Inflammatory Bowel Disease (IBD)

Medical Advisory Board

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

Steven R. Brant, M.D. is an Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine at the Johns Hopkins University School of Medicine with a Joint Appointment, Department of Epidemiology, Johns Hopkins University School of Public Health.

Dr. Brant did his undergraduate training at Brandeis University, Waltham MA, where he worked for 2 years in the laboratory of the late William P. Jencks, and graduated with highest honors, Magna Cum Laude, in biochemistry in 1981.

He attended and completed medical school at the University of Florida, Internal Medicine residency at Indiana University Medical Center, Indianapolis, and Gastroenterology and Hepatology fellowship at The Johns Hopkins Hospital.

He joined the faculty at Johns Hopkins as an Assistant Professor of Medicine in 1992 and was promoted to Associate Professor in 2002. During his fellowship training and as a junior faculty member, Dr. Brant worked in the laboratory of Dr.

Mark Donowitz and cloned, characterized and genetically mapped the NHE3 gene, the major epithelial protein for electro-neutral sodium uptake in the kidney and small and large intestines. Dr. Brant was awarded two patents for his NHE3 related discoveries.

Since 1996, Dr. Brant moved his research focus to defining the genetic underpinnings of inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis. In 1998, Dr. Brant performed the first IBD genome-wide linkage study in North America.

He contributed to the discovery of numerous genes for Crohn’s disease and ulcerative colitis including the first Crohn’s disease gene, NOD2 and one of the first ulcerative colitis genes, NFKB1, the NFKB1 disease variants discovered by his lab for which he was also awarded a U.S. patent.  Dr.

Brant performed the first population genetic studies of IBD genes, and he provided the first evidence for significant IBD risk genes in the African American population – a current research focus of his laboratory.  Since 2002, Dr.

Brant has served as Co-Editor of the Genetics Section of the esteemed scientific journal, Inflammatory Bowel Diseases. In 2005 he was elected to the American Society of  Clinical Investigation.

In 2009, Dr. Brant was appointed as the Director of the Meyerhoff Inflammatory Bowel Disease Center at Johns Hopkins.  He leads its clinical operations as well as its basic and clinical research programs. Dr. Brant is also a talented gastroenterologist specializing in IBD, where he sees patients referred nationally and internationally. Dr.

Brant has participated in multiple clinical trials for IBD investigational therapies and has served as principle investigator for the Johns Hopkins site. Dr. Brant served for several years as Course Director (and later as Co-Director) for the Johns Hopkins yearly CME course in Gastroenterology.

He teaches medical students and genetics graduate students at Johns Hopkins and is a frequent lecturer nationally and internationally.


Medication Therapy Management Improves Adherence 30% Over Standard of Care for IBD

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

October 17, 2016 01:30 PM Eastern Daylight Time

ATLANTA & LAS VEGAS–(BUSINESS WIRE)–Curant Health, provider of enhanced medication therapy management and specialty pharmacy services, and Johns Hopkins Medicine’s Meyerhoff Inflammatory Bowel Disease Center revealed today that medication therapy management improves adherence more than 30 percent compared to the standard of care for IBD patients.

Among 110 randomized subjects (24 of which were excluded primarily due to insurance restrictions), 55% of patients in the intervention arm receiving MTM were considered to have improved adherence compared to 25% in both control arms.

Table 1: Adherence Change among Subjects with Baseline and Follow-up Adherence Score (n=73)

Adherence Change Treatment (n=29) Control 1 (n=24) Control 2 (n=20)
Decreased adherence 3.4% 20.8% 25.0%
Increased adherence 55.2% 25.0% 25.0%
No change in adherence 41.4% 54.2% 50.0%

The preliminary results of Project A.L.I.V.E.

(Adherence and Long-term IBD Value-added Effectiveness) were delivered earlier today by Principal Investigator and Assistant Professor of Medicine at Johns Hopkins University Dr.

Sharon Dudley-Brown and Curant Health Director of Clinical Pharmacy Vickie Andros, PharmD, in a poster presentation at the 2016 American College of Gastroenterology Annual Scientific Meeting.

