or medical document
in a chart that's misspelledmore often than Crohn's
disease, I don't know what itis . Okay. So now that we've
tackled that before we get moveon from that , uh, we're always
naming things after, usuallysome guy from 50 years ago, a
(05:46):
hundred years ago, 150 yearsago. So we're kind of getting
away from that in, in medicalscience. So I wonder what it'll
be called in the future, butright now it's still Crohn's
disease. Okay. Symptoms. Whenpatients come to see you, what,
what are they telling youthey're experiencing?
Speaker 3 (06:00):
So most commonly we see patients come in with
abdominal pain and, and , andlongstanding diarrhea. So
lasting several weeks. Uh, thediarrhea is frequently bloody,
but it's not always weightloss, nausea, vomiting, fever,
often seen as well. And tocomplicate things even further,
people have symptoms outside oftheir GI system. So , uh, skin
(06:20):
rashes, eye problems, jointpain can all be associated with
Crohn's disease as well.
Speaker 2 (06:25):
And so those could be caused by lots of things.
Speaker 3 (06:27):
Uh , that's what makes it so challenging to
diagnose. Uh, how
Speaker 2 (06:29):
Often do you see what, what sounded like more
serious symptoms? Fever, bloodydiarrhea. Because I think
there's a lot of listenersright now who are going, well,
yeah, I got loose stools, Ihave diarrhea all the time, but
probably fewer are saying,yeah, and emol , I've got a
fever and I got weight loss,and I got blood in my stool.
How often do you see those?
Speaker 3 (06:48):
So they're, they're probably the more commonly seen
in patients with Crohn disease.
You know, patients who haveloose stools or, or mild
abdominal pain for otherreasons could have Crohn's
disease, but more likely otherconditions leading to that. Uh,
but I'd say the majority ofpatients with Crohn disease
have at least one or more ofthose more severe symptoms.
Speaker 2 (07:05):
So when should somebody seek attention,
particularly from a specialistlike you ? Because I'm just
trying to imagine peoplelistening to this and how many
people are saying, yeah, I haveloose stools. I do, I have 'em
almost all the time. Whenshould they come see somebody?
Speaker 3 (07:21):
Well, if , if you're having loose stools almost all
the time, I , you shouldprobably come see us. And , and
again, it may be chrome , itmay be something different,
but, but certainly worthtalking to us. You know, we've
all experienced short-livedsymptoms, you know, nausea,
vomiting, abdominal pain,diarrhea, and, you know, nine
times outta 10, that's a GIbug. Food poisoning, something
like that lasts for a few days,passes on its own. But you
(07:42):
know, if these symptoms startto last 2, 3, 4 more weeks ,
uh, maybe you start losingweight, you start to see that
blood in your stool, at thatpoint, you should start
thinking more about a chronicdisease like Crohn disease. To
be honest, severe complicationscan develop from ignoring these
symptoms. And so it's, it'sreally important to get on top
of them early.
Speaker 2 (08:00):
I was gonna ask you about that. Is there a , is
there a benefit to finding outabout it earlier in the course?
Speaker 3 (08:06):
Absolutely. So as that inflammation progresses
throughout the gastrointestinalsystem, we see things like
fistulas, which are abnormalconnections between loops of
bowel. We see strictures, whichis essentially scar tissue ,
tissue , uh, leading tonarrowing of the intestines. We
can see perforations or holesin the intestine. And, and that
longstanding inflammation caneven lead to colon cancer in
(08:26):
some situations. So, so someearly is
Speaker 2 (08:28):
Better, some fairly unsavory things that can happen
later in the disease.
Absolutely . So how do youdiagnose Crohn's disease?
Speaker 3 (08:35):
So it's really a combination of a lot of things.
