Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:19

Hey everybody, and welcome to episode 14 of the Healthy Matters podcast. I'm your host, Dr. David Hilton, and thank you for tuning in today. So let me ask you this, have you ever heard someone mention Crohn's Disease and thought, wait, is that that stomach thing or is that IBS? Is it IBD? Well, don't worry, you're not alone today. We're tackling what Crohn's disease is, how it affects people, what causes it, and what treatments look like in real life To help us make sense of it, I am joined by Dr. Jason Ekman . He is a gastroenterologist in Hennepin Healthcare right here in downtown Minneapolis, and he specializes in diagnosing and treating conditions like this one, and he's helped countless patients navigate life with Crohn's disease. So, Jason, welcome to the podcast.

Speaker 3: 1:03

Thank you very much for having me. Great to

Speaker 2: 1:05

Have you here. So start with the basics, if you would, in the most basic terms, what is Crohn's disease?

Speaker 3: 1:11

Yeah. So at its most basic, Crohn's disease is a condition where the body attacks the lining of the intestines leading to inflammation.

Speaker 2: 1:17

So why is that a problem?

Speaker 3: 1:18

Well, it's a problem because inflammation leads to a lot of really uncomfortable symptoms that can really affect your quality of life.

Speaker 2: 1:24

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: 1:31

Disease is a type of inflammatory bowel disease. Ulcerative colitis would be the other main camp.

Speaker 2: 1:36

Okay. So we're not gonna talk tons about ulcerative colitis today, but can you summarize how they're different?

Speaker 3: 1:43

Sure. So ulcerative colitis by definition is inflammation of the colon. So colitis means inflamed colon. Crohn disease can involve the colon, but it can also involve anywhere else in the gastrointestinal system, anywhere from the mouth to the anus.

Speaker 2: 1:56

Okay. So we're gonna be talking about a specific kind of inflammatory bowel disease, Crohn's disease today. Paint a picture for us. If I were to visualize what does inflammation of the bowel wall look like? What is what and why is that a problem? Sure.

Speaker 3: 2:11

So just like we have skin on the outside of our body, and that skin can be inflamed and have rashes and bruises and cuts , uh, so to the inside of our intestines has a skin, if you will, as well, called mucosa. And so when that skin gets inflamed and the inside of your intestines, it leads to the pain and the discomfort and everything else we'll talk about with, with Crohn's

Speaker 2: 2:32

Disease. And there's lots of causes of that, right. Of inflammation, not of Crohn's, but I mean absolutely. You can have lots of reasons. Your intestinal wall can be inflamed.

Speaker 3: 2:39

Sure. Anywhere from infections to to foods you eat to conditions like inflammatory bowel disease .

Speaker 2: 2:45

Okay. So let's talk about causes. Who gets Crohn's disease and, and why?

Speaker 3: 2:49

So anybody can get Crohn's disease, but uh, the most common people we see that in is patients aged about 15 to 30 years old. Oh , that's young. 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 get it. And we also see a second peak later in life, sort of between the ages of 50 and 80 as well, for reasons that we don't quite fully understand.

Speaker 2: 3:12

Do we know why people get it?

Speaker 3: 3:13

So that's a complicated question. Uh, you know, it's, it's not just one specific thing. So there's definitely a genetic component. Uh, we do see that people with a family history, especially in parents or siblings , uh, are more likely to get Crohn's disease than people without that. But that being said, people without a family history can certainly get Crohn's disease as well. And then there's also likely a , an environmental component, if you will. So , uh, things that we're exposed to, like certain infections potentially , um, ingestions , uh, other sorts of illnesses can lead to, to Crohn's disease as well . What

Speaker 2: 3:46

About diet? Does that affect It doesn't cause it,

Speaker 3: 3:48

It doesn't cause it , uh, so diet may play a role . We have yet to identify a specific food or a specific food group that is the cause. But certainly there's a possibility that something that we ingest helps to precipitate the inflammation. So

Speaker 2: 4:02

How common is it?