Systematic review of the literature validates that once this study is completed, it will contain the first reported long term adherence data for CD or UC and the first data published evaluating the impact of MTM on IBD outcomes.

Project A.L.I.V.E. seeks to “implement and evaluate the effectiveness of an Inflammatory Bowel Disease (IBD) Medication Therapy Management (MTM) patient fulfillment model compared to standard care in a large university hospital setting.”

According Dr. Dudley-Brown, Crohn's disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications. In 2004, the annual cost of IBD in the United States was estimated at $1.84 billion. IBD is associated with high morbidity, loss of work productivity and impaired quality of life.

According to the IMS Institute for Health Informatics, medication non-adherence is responsible for more than $200 billion in wasted healthcare spending.

“Project A.L.I.V.E. is well on its way to measuring program valuefor IBD patients and caregivers with preliminary results showing improved adherence in the treatment arm.

We anticipate that our enhanced medication therapy management and patient support services will continue to demonstrate project value through outcomes improvement and impact on cost through a reduction in hospitalizations and ED visits for this patient population,” Andros says .

“Continuing to validate our work alongside Dr. Dudley-Brown, her colleagues, and most importantly improving the lives of people suffering from IBD, is central to our mission.”


Curant Health is passionate about improving the lives of chronically ill people nationwide through its innovative medication management program.

Specially trained patient care coordinators and pharmacists form the foundation of the program.

Regular, intensive interaction with caring Curant Health professionals provides support for patients dealing with the daily challenges of living with chronic conditions.


Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System.


Johns Hopkins Gazette | December 18, 2006

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine
An international team of researchers has identified another gene mutation linked to the inflammatory bowel diseases Crohn's disease and ulcerative colitis.

The team, including Johns Hopkins gastroenterologists and geneticists, says the novel mutation is in the interleukin-23 gene receptor present in healthy people without Crohn's disease but rare in those with the disease.

IL-23 is a protein that regulates chronic inflammation and helps the body fight bacterial infections. Its receptor, IL23R, is present on lymphocytes and macrophages, white blood cells responsible for mounting immune response to infections.

IL-23 has long been linked to inflammatory bowel diseases and autoimmune psoriasis, but this new genetic variation in the protein's receptor offers a novel pathway for tracking the disease process and for potential drug treatments.

Results of the study, by a consortium of researchers from Johns Hopkins and six other American and Canadian institutions, appeared in Science Express, an online publication of the journal Science, on Oct. 26.

“The IL-23 receptor variation we discovered appears to affect the IL-23 pathway, altering the body's response to chronic inflammation, which may trigger autoimmune disease,” said study co-author Steven R.

Brant, associate professor of medicine and director of research and the genetics laboratories of Hopkins' Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center.

“The fact that this gene has already been implicated in another autoimmune disease psoriasis offers strong evidence that we are on the right track.

In the Crohn's study, researchers located the IL23R disease-associated protein variant by scanning nearly all the 22,000 genes that make up the human genome. The study looked at 547 test subjects with Crohn's disease and 548 healthy controls.

Patients were recruited from six of the seven centers in the consortium.

Researchers examined more than 300,000 variations in the genetic code, known as single nucleotide polymorphisms, or SNPs, to identify which of the variations among these 22,000 genes can explain the genetic predisposition to developing Crohn's disease.

SNPs are commonly occurring variations in DNA code that are routinely used as a method for finding genetic links to diseases. Researchers scanned the genomes using a relatively new technology that allows researchers to study variations found in nearly all human genes for association with diseases.

Researchers found that test subjects with Crohn's disease were roughly fourfold less ly to have an SNP variation that alters an important amino acid of the IL-23 receptor gene.

More than 1 million Americans have Crohn's disease or ulcerative colitis.

Because inflammatory bowel disease tends to run in families and is more prevalent in certain ethnic populations, scientists have long suspected that there is a significant genetic component.

A previous study, conducted in part at Johns Hopkins, identified another gene mutation on the CARD15/NOD2 gene, common in people with Crohn's disease, but Brant said the new gene is a better candidate for drug treatments.

“IL-23 is directly linked to an inflammatory pathway, making it a better candidate for drug therapies than CARD15/NOD2,” he said.