You know, first we'll see youin clinic with the symptoms
that we've talked about. We'lloften get lab tests on that
day. We'll do a physicalexamination as well, and then
see if we can get a sense forwhere that abdominal pain might
be coming from. The next stepis typically a scope, so a
colonoscopy, maybe an upperendoscopy depending on your
symptoms. This allows us tolook directly the , on the
(08:57):
inside of your intestines and,and see what's involved. And
even take samples to confirmthe diagnosis. And we'll often
obtain an image imaging studyas well, something like a CT
scan or an MRI to help get anidea both of, of where the ,
the Crohn's disease isinvolving your system, as well
as any complications that we'vetalked about.
Speaker 2 (09:15):
So you're the guy at the control end of that
colonoscopy. You're, you've gotthe controls in your hand,
you've got the machine, you'vegot your video monitor. All the
rest of us are at the businessend. We're at the other end of
the colonoscopy. Could you giveus the insider's take on what
does Crohn disease look likewhen you're in there versus
what a normal colon looks like?
(09:37):
What are you looking for?
Speaker 3 (09:39):
Yeah, so again, going back to that analogy that
I, I talked about earlier withthe , the rash on your skin.
You know , uh, normal lookingskin is quite smooth and
healthy appearing. Same withthe inside of your intestines.
Uh, we see a very smooth, shinyhealth appearing mucosa when
patients have Crohn's disease.
We see a lot of redness,irritation, we can see very
(09:59):
deep ulcers. And all of thesethings are , uh, a strong sign
that something wrong is goingon. So
Speaker 2 (10:04):
You can visualize it and see this doesn't look
normal,
Speaker 3 (10:07):
Can definitely tell it doesn't look normal. I can't
guarantee a hundred percentjust looking at it that it's
Crohn's disease, but I cancertainly get to the point
where I can take samples and,and confirm the diagnosis.
Speaker 2 (10:17):
So when you're taking a sample or a biopsy of
someone's intestinal wall, howdo you do that? 'cause I, I've,
I've talked to a lot of peoplesaying what they're gonna ,
he's gonna take a chunk outtamy, you know, it's not a chunk
Speaker 3 (10:30):
Yeah, so we have what's called a working channel
in our camera. So it's, it's areally long flexible tube that
we use to visualize inside theintestine,
Speaker 2 (10:38):
Long being the key word .
Speaker 3 (10:39):
Yep . Long and soft.
It , uh, you know , okay,
Speaker 2 (10:41):
It's soft and flexible
Speaker 3 (10:42):
very, very small , uh,instrument called the forceps,
which is essentially a, amicroscopic tweezers that'll
take like a millimeter sampleout of the intestines. You
can't feel it, you won't noticethat it's gone, but it gives us
enough information to get thediagnosis.
Speaker 2 (10:58):
And then you send that little, you pull it
through the , your, your scopeback out and you put it in a
jar or whatever, and you sendit off to a lab. And that's how
you can make the definitivediagnosis.
Speaker 3 (11:06):
Exactly. We ask for, for help from our friends in
the pathology lab to, to tellus what we saw.
Speaker 2 (11:11):
Okay. So that's the diagnosis. We're talking to Dr.
Jason Ekman. He is agastroenterologist and we're
diving into Crohn's Disease.
And right now we're gonna takea short break now that we have
the foundation of what Crohndisease really is, when we come
back, we're gonna discuss whatit's like to live with Crohn's
Disease and what treatments areavailable. And I'm here to tell
you there's a lot moretreatments than there used to
(11:32):
be. I'm gonna ask Jason whatthe future looks like for
Crohn's disease and what peopleneed to know who are living
with Crohn's disease. So stickaround, we'll be right back
Speaker 4 (11:43):
When Hennepin Healthcare says, we're here for
life. They mean here for you,your life, and all that. It
brings Hennepin Healthcare as ahospital, HCMC, a network of
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downtown Minneapolis. Theyprovide all of the primary and
specialty care you'd expect tofind, as well as services like
(12:04):
acupuncture and chiropracticcare. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (12:21):
And we're back talking with Dr. Jason Ekman
about Crohn's disease, one ofthe inflammatory bowel
diseases. He is agastroenterologist at Hennepin
Healthcare. Dr. Ackman , let'stalk a little bit about the
impacts on people's daily life.