Speaker 3: 4:03

It is something we see pretty frequently in our clinic. So estimates I've seen recently estimate between , uh, half to a million people in the United States have Crohn's disease. Upwards of seven or 8 million people across the globe have inflammatory bowel disease, which again, is that combination of Crohn's disease and ulcerative colitis, but it's definitely out there.

Speaker 2: 4:22

So that's a lot,

Speaker 3: 4:23

A lot of

Speaker 2: 4:24

People. Yeah. This isn't, I wouldn't call rare. It's maybe not, you know, super duper common. It's not like high blood pressure, but this is not a rare disorder. You see it all the time. I , I see it in 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 it to guys like , uh, Dr. Ekman before I move on to like, what does it look like, signs and symptoms, what , why the word Crohn's disease and , okay. Listeners, nobody can spell it either. 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: 4:55

It is exactly that. Some guy who, who first described this sort of constellation of, of inflammation throughout the intestines and, and it actually is Crohn disease. Oh,

Speaker 2: 5:05

It's Crohn . I've been saying Crohn's the whole time. And I've been, and

Speaker 3: 5:08

You'll hear me say Crohn's disease as well, but it , it really, if , if you look in the literature, it is C-R-O-H-N disease.

Speaker 2: 5:14

No. Apostrophe. Yes . Okay . Well , okay. I'm, I've been doing this for 25 years and I, I think I've been getting that wrong.

Speaker 3: 5:20

You know, it's not just his disease, it's all of our disease . It's

Speaker 2: 5:23

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 is C-R-O-H-N. And if there's anything in a medical literature or medical document in a chart that's misspelled more often than Crohn's disease, I don't know what it is . Okay. So now that we've tackled that before we get move on from that , uh, we're always naming things after, usually some guy from 50 years ago, a hundred years ago, 150 years ago. So we're kind of getting away from that in, in medical science. So I wonder what it'll be called in the future, but right now it's still Crohn's disease. Okay. Symptoms. When patients come to see you, what, what are they telling you they're experiencing?

Speaker 3: 6:00

So most commonly we see patients come in with abdominal pain and, and , and longstanding diarrhea. So lasting several weeks. Uh, the diarrhea is frequently bloody, but it's not always weight loss, nausea, vomiting, fever, often seen as well. And to complicate things even further, people have symptoms outside of their GI system. So , uh, skin rashes, eye problems, joint pain can all be associated with Crohn's disease as well.

Speaker 2: 6:25

And so those could be caused by lots of things.

Speaker 3: 6:27

Uh , that's what makes it so challenging to diagnose. Uh, how

Speaker 2: 6:29

Often do you see what, what sounded like more serious symptoms? Fever, bloody diarrhea. Because I think there's a lot of listeners right now who are going, well, yeah, I got loose stools, I have 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: 6:48

So they're, they're probably the more commonly seen in patients with Crohn disease. You know, patients who have loose stools or, or mild abdominal pain for other reasons could have Crohn's disease, but more likely other conditions leading to that. Uh, but I'd say the majority of patients with Crohn disease have at least one or more of those more severe symptoms.

Speaker 2: 7:05

So when should somebody seek attention, particularly from a specialist like you ? Because I'm just trying to imagine people listening to this and how many people are saying, yeah, I have loose stools. I do, I have 'em almost all the time. When should they come see somebody?

Speaker 3: 7:21

Well, if , if you're having loose stools almost all the time, I , you should probably come see us. And , and again, it may be chrome , it may be something different, but, but certainly worth talking to us. You know, we've all experienced short-lived symptoms, you know, nausea, vomiting, abdominal pain, diarrhea, and, you know, nine times outta 10, that's a GI bug. Food poisoning, something like that lasts for a few days, passes on its own. But you know, if these symptoms start to last 2, 3, 4 more weeks , uh, maybe you start losing weight, you start to see that blood in your stool, at that point, you should start thinking more about a chronic disease like Crohn disease. To be honest, severe complications can develop from ignoring these symptoms. And so it's, it's really important to get on top of them early.