Brant said the team has identified additional gene variations potentially related to Crohn's disease, and the consortium will investigate these as well.

Co-author Themistocles Dassopoulos, an assistant professor of medicine at the Meyerhoff Inflammatory Bowel Disease Center, said, “As more genes associated with Crohn's disease are discovered, we envision a time when gene testing may provide important guidance regarding the prognosis and treatment of each patient.”

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.


Ulcerative Colitis

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

Linkedin Pinterest Stomach and Gut Inflammatory Bowel Disease

Ulcerative colitis is an inflammatory bowel disease in which the inner lining of the large intestine and rectum become inflamed. Ulcerative colitis is characterized by diarrhea, abdominal pain and blood in the stool. The disease may vary in how much of the colon is affected and in severity as well. 

Ulcerative Colitis Symptoms

Symptoms may include:

  • Bloody diarrhea, often the main symptom of ulcerative colitis
  • Frequent bowel movements
  • Abdominal or rectal pain
  • Fever
  • Weight loss
  • Joint pain
  • Skin rashes
  • Occasionally, constipation and rectal spasm

Ulcerative Colitis Diagnosis at Johns Hopkins

A thorough physical examination and careful monitoring help obtain an accurate diagnosis. Your doctor will monitor you before and during an ulcerative colitis attack with blood work and a colonoscopy; this allows for valuable information by noting the length and extent of the attack.

Another good indicator of the severity of the disease is the frequency and severity of diarrhea. You have severe disease if you experience six or more bowel movements per day. Your doctor is especially looking to see if the frequency of bowel movements increases during an attack.

Your doctor will also order blood tests to help confirm a diagnosis. Other diagnostic procedures include:

  • Imaging scans
  • Flexible sigmoidoscopy
  • Colonoscopy

Imaging scans allow your doctor to get detailed images of the affected area. Imaging studies include:

  • Computed tomography (CT) scan: A CT scan is a powerful X-ray that is very useful in diagnosing ulcerative colitis. It provides accurate images of the bowel wall.
  • Barium enema: A barium preparation is inserted through a rectal tube, coating the entire colon. X-rays are taken of the colon.

Flexible Sigmoidoscopy

If you have lower abdominal symptoms, you may need a flexible sigmoidoscopy. A sigmoidoscopy is a type of endoscopic procedure that allows your doctor to examine part of your colon from the rectum. The test takes 10 to 20 minutes.

A flexible sigmoidoscopy examines the rectum and lower colon. During the procedure:

  • Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.
  • Your doctor inserts the sigmoidoscope, a thin, flexible tube, through the rectum and into the anus and large intestine to view the area.
  • The procedure may cause some cramping or discomfort.

In this video, learn why the bowel preparation for a colonoscopy is so important to the results of the procedure.

A colonoscopy is similar to a flexible sigmoidoscopy but takes longer (30 to 60 minutes) and allows your doctor to examine the entire large intestine.

During a colonoscopy:

  • Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.
  • You are sedated before the procedure.
  • Your doctor inserts the colonoscope through the rectum and into the anus and large intestine.
  • A biopsy forceps may be inserted through the scope in order to remove a small sample of tissue for further analysis.
  • The procedure may cause some cramping or discomfort.

Ulcerative Colitis Treatment at Johns Hopkins

The goal of treating ulcerative colitis is to reduce the inflammation, hopefully leading to remission. The main treatment options available are medication and surgery. Learn more about ulcerative colitis treatment at Johns Hopkins.


Curant Health And Johns Hopkins Medicine Launch First-Ever Study Measuring Impact of Medication Therapy Management Outcomes For IBD Patients

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

September 30, 2014 – Atlanta, GA – Curant Health, provider of enhanced medication therapy management and specialty pharmacy services, is launching a study with the Meyerhoff Inflammatory Bowel Disease Center of the Johns Hopkins University School of Medicine to “implement and evaluate the effectiveness of an Inflammatory Bowel Disease (IBD) Medication Therapy Management (MTM) patient fulfillment model compared to standard care in a large university hospital setting.”

Project “A.L.I.V.E” (Adherence and Long-term IBD Value-added Effectiveness) was announced this morning during MedCity ENGAGE, a gathering of healthcare professionals in Bethesda, Md.