Can you share with us what youhear from patients about how
their Crohn's disease canaffect their daily life?
Speaker 3 (12:40):
Yeah, you know, it's, it's a disease that
really has wide ranging effectson, on all facets of life. Can
be difficult to go to work, toschool, to socialize, raise a
family, just deal with, withbasic life, with a lot of the
symptoms we've talked about.
For example, eating out or evenin a eating in at at home can
be challenging when you havenausea, when you're worried
that that next meal is gonnasend you a run into the
(13:02):
bathroom. So patients areconstantly vigilant of where
the nearest bathroom is, howquickly they can get there, and
a lot of logistical challengeslike that. So, you know, both
these physical and emotionalsymptoms really wear you down
with time.
Speaker 2 (13:14):
Is there much pain associated with it?
Speaker 3 (13:17):
Absolutely. Uh , again, physical and emotional,
right? But , uh, you know,abdominal pain, that
inflammation really can, canmake your, your stomach hurt
quite a bit.
Speaker 2 (13:25):
So what advice do you give people? Uh , we're
gonna get into some of thetreatments to actually relieve
these symptoms, but it's notcurable really.
Speaker 3 (13:32):
That's correct. It is not curable from the sense
that in the traditional sense ,cancer can be cured in certain
C circumstances. It's a chronicdisease, you live with it the
rest of your life, but like yousaid, we will get more into to
, to medications and, andtreatment options. But we do
have good options there.
Speaker 2 (13:45):
Yeah, there's some really good options. Now. There
can be, actually my patientshave said kind of life changing
for them. What advice do yougive people though, while
you're getting 'em into sometreatments with the hope for
some better results in thefuture? What kind of , of , uh,
what advice do you tell people?
Speaker 3 (14:00):
Uh , you know, I think it's, it's important to
be pragmatic. So if you'reliving with Crohn's Disease,
you know, taking that trip upto the boundary waters for a
week or an international flightmay not be , oh my goodness,
you know, the best decision ifyour symptoms aren't under
great control. Um, but once youget on the right medications,
stay on the right medications,most patients can leave
essentially pretty normallives, maybe working around
their medication schedule. But, but otherwise they do quite
(14:22):
well. So I really stress theimportance of getting on and
staying on the rightmedications.
Speaker 2 (14:26):
So you mentioned earlier there are some
long-term potentialcomplications, particularly
with untreated Crohn's disease,and some of those were, were
fairly significant. Does thedisease, if, if, if it
progresses lead to a shorterlife expectancy? In other
words, is it a life-threateningillness?
Speaker 3 (14:42):
It can be a life-threatening illness. And,
and certainly we, we seepatients in the hospital with,
with very severe symptoms that,that are , are in a
life-threatening situation.
There are patients with verysevere disease that probably
have , uh, a slight decrease intheir life expectancy. But most
patients, again, when they geton the right medications and
stay on those medications , uh,they live very normal lives
(15:04):
that , uh, shouldn't reallysignificantly decrease their
life expectancy.
Speaker 2 (15:06):
So that's, that's hopeful. Mm-hmm
Um , what about some of theother complications you talked
about in our first half of theshow? You mentioned things like
fistulas and increased coloncancer risk . Could you say a
little bit more about that? I'mgonna imagine that lots of
people don't really know what afistula is.
Speaker 3 (15:23):
Yeah. So a a fistula is basically develops when you
have a lot of inflammation andit hooks up or, or connects
loops of bowel that shouldn'tbe connected and bypasses large
amounts of the intestine, whichcan lead to, to problems with
absorption of nutrients. Hencethat weight loss we talked
about and some of the othersymptoms
Speaker 2 (15:42):
And fistulas can be fixed or is that just like a ,
something you live with?
Speaker 3 (15:46):
No fistulas can be fixed sometimes just treating
with the right medications andreducing that inflammation
allows those to close up. Um,but sometimes surgery is needed
as well.