Speaker 2: 8:00

I was gonna ask you about that. Is there a , is there a benefit to finding out about it earlier in the course?

Speaker 3: 8:06

Absolutely. So as that inflammation progresses throughout the gastrointestinal system, we see things like fistulas, which are abnormal connections between loops of bowel. We see strictures, which is essentially scar tissue , tissue , uh, leading to narrowing of the intestines. We can see perforations or holes in the intestine. And, and that longstanding inflammation can even lead to colon cancer in some situations. So, so some early is

Speaker 2: 8:28

Better, some fairly unsavory things that can happen later in the disease. Absolutely . So how do you diagnose Crohn's disease?

Speaker 3: 8:35

So it's really a combination of a lot of things. You know, first we'll see you in clinic with the symptoms that we've talked about. We'll often get lab tests on that day. We'll do a physical examination as well, and then see if we can get a sense for where that abdominal pain might be coming from. The next step is typically a scope, so a colonoscopy, maybe an upper endoscopy depending on your symptoms. This allows us to look directly the , on the inside of your intestines and, and see what's involved. And even take samples to confirm the diagnosis. And we'll often obtain an image imaging study as well, something like a CT scan or an MRI to help get an idea both of, of where the , the Crohn's disease is involving your system, as well as any complications that we've talked about.

Speaker 2: 9:15

So you're the guy at the control end of that colonoscopy. You're, you've got the controls in your hand, you've got the machine, you've got your video monitor. All the rest of us are at the business end. We're at the other end of the colonoscopy. Could you give us the insider's take on what does Crohn disease look like when you're in there versus what a normal colon looks like? What are you looking for?

Speaker 3: 9:39

Yeah, so again, going back to that analogy that I, I talked about earlier with the , the rash on your skin. You know , uh, normal looking skin is quite smooth and healthy appearing. Same with the inside of your intestines. Uh, we see a very smooth, shiny health appearing mucosa when patients have Crohn's disease. We see a lot of redness, irritation, we can see very deep ulcers. And all of these things are , uh, a strong sign that something wrong is going on. 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 percent just looking at it that it's Crohn's disease, but I can certainly 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, how do you do that? 'cause I, I've, I've talked to a lot of people saying what they're gonna , he's gonna take a chunk outta my, you know, it's not a chunk <laugh> , but what do you , how do 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 a really long flexible tube that we use to visualize inside the intestine,

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

<laugh> . Um , and we can, and we can put this very, very small , uh, instrument called the forceps, which is essentially a, a microscopic tweezers that'll take like a millimeter sample out of the intestines. You can't feel it, you won't notice that it's gone, but it gives us enough information to get the diagnosis.

Speaker 2: 10:58

And then you send that little, you pull it through the , your, your scope back out and you put it in a jar or whatever, and you send it off to a lab. And that's how you can make the definitive diagnosis.

Speaker 3: 11:06

Exactly. We ask for, for help from our friends in the pathology lab to, to tell us what we saw.

Speaker 2: 11:11

Okay. So that's the diagnosis. We're talking to Dr. Jason Ekman. He is a gastroenterologist and we're diving into Crohn's Disease. And right now we're gonna take a short break now that we have the foundation of what Crohn disease really is, when we come back, we're gonna discuss what it's like to live with Crohn's Disease and what treatments are available. And I'm here to tell you there's a lot more treatments than there used to be. I'm gonna ask Jason what the future looks like for Crohn's disease and what people need to know who are living with Crohn's disease. So stick around, 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 a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 12:21

And we're back talking with Dr. Jason Ekman about Crohn's disease, one of the inflammatory bowel diseases. He is a gastroenterologist at Hennepin Healthcare. Dr. Ackman , let's talk a little bit about the impacts on people's daily life. Can you share with us what you hear from patients about how their Crohn's disease can affect their daily life?