According to Principal Investigator and Assistant Professor of Medicine at Johns Hopkins University Dr.

Sharon Dudley-Brown, Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications.

In 2004, the annual cost of IBD in the United States was estimated at $1.84 billion. IBD is associated with high morbidity, loss of work productivity and impaired quality of life.

According to the study abstract, the absence of an integrated MTM platform in IBD care limits the ability to track and fully understand patient outcomes including Adverse Drug Events (ADE’s), hospital readmissions and long-term adherence rates. Systematic review of the literature validates there is no reported long term adherence data for CD or UC.  wise, no data has been published evaluating the impact of MTM on IBD outcomes.

“Our enhanced medication therapy management services are proven to reduce readmissions rates and improve adherence to medication regimens for chronically ill patients, the most difficult and costly to treat,” says Patrick Dunham, President and CEO of Curant Health. “Continuing to validate our work alongside Dr. Dudley-Brown and her colleagues, and most importantly improving the lives of people suffering from chronic conditions IBD, is central to our mission.”

During each MTM session with the patient, pharmacists will complete a medication reconciliation, identify any medication related issues, monitor therapy and provide patient education on the importance of adherence with treatment and provider follow-up, instructions on how to take/administer medications and side effects of medications.

The team will evaluate results at 30 days, 60 days, six months, nine months and 12 months from the initiation of the IBD MTM patient fulfillment model.

About Curant Health

Curant Health is a recognized leader in the field of enhanced medication therapy management, improving patients’ outcomes and lives while lowering the cost to treat chronic, high-expense conditions, including HIV, HCV, diabetes, hypertension and COPD. Twice recognized as one of America’s Fastest Growing Companies by Inc. Magazine, Curant was one of 10 finalists in Microsoft’s Excellence in Innovation competition for its development and deployment of its EMR system, MedPlan.

Health systems currently employing Curant’s services include University of New Mexico Truman Health Services, the University of Alabama at Birmingham, Emory Midtown ID Clinics, University of Louisville Research Foundation, Virginia Commonwealth University and others.

About Johns Hopkins Medicine

Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System.


Diagnosis and Treatment of Inflammatory Bowel Disease in Older Patients

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

G&H How frequently does inflammatory bowel disease occur among elderly patients?

CYH Inflammatory bowel disease (IBD) typically presents between the ages of 15 and 45 years, with the highest incidence among people in their 20s.

Because of this age distribution, IBD is considered to be a disease of younger people. However, clinicians need to recognize that IBD can occur at any age, so it should not be overlooked in older patients.

Most studies report that approximately 10–15% of patients are diagnosed with IBD after the age of 60 years.

G&H Does the disease presentation differ when IBD occurs in older patients?

CYH Older IBD patients tend to present with more of an inflammatory colitis—either ulcerative colitis or Crohn’s colitis. In general, younger patients may have more classic symptoms of IBD—including bloody diarrhea, urgency, abdominal cramping, and systemic symptoms.

While rectal bleeding and diarrhea are also common features of older-onset IBD, the older patient may also have more indolent symptoms of IBD with fewer complaints of bleeding, abdominal pain, weight loss, and extraintestinal manifestations than younger IBD patients.

In some cases, IBD may present in older patients with only subtle findings of anemia or gradual weight loss.

G&H Are there any special considerations when diagnosing IBD in an older patient?

CYH The diagnosis of IBD in an older patient is actually somewhat challenging because the differential diagnosis is broader in this population. In older patients, clinicians need to consider not only IBD but also infectious colitis, microscopic colitis, segmental colitis associated with diverticula, ischemic colitis, and even cancers that could present similarly to IBD.

G&H How does IBD in older individuals differ from IBD that is diagnosed earlier in life?

CYH Patients with early-onset disease (ie, those diagnosed as young or middle-aged adults) tend to have more of a family history of IBD, which suggests that their condition may be influenced more strongly by genetics than by environmental influences. Also, smoking history is not as predominant a feature in patients who are diagnosed with IBD at a younger age.

The opposite is true for older patients: Smoking history is a more prominent risk factor in this population—indeed, 60–70% of older patients with IBD have a smoking history—and family history is rarely present, suggesting that genetics play less of a role in late-onset IBD. Aside from these differences, the risk factors for IBD are similar for both older and younger patients.