Speaker 2 (15:54):
Okay. Let's get into some of the treatments. So
starting out with , uh,immediate treatments for
symptom relief. And then let'sget a little bit more into the
long-term medications that areavailable now for treating it.
Sure.
Speaker 3 (16:08):
That's, and that's a great , um, distinction to
make. You know, we use thingscalled steroids, which , uh,
are different than maybe thesteroids you think about for
bodybuilding, but these arevery potent anti-inflammatory
medications that act veryquickly and are very effective
for almost all patients thatreally reducing that
inflammation and therefore thesymptoms right
Speaker 2 (16:26):
Away. Yeah. So these are corticosteroids, they're
powerful anti-inflammatories.
I've talked about steroids alot on the show and I'm never
referring to the bodybuildertype listeners.
always talking about the Sothey're aware. Yeah . Well, I
don't know if they're aware. Ialways say it if we're not
talking about what you mightthink, but I have said on the
show Yeah , steroids, they kindof cure what ails you . Yeah .
Because they're ananti-inflammatory and they sort
(16:47):
of calm everything downregardless of where the
inflammation is. So does thathelp in people's symptoms when
they take Absolutely.
Prednisone or something
Speaker 3 (16:54):
Similar ? Yeah, exactly. You know, patients
within a few days to a weekfeel typically much, much
better. The downside , whichyou may have talked about on
the show previously, as well aswell,
Speaker 2 (17:02):
Tell us what they are 'cause I haven't lately .
Speaker 3 (17:03):
Sure, yeah. So , um, there's a lot of side effects
that can arise from takinglong-term steroids. Things like
diabetes, things like poorsleep, weight gain, and
immunosuppression, meaning ,uh, increased risk of
infection. Yeah .
Speaker 2 (17:14):
You really don't wanna be on steroids if you can
help it. That's true for yourwhole life. But that's kind of
what we had for the longesttime. Right . Yeah. And then we
had some other things you , yougave enemas and this, that and
the other thing. What are someof the other symptomatic relief
things people can take?
Speaker 3 (17:28):
Uh , from a symptom standpoint? You know, we can
take pain medications likeTylenol , uh, which, which can
help to some degree . We cantake antidiarrhea medications
like Loperamide or Imodium ,uh, but those are really sort
of a bandaid approach. You're ,you're helping with the
symptoms, but you're notdirectly affecting the
underlying disease.
Speaker 2 (17:45):
Right. It doesn't get at the causes at all. Okay.
So let's talk about what's comeout in the last 5, 10, 15 years
and there's now what I wouldprobably venture to say is the
mainstay of treatment ofCrohn's disease, the biologics,
what I refer to as biologics.
Could you talk about those?
Speaker 3 (18:01):
Sure. I think, you know , maybe before we move on
to the biologics , uh, we, wehad and still have a class of
medications calledimmunomodulators, which were
very common for, for decades,and they're still used to some
degree. Um, these decreasedinflammation very effectively
and can be used longer term .
Um, but , uh, you know, theytend to have a bit more side
effects and need more frequentmonitoring, and that's where
(18:24):
the advent of, of thesebiologic medications has really
been helpful.
Speaker 2 (18:27):
Yeah, thanks for that reminder, because I, I
skipped over a whole class ofmedicines there, these immune
modulators. What are some ofthose?
Speaker 3 (18:33):
So azathioprine is probably the most common one
you'll hear about. Um, there'sone called six Mercaptopurine,
another one calledmethotrexate. Um, all are , are
quite effective medications fora lot of patients. But, but
again, with some of thelong-term side effects, we've,
I think are, are moving awayfrom those and more towards the
biologics.
Speaker 2 (18:51):
If your physician does recommend azathioprine or
six mp , those are stillaccepted treatments?
Speaker 3 (18:56):
Absolutely. I still use them. Uh , and sometimes I
use them in combination withothers, sometimes on their own.
But , uh, they are still veryacceptable
Speaker 2 (19:03):
Treatments and those have been around a long
Speaker 3 (19:04):
Time. They have been for a lot of different
diseases.