Speaker 3: 12:40

Yeah, you know, it's, it's a disease that really has wide ranging effects on, on all facets of life. Can be difficult to go to work, to school, to socialize, raise a family, just deal with, with basic life, with a lot of the symptoms we've talked about. For example, eating out or even in a eating in at at home can be challenging when you have nausea, when you're worried that that next meal is gonna send you a run into the bathroom. So patients are constantly vigilant of where the nearest bathroom is, how quickly they can get there, and a lot of logistical challenges like that. So, you know, both these physical and emotional symptoms 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, can make 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 the treatments to actually relieve these symptoms, but it's not curable 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 chronic disease, you live with it the rest of your life, but like you said, we will get more into to , to medications and, and treatment 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 patients have said kind of life changing for them. What advice do you give people though, while you're getting 'em into some treatments with the hope for some better results in the future? 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're living with Crohn's Disease, you know, taking that trip up to the boundary waters for a week or an international flight may not be , oh my goodness, you know, the best decision if your symptoms aren't under great control. Um, but once you get on the right medications, stay on the right medications, most patients can leave essentially pretty normal lives, maybe working around their medication schedule. But , but otherwise they do quite well. So I really stress the importance of getting on and staying on the right medications.

Speaker 2: 14:26

So you mentioned earlier there are some long-term potential complications, particularly with untreated Crohn's disease, and some of those were, were fairly significant. Does the disease, if, if, if it progresses lead to a shorter life expectancy? In other words, is it a life-threatening illness?

Speaker 3: 14:42

It can be a life-threatening illness. And, and certainly we, we see patients in the hospital with, with very severe symptoms that, that are , are in a life-threatening situation. There are patients with very severe disease that probably have , uh, a slight decrease in their life expectancy. But most patients, again, when they get on the right medications and stay on those medications , uh, they live very normal lives that , uh, shouldn't really significantly decrease their life expectancy.

Speaker 2: 15:06

So that's, that's hopeful. Mm-hmm <affirmative> . Um , what about some of the other complications you talked about in our first half of the show? You mentioned things like fistulas and increased colon cancer risk . Could you say a little bit more about that? I'm gonna imagine that lots of people don't really know what a fistula is.

Speaker 3: 15:23

Yeah. So a a fistula is basically develops when you have a lot of inflammation and it hooks up or, or connects loops of bowel that shouldn't be connected and bypasses large amounts of the intestine, which can lead to, to problems with absorption of nutrients. Hence that weight loss we talked about and some of the other symptoms

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 and reducing 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's get a little bit more into the long-term medications that are available now for treating it. Sure.

Speaker 3: 16:08

That's, and that's a great , um, distinction to make. You know, we use things called steroids, which , uh, are different than maybe the steroids you think about for bodybuilding, but these are very potent anti-inflammatory medications that act very quickly and are very effective for almost all patients that really reducing that inflammation and therefore the symptoms right

Speaker 2: 16:26

Away. Yeah. So these are corticosteroids, they're powerful anti-inflammatories. I've talked about steroids a lot on the show and I'm never referring to the bodybuilder type listeners. <laugh> , we're always talking about the So they're aware. Yeah . Well, I don't know if they're aware. I always say it if we're not talking about what you might think, but I have said on the show Yeah , steroids, they kind of cure what ails you . Yeah . Because they're an anti-inflammatory and they sort of calm everything down regardless of where the inflammation is. So does that help 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 week feel typically much, much better. The downside , which you may have talked about on the show previously, as well as well,

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 taking long-term steroids. Things like diabetes, things like poor sleep, 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 your whole life. But that's kind of what we had for the longest time. Right . Yeah. And then we had some other things you , you gave enemas and this, that and the other thing. What are some of the other symptomatic relief things people can take?

Speaker 3: 17:28

Uh , from a symptom standpoint? You know, we can take pain medications like Tylenol , uh, which, which can help to some degree . We can take 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 not directly 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 come out in the last 5, 10, 15 years and there's now what I would probably venture to say is the mainstay of treatment of Crohn'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, we had and still have a class of medications called immunomodulators, which were very common for, for decades, and they're still used to some degree. Um, these decreased inflammation very effectively and can be used longer term . Um, but , uh, you know, they tend to have a bit more side effects and need more frequent monitoring, and that's where the advent of, of these biologic medications has really been helpful.