G&H Are there any special considerations when selecting therapy for an elderly patient with IBD?

CYH Yes, there are many unique features of older patients that clinicians need to consider when selecting a treatment. First, an older patient may have preexisting medical conditions, and these comorbidities (or the drugs used to treat them) can impact how the patient’s IBD should be managed.

For example, clinicians may be hesitant to prescribe steroids for an older patient with diabetes, as steroids could exacerbate this condition.

Also, many older patients have hypertension, and certain classes of antihypertensive medications, such as antigotensin-converting enzyme inhibitors, can interact with some of the medications used to treat IBD (such as 6-mercaptopurine and azathioprine), potentially resulting in additional adverse effects.

In general, drug-drug interactions and polypharmacy are major concerns when treating older patients.

Some studies report that over 50% of patients over the age of 50 years take 5 medications or more daily, and many older patients do not know their complete drug list; in some cases, this lack of information can result in gastroenterologists starting an IBD therapy without recognizing the potential for serious interactions.

Finally, clinicians should consider the logistic issues of a complex drug regimen, as proper adherence to such a regimen may be more difficult for older patients. Many IBD medications involve a large number of pills, frequent laboratory monitoring, use of a self-injectable syringe or pen, or regular trips to an infusion center, all of which may be more challenging for older patients.

G&H Are certain treatments preferred for older patients?

CYH Clinicians presume similar treatment efficacy for older versus younger patients, but data to support this assumption are lacking because older individuals are often excluded from clinical trials.

Some studies suggest that, while the efficacy of medications may be similar across age groups, the adverse event rate may be higher among older patients.

This possibility is particularly worrisome because some IBD medications are already known to be associated with potentially serious side effects.

For example, steroids are commonly used to treat IBD; however, studies have shown that steroids are the class of medications most associated with serious infections, and older patients are generally more susceptible to infections. Older patients are also more susceptible to osteoporosis and fractures, and steroids can exacerbate this risk.

Similarly, the latest literature suggests that thiopurines (such as 6-mercaptopurine and azathioprine) can increase a patient’s risk of non-Hodgkin lymphoma, and older patients are the age group that is most susceptible to lymphoma.

Given these risks, clinicians should pay particular attention to the potential side effects associated with a particular medication when selecting a treatment strategy for an older patient.

G&H What further research is needed in this area?

CYH There is such a paucity of evidence-based medicine focusing on older IBD patients. Interest in this area is increasing, which is very important, but many unanswered questions remain.

The first question that should be addressed, which is very basic, is whether IBD in older patients is different from IBD in younger patients: Is there actually a different disease process when IBD occurs later in life? Studies that increase our understanding of the differences in the pathophysiology of the disease process in older versus younger patients will be the key to determining whether the response to currently available medications will be the same in these 2 groups.

Further outcomes-related research should not only investigate therapeutic efficacy but also look at adverse effects of medications in older patients. In particular, the risk of malignancy is a concern in this population because increasing age is a known risk factor for many cancers.

G&H Overall, what are the key points clinicians should keep in mind when diagnosing or managing older patients with IBD?

CYH While a number of diagnoses are possible, IBD needs to be included in the differential diagnosis for an older patient who presents with suggestive gastrointestinal symptoms.

Once the patient has been diagnosed, the clinician should then consider which treatment options are most appropriate for an older patient.

The biggest concern when treating older patients is safety, so clinicians should aim to minimize the duration and dose of steroids and ensure appropriate monitoring for adverse effects, both through laboratory testing and physical examinations.

Other special considerations when treating older patients include monitoring their nutritional status, as malnutrition is more prevalent in an older patient population, and having a low threshold when looking for infection since infectious risks increase with age.

Finally, gastroenterologists should work with primary care physicians to ensure that older patients are up to date on their immunizations, as vaccination can minimize the risk of infection associated with immunosuppressant therapies.

Specific vaccinations that may be considered in older patients include zoster, influenza, pneumococcal, and hepatitis.