Speaker 2 (19:06):
Yeah. People might be familiar with those from a
variety of things. Mm-hmm
that I alluded to earlier,these are the most modern, for
lack of a better word,treatments. Tell , talk to us
about those. Yeah,
Speaker 3 (19:18):
Absolutely. These, these really have become the
mainstay of treatment over thepast couple decades probably.
Um, and these target, theinflammatory cascade we call
it. So basically the process ofinflammation within the body,
they're very effective, they'rebetter tolerated , uh, than ,
and some of the othermedications we've talked about,
the downside to a lot of themis that they're often given
(19:39):
through the vein, sointravenously or
subcutaneously, meaning underthe skin, which can be a bit of
a hassle for some people, butYeah .
Speaker 2 (19:46):
You're not just taking the daily pill.
Speaker 3 (19:46):
Correct. Um, but, but they are so effective , uh,
and , and they work so wellthat patients tend to be okay
with dealing with thatinconvenience.
Speaker 2 (19:54):
How often do you have to do that or , I know it
varies. It does
Speaker 3 (19:57):
Vary,
Speaker 2 (19:57):
But it's not every
Speaker 3 (19:58):
Day. It's not every day . So usually it's anywhere
between every two weeks toevery eight
Speaker 2 (20:02):
Weeks. There's another downside to the
biologics is that you can'tpronounce any of 'em . That's
true.
Speaker 3 (20:07):
But
companies have come up withcatchy names that we can say
easily . I know,
Speaker 2 (20:12):
And I , and I will tell listeners , um, uh, I have
a , an issue with advertisingof medications, but if you're
watching TV and you see some ofthese medications with all
these bizarre names, if youlook kind of closely at the, at
the generic name that theysometimes put on the screen, it
usually ends in an AB or an ib. There are too many syllables
(20:33):
and there's too many consonantsin there, but those are the
medications we're talkingabout. Exactly. And , and
they're, they're, they'reasking you to go ask your
doctor if such and such isright for you. That's kind of
what the biologics are. Butthat cynical side, put that
aside, they're highlyeffective,
Speaker 3 (20:49):
They're very effective. And, and sometimes
we try one and maybe it doesn'twork, but you can almost always
find a different one that worksin a different way that'll,
that'll work for a patient.
Speaker 2 (20:57):
What types of side effects might people get? You
said they're fairly welltolerated, probably a lot fewer
side effects than say,prednisone and the steroids.
Speaker 3 (21:05):
Definitely. So the most common are, are mild
infusion or injectionreactions. Uh, more serious
side effects would be , uh,infection. It does suppress the
immune system. And so you're ata slightly increased risk for
things like, you know, coldsor, or other mild infections
like that. There are , uh, somemuch lower risk of things like
developing skin cancer orlymphoma, but those are
(21:28):
incredibly rare and, and , uh,something we can keep an eye
out for before they hit.
Speaker 2 (21:33):
So these more advanced medications, are they
treating symptoms or are theyactually doing anything to the
underlying disease process?
Speaker 3 (21:41):
So they're doing both, you know, by addressing
the underlying inflammation anddisease process , uh, patients
will also feel better.
Speaker 2 (21:48):
Does it affect the, the long-term course of the
disease or don't we know that?
So in other words, are yougonna be the, a different
person 20 or 30 years down theroad because you took these
now?
Speaker 3 (21:59):
Probably. So, as I think I alluded to earlier, if
you don't treat disease earlyon, the disease can progress.
That inflammation leads to allthese complications we talked
about. So by getting on thatmedication early, and again,
I'll stress it, staying on thatmedication, even if you're
feeling well , uh, thatprevents flare-ups of your
disease, inflammation comingback and, and can hopefully
(22:20):
reduce the likelihood thatthese complications arise.
Speaker 2 (22:23):
You alluded to surgery earlier. Uh, and
patients do ask me that a lot.
Is there a surgery for this?
What do you say to that?