Speaker 2: 18:27

Yeah, thanks for that reminder, because I, I skipped over a whole class of medicines there, these immune modulators. What are some of those?

Speaker 3: 18:33

So azathioprine is probably the most common one you'll hear about. Um, there's one called six Mercaptopurine, another one called methotrexate. Um, all are , are quite effective medications for a lot of patients. But, but again, with some of the long-term side effects, we've, I think are, are moving away from those and more towards the biologics.

Speaker 2: 18:51

If your physician does recommend azathioprine or six mp , those are still accepted treatments?

Speaker 3: 18:56

Absolutely. I still use them. Uh , and sometimes I use them in combination with others, sometimes on their own. But , uh, they are still very acceptable

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 <affirmative>. 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 the past couple decades probably. Um, and these target, the inflammatory cascade we call it. So basically the process of inflammation within the body, they're very effective, they're better tolerated , uh, than , and some of the other medications we've talked about, the downside to a lot of them is that they're often given through the vein, so intravenously or subcutaneously, meaning under the skin, which can be a bit of a hassle for some people, but Yeah .

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 well that patients tend to be okay with dealing with that inconvenience.

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 to every eight

Speaker 2: 20:02

Weeks. There's another downside to the biologics is that you can't pronounce any of 'em . That's true.

Speaker 3: 20:07

But <laugh> , thankfully the pharmaceutical companies have come up with catchy 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 advertising of medications, but if you're watching TV and you see some of these medications with all these bizarre names, if you look kind of closely at the, at the generic name that they sometimes put on the screen, it usually ends in an AB or an ib . There are too many syllables and there's too many consonants in there, but those are the medications we're talking about. Exactly. And , and they're, they're, they're asking you to go ask your doctor if such and such is right for you. That's kind of what the biologics are. But that cynical side, put that aside, they're highly effective,

Speaker 3: 20:49

They're very effective. And, and sometimes we try one and maybe it doesn't work, but you can almost always find a different one that works in 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 well tolerated, 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 injection reactions. Uh, more serious side effects would be , uh, infection. It does suppress the immune system. And so you're at a slightly increased risk for things like, you know, colds or, or other mild infections like that. There are , uh, some much lower risk of things like developing skin cancer or lymphoma, but those are 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 they actually doing anything to the underlying disease process?

Speaker 3: 21:41

So they're doing both, you know, by addressing the underlying inflammation and disease 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 you gonna be the, a different person 20 or 30 years down the road because you took these now?

Speaker 3: 21:59

Probably. So, as I think I alluded to earlier, if you don't treat disease early on, the disease can progress. That inflammation leads to all these complications we talked about. So by getting on that medication early, and again, I'll stress it, staying on that medication, even if you're feeling well , uh, that prevents flare-ups of your disease, inflammation coming back and, and can hopefully reduce the likelihood that these 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 two reasons. One is we can't find a medication that is effectively treating the inflammation. And in those circumstances, we can try to remove that area of the intestines that are inflamed. The challenge there though is that Crohn's disease can affect anywhere within the intestines. So we take that area out, it's a little bit like whack-a-mole, you know, it can pop up against somewhere else in the bowel. Right.

Speaker 2: 22:56

You said mouth to anus. Right. How do you know what to take out? You can't take, can't take it all

Speaker 3: 23:00

<laugh> .

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 medication and, and prevent it from flaring up elsewhere. The other reason we would do surgery is developing any of those complications we talked about earlier. So the fistulas, the strictures, the perforations , uh, we do surgery then to, to remove those areas that are problematic.

Speaker 2: 23:22

I do wanna go back briefly to ulcerative colitis, the other big inflammatory bowel disease because isn't surgery a little more straightforward in that case?

Speaker 3: 23:31

It is. We, we often approach it in a similar way, meaning if there's been a complication or if we can't get your symptoms under control with medications, we, we pursue surgery, but as I talked about earlier 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 with surgery if need be. So

Speaker 2: 23:54

Back to Crohn's disease, is there a certain place in your GI tract from mouth to anus, the whole thing? Is there a place where it's most common?