Suggested Reading 

Ha CY, Newberry RD, Stone CD, Ciorba MA. Patients with late-adult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol. 2010;8:682-687.e1.

Stallmach A, Hagel S, Gharbi A, et al. Medical and surgical therapy of inflammatory bowel disease in the elderly—prospects and complications. J Crohns Colitis. 2011;5:177-188.

Quezada SM, Steinberger EK, Cross RK. Association of age at diagnosis and Crohn’s disease phenotype. Age Ageing. 2012 Aug 22. Epub ahead of print.

Regueiro M, Kip KE, Cheung O, Hegazi RA, Plevy S. Cigarette smoking and age at diagnosis of inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:42-47.

Page MJ, Poritz LS, Kunselman SJ, Koltun WA. Factors affecting surgical risk in elderly patients with inflammatory bowel disease. J Gastrointest Surg. 2002;6:606-613.

Katz S, Pardi DS. Inflammatory bowel disease of the elderly: frequently asked questions (FAQs). Am J Gastroenterol. 2011;106:1889-1897.


Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

June 23, 1998

The largest, most comprehensive genome-wide study of patients with inflammatory bowel disease (IBD)–including Crohn's disease and ulcerative colitis–has focused and narrowed the search for the genes that cause this common and debilitating illness, a team of researchers from the University of Chicago Medical Center, Johns Hopkins Medical Institutions, and the Marshfield Medical Research Foundation in Marshfield, Wisconsin report in the June 23, 1998 issue of the Proceedings of the National Academy of Scientists.

After typing 377 genetic markers on DNA from 439 IBD patients and 198 close relatives from 174 separate families, the researchers identified regions–on chromosomes 1p, 3q, and 4q–which appear to contain genes that trigger the onset of the disease.

They also confirmed the role of one previously localized gene named IBD1, near the center of chromosome 16, which appears to act in concert with the disease gene on chromosome 1.

“The prospect of finding the genes involved is exciting because we know so little about what causes IBD,” said Judy Cho, MD, a gastroenterologist at the University of Chicago and lead author of the study.

“This genetic approach is our best bet for unraveling the complicated set of events that initiates these disorders and developing more specific therapies to treat the disease and not just the symptoms.

Steven R. Brant, MD, director of the IBD Genetics Laboratory at Johns Hopkins and senior author of the study, said “Identifying the location of IBD genes is an important step toward the goal of preventing Crohn's disease and ulcerative colitis from occurring in genetically susceptible individuals.” Brant is also an assistant professor of medicine.

Inflammatory bowel disease includes Crohn's disease (CD) and ulcerative colitis (UC)–chronic disorders that primarily affect the intestines, causing pain, severe diarrhea, intestinal bleeding, weight loss and fever.

They afflict about 250 every 100,000 people, usually beginning in adolescents and young adults. Symptoms vary in severity and duration. Some patients suffer frequent prolonged attacks and others with fewer recurrences.

There is no cure for IBD. Treatments focus on controlling the inflammation through powerful drugs such as corticosteroids. Some patients require long-term use of medications, and many patients need surgery to remove inflamed or damaged portions of the intestines. Additional there is a greater risk of developing colorectal cancer.

Although environmental factors clearly contribute, these is strong evidence from studies of twins and affected families that IBD–especially Crohn's disease–has a genetic basis. The patterns of inheritance, however, are extremely complex. Multiple genes play a role–some affecting CD, some UC, and some both.

IBD is two to eight times more common in Ashkenazi Jews. This is the first genome-wide study to look at Ashkenazi Jews, who made up 37 percent of the families in this study.

The complex inheritance patterns were reflected by this study's results. The researchers looked at families with either CD, UC, or both. They found a strong link between a gene on chromosome 1 for all families, but most of the evidence for this association came from families who were not of Ashkenazi Jewish heritage.

The linkage on chromosome 3q involved all families. But the association between the region on chromosome 4 was stronger for families that have both CD and UC, especially for those of Ashkenazi Jewish heritage.

“Although we now have some great clues, we are years away from isolating the individual genes that contribute to this disease,” said Cho. Each suspect region contains hundreds of genes.

“Once we narrow the search we still have to find out how these genes interact with the environment and each other.