Speaker 3 (22:30):
A lot of patients end up needing surgery , uh,
for Crohn's disease. What
Speaker 2 (22:34):
Do they do? So
Speaker 3 (22:34):
What they typically do in these situations, we, we
do surgery for one of tworeasons. One is we can't find a
medication that is effectivelytreating the inflammation. And
in those circumstances, we cantry to remove that area of the
intestines that are inflamed.
The challenge there though isthat Crohn's disease can affect
anywhere within the intestines.
So we take that area out, it'sa little bit like whack-a-mole,
you know, it can pop up againstsomewhere else in the bowel.
(22:56):
Right.
Speaker 2 (22:56):
You said mouth to anus. Right. How do you know
what to take out? You can'ttake, can't take it all
Speaker 3 (23:00):
Speaker 2 (23:01):
Yeah , you can't take all that out.
Speaker 3 (23:02):
Yeah. So you take out the area that you know is
causing the problem now and,and then you hope that you can
get a patient on a medicationand, and prevent it from
flaring up elsewhere. The otherreason we would do surgery is
developing any of thosecomplications we talked about
earlier. So the fistulas, thestrictures, the perforations ,
uh, we do surgery then to, toremove those areas that are
problematic.
Speaker 2 (23:22):
I do wanna go back briefly to ulcerative colitis,
the other big inflammatorybowel disease because isn't
surgery a little morestraightforward in that case?
Speaker 3 (23:31):
It is. We, we often approach it in a similar way,
meaning if there's been acomplication or if we can't get
your symptoms under controlwith medications, we, we pursue
surgery, but as I talked aboutearlier with colitis, meaning
colon, by definition,ulcerative colitis only affects
the colon. So, so
Speaker 2 (23:46):
You know where it is a little bit better,
Speaker 3 (23:48):
We can essentially cure ulcerative colitis by
fully removing the colon withsurgery if need be. So
Speaker 2 (23:54):
Back to Crohn's disease, is there a certain
place in your GI tract frommouth to anus, the whole thing?
Is there a place where it'smost common?
Speaker 3 (24:03):
It's most commonly seen at the very end of the
small intestine, which iscalled the ileum, and then the
very first part of the colon,which is called the cecum . And
so ileocecal Crohn's is themost common , uh, way we see
it, but
Speaker 2 (24:15):
Right at the farthest end of what you can
see with a colonoscope, right?
Correct. So you can see it inthat place. Yep .
Speaker 3 (24:21):
Probably three quarters or more of the time we
can find Crohn's in that area.
Uh , and then elsewhere in thecolon or the small intestine is
a little bit harder to, to findthere.
Speaker 2 (24:29):
How does one find it in the 20 foot long small
intestine
Speaker 3 (24:34):
That, that is true, thankfully. For, for my job and
for patients. Can you
Speaker 2 (24:37):
Imagine that the five foot long Yeah . Scope .
They use it for thecolonoscopies long enough?
Speaker 3 (24:42):
Yeah. Long but not that long. Yeah . So , uh, what
we do is either use imaging, sothe CT scans the MRIs that I
talked about earlier, or wehave something called video
capsule endoscopy or colloquial, uh, the pill cam , which is
essentially a , a large pillthat people swallow with a
camera in it that takespictures every, every couple
seconds , uh, and traverses thewhole length of the intestines
(25:04):
and can give us some goodpictures of, of what's going
on.
Speaker 2 (25:06):
People ask me a lot about the, the camera that you
swallow mm-hmm
That's what you're talkingabout, right ?
Speaker 3 (25:11):
Pill cam . Exactly.
Yeah.
Speaker 2 (25:13):
Um, and that must be a heck of a deal to look at
those pictures. You gothundreds, thousands of pictures
of the inside of someone'sintestines. They must all start
to kind of look alike.
Speaker 3 (25:22):
That's not the most exciting part of our job. Do
you
Speaker 2 (25:24):
Read those?
Speaker 3 (25:26):
Uh, thankfully I do.