Speaker 3: 24:03

It's most commonly seen at the very end of the small intestine, which is called the ileum, and then the very first part of the colon, which is called the cecum . And so ileocecal Crohn's is the most 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 in that 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 the colon or the small intestine is a little bit harder to, to find there.

Speaker 2: 24:29

How does one find it in the 20 foot long small intestine <laugh> ? You can't put 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 the colonoscopies long enough?

Speaker 3: 24:42

Yeah. Long but not that long. Yeah . So , uh, what we do is either use imaging, so the CT scans the MRIs that I talked about earlier, or we have something called video capsule endoscopy or colloquial , uh, the pill cam , which is essentially a , a large pill that people swallow with a camera in it that takes pictures every, every couple seconds , uh, and traverses the whole length of the intestines and can give us some good pictures of, of what's going on.

Speaker 2: 25:06

People ask me a lot about the, the camera that you swallow mm-hmm <affirmative> . That's what you're talking about, 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 got hundreds, thousands of pictures of the inside of someone's intestines. 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's coming down the pipeline

Speaker 2: 25:29

For me. <laugh> , I'll bet you guys fight over who gets to look at thousands of pictures of the inside of someone's intestines. Not exactly as good as looking at someone's vacation photos. Hey . Right. Okay. I would like to , um, before I let you go, talk a little bit about the future. What might be down the road that you're aware of, either in research, new medications , uh, what does the future look like for people living with Crohn's disease?

Speaker 3: 25:52

Yeah, so, you know, as you alluded to, not too long ago, we only had a few medications available to us. And, and now it seems like every few months or every year we have a new medication. Every few years we have, you know, a new class of medications that we can use to, to help treat patients, which is, which is really exciting. It's a very active area of research. And I think the genetic component as well is probably gonna come into to play quite a bit more where we're able to identify certain medications that will be more effective for certain people 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 try something else. See if it works. I'm , I'm being a little , uh, flippant about it, but sometimes we have to try medicine. 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 type that you have, this is the medication that might work with , that's exciting. Exactly. So that's actually quite encouraging. Mm-hmm <affirmative>. What other resources are available for people , uh, living with inflammatory 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 aware of that, but they're probably the largest organization of both experts and patients , uh, who are involved in, in Crohn's disease and ulcerative colitis. There are a lot of great resources on their website , uh, ranging from just good information about the disease as well as community resources get togethers and, and , uh, crowdsourcing of, of different techniques and approaches to dealing with life with inflammatory bowel disease. And

Speaker 2: 27:17

Listeners, we'll put a link to those in our show notes, so be sure to check those out. Dr. Jason Ekman, what would you leave listeners, if you had a bit of advice to leave about this topic, what would that be?

Speaker 3: 27:30

So I think one important thing is, is really listening to your body and listening to your symptoms. As we've talked about, I think several times already, you know, we don't wanna leave Crohn's Disease undiagnosed and untreated for a long time. The other thing is, is , you know, Crohn is a scary disease. And, and you hear people like me today saying, well, we don't fully understand it. And , and that can sound very scary to somebody diagnosed with Crohn's disease, but I just really wanna 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 people to the gastroenterologist at Hennepin Healthcare, including Dr. Eckman with some kind of scary symptoms. They had diarrhea for ages or losing weight. They're in pain. And due to the expert treatments available and the expertise that's available, their lives were actually changed for the better. There is a lot of hope on the future and the treatments available for you if you're living with Crohn's Disease. And this is a friendly reminder. If you're having symptoms, you'll know you don't know what they are. Please do seek help. Go to your primary care physician or other clinician, go to a gastroenterologist. There is help available for you. Jason, thanks for being on the show today.

Speaker 3: 28:39

Thanks for having me.

Speaker 2: 28:40

It's been a great conversation about Crohn Disease and listeners, I hope you've picked up some information that's useful to you. 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 drop another episode. And in the meantime, be healthy and be well.

Speaker 1: 28:56

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.