But it's still a tremendous boost to move one big step further toward unraveling this baffling disease and starting to develop better treatments.”

Other researchers who contributed to this study include Stephen Hanauer, Barbara Kirschner, Dan Nicolae, Carter Fields, Michael Pickles and Yifan Fu from Chicago; Theodore Bayless, Patrick Rohal, Leslee Gold, Li Qin, Jasdeep Mann, Ethylyn Wang Jabs and Michele LaBuda from Hopkins; and James Weber from Marshfield.

Support for the research was provided by: the Crohn's and Colitis Foundation of America; the Gastrointestinal Research Foundation; the Logan Center for Gastrointestinal Research, University of Chicago; the Myerhoff Inflammatory Bowel Disease Center, Hopkins; the Mazza Foundation; the Edison Foundation; Glaxo Institute for Digestive Health; and the National Institutes of Health.

The largest, most comprehensive genome-wide study of patients with inflammatory bowel disease, including Crohn's disease and ulcerative colitis, has narrowed the search for the genes that cause this common and debilitating illness–identifying new regions on chromosomes 1p, 3q, and 4q that may contain genes that trigger IBD.


Inflammatory Bowel Disease (IBD) Diagnosis and Treatment Options | Johns Hopkins Inflammatory Bowel Disease Center

Inflammatory Bowel Disease (IBD) | Johns Hopkins Medicine

Inflammatory bowel disease (IBD) is the overarching name for two chronic diseases which cause swelling of the intestines or the colon: Crohn’s disease and ulcerative colitis. Ulcerative colitis only affects the colon, but Crohn's disease may affect any area of the gastrointestinal tract, most commonly the end of the small intestine (the ileum) and the colon. 

What causes inflammatory bowel disease (IBD)?

Although there are a number of theories involving genetic and environmental factors, the cause of inflammatory bowel disease ultimately remains unknown.

Common genetic variations in over 100 genes have been identified as increasing the risk of IBD. Having a relative with IBD increases the risk several fold. People of Jewish ancestry have a greater risk of developing inflammatory bowel disease, although the disease occurs in all ethnic and racial groups.

Environmental risk factors include living in a Western industrialized country, particularly in urban and higher latitude environments, and for Crohn’s disease smoking and for ulcerative colitis not-smoking. Numerous other factors have been proposed including infectious triggers.

What are the symptoms of inflammatory bowel disease (IBD)?

Crohn’s disease and ulcerative colitis share many of the same symptoms, including:

  • Abscesses
  • Abdominal pain
  • Arthritis
  • Diarrhea
  • Eye inflammation
  • Fistulas
  • Incontinence
  • Rectal bleeding
  • Skin inflammation
  • Weight loss

How is inflammatory bowel disease treated?

Treatment options vary depending on the severity of each patient’s case. These treatments are designed to help control symptoms, reduce inflammation, and relieve abdominal pain, diarrhea, and rectal bleeding.

At the Johns Hopkins Inflammatory Bowel Disease Center, our team of gastroenterologists and gastric surgeons specialize in providing treatment for the simple to the most complex and complicated cases. Treatment for Crohn’s and ulcerative colitis may include:

  • Topical anti-inflammatory medications – These medications are usually very well tolerated, have minimal systemic risks, and are especially useful for mild-to-moderate cases of IBD.
  • Antibiotics – Certain antibiotics are helpful for mild-to-moderate Crohn's disease cases, and for abscess and anal fistula treatment.
  • Immunomodulator and biological immunosuppressive medications – These medications are used to suppress the immune system's attack on the intestine, and are recommended for moderate to severe cases.
  • Steroids – In combination with other anti-inflammatory drugs, steroids can greatly improve symptoms in patients, and are typically used for short-term treatment and to treat inflammation flareups.
  • Dietary changes – Occasionally, dietary therapy can have similar effects to drug therapy, but are often used in conjunction with medication.
  • Surgery – When medications no longer control symptoms, or an intestinal blockage occurs, surgery may be necessary. Often, surgical treatment involves the removal of the diseased portion of the bowel, but occasionally a complete removal of the colon or rectum is considered.

Request an Appointment

If you or a loved one suffers from inflammatory bowel disease, our specialists can help – request an appointment today.