Not yet, but I'm sure it'scoming down the pipeline
Speaker 2 (25:29):
For me.
who gets to look at thousandsof pictures of the inside of
someone's intestines. Notexactly as good as looking at
someone's vacation photos. Hey. Right. Okay. I would like to
, um, before I let you go, talka little bit about the future.
What might be down the roadthat you're aware of, either in
research, new medications , uh,what does the future look like
(25:50):
for people living with Crohn'sdisease?
Speaker 3 (25:52):
Yeah, so, you know, as you alluded to, not too long
ago, we only had a fewmedications available to us.
And, and now it seems likeevery few months or every year
we have a new medication. Everyfew years we have, you know, a
new class of medications thatwe can use to, to help treat
patients, which is, which isreally exciting. It's a very
active area of research. And Ithink the genetic component as
(26:12):
well is probably gonna comeinto to play quite a bit more
where we're able to identifycertain medications that will
be more effective for certainpeople depending on their
genetic makeup. So
Speaker 2 (26:22):
A little less trial and error. Hey, try this, see
if it works, and then trysomething else. See if it
works. I'm , I'm being a little, uh, flippant about it, but
sometimes we have to trymedicine. See if it works for
you.
Speaker 3 (26:32):
Exactly. You never know who's gonna respond to
which medication.
Speaker 2 (26:35):
Right. And wouldn't that be great if we knew ahead
of time, hey, the genetic typethat you have, this is the
medication that might work with, that's exciting. Exactly. So
that's actually quiteencouraging. Mm-hmm
people , uh, living withinflammatory bowel disease?
Speaker 3 (26:49):
You know, I think a , a great resource is the
Crohn's and Colitis Foundation.
Uh, people may already be awareof that, but they're probably
the largest organization ofboth experts and patients , uh,
who are involved in, in Crohn'sdisease and ulcerative colitis.
There are a lot of greatresources on their website ,
uh, ranging from just goodinformation about the disease
as well as community resourcesget togethers and, and , uh,
(27:12):
crowdsourcing of, of differenttechniques and approaches to
dealing with life withinflammatory bowel disease. And
Speaker 2 (27:17):
Listeners, we'll put a link to those in our show
notes, so be sure to checkthose out. Dr. Jason Ekman,
what would you leave listeners,if you had a bit of advice to
leave about this topic, whatwould that be?
Speaker 3 (27:30):
So I think one important thing is, is really
listening to your body andlistening to your symptoms. As
we've talked about, I thinkseveral times already, you
know, we don't wanna leaveCrohn's Disease undiagnosed and
untreated for a long time. Theother thing is, is , you know,
Crohn is a scary disease. And,and you hear people like me
today saying, well, we don'tfully understand it. And , and
(27:51):
that can sound very scary tosomebody diagnosed with Crohn's
disease, but I just reallywanna reiterate that we have
great medications and so if ,if you come to see us in clinic
and we make this diagnosis, we,we really can help you.
Speaker 2 (28:02):
Thank you for that.
I personally have sent peopleto the gastroenterologist at
Hennepin Healthcare, includingDr. Eckman with some kind of
scary symptoms. They haddiarrhea for ages or losing
weight. They're in pain. Anddue to the expert treatments
available and the expertisethat's available, their lives
were actually changed for thebetter. There is a lot of hope
on the future and thetreatments available for you if
(28:24):
you're living with Crohn'sDisease. And this is a friendly
reminder. If you're havingsymptoms, you'll know you don't
know what they are. Please doseek help. Go to your primary
care physician or otherclinician, go to a
gastroenterologist. There ishelp available for you. Jason,
thanks for being on the showtoday.
Speaker 3 (28:39):
Thanks for having me.
Speaker 2 (28:40):
It's been a great conversation about Crohn
Disease and listeners, I hopeyou've picked up some
information that's useful toyou. And I want to thank you
for joining us for the podcast,and I hope you'll join us in
two weeks time when we dropanother episode. And in the
meantime, be healthy and bewell.
Speaker 1 (28:56):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(29:18):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(29:40):
time, be healthy and be well.
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