Skip to Main Content

Crohn's Disease and Colitis

Dr. Jeff Tuvlin, MD, a gastroenterologist at KentuckyOne Health, talks about new advances in treating Crohn's disease and Colitis.
Season 11 Episode 9 Length 27:04 Premiere: 11/22/15

Surgery for Crohn’s Disease and Colitis? Not Necessarily

The inflammatory bowel diseases known as ulcerative colitis and Crohn’s disease affect approximately 1 million Americans. Aside from causing symptoms such as abdominal pain, diarrhea, weight loss, and blood in the stool, these diseases can, if untreated, lead to more grave conditions, such as colon cancer.

In recent years, breakthroughs in treating colitis and Crohn’s disease through medication have dramatically reduced the need for surgery. In this week’s Kentucky Health, host Dr. Wayne Tuckson speaks with a leading Louisville gastroenterologist about the causes, symptoms, diagnosis and treatment of these chronic conditions.

Dr. Jeffrey Tuvlin, MD, is a gastroenterologist with KentuckyOne Health and, according to Dr. Tuckson, is a “go-to” person for many in the Louisville medical community who need advice on treating inflammatory bowel disease, or IBD.

Unlike many maladies, IBD most often strikes younger people. Dr. Tuvlin says that ulcerative colitis and Crohn’s disease have “two peaks in diagnosis,” and that the majority of patients are diagnosed before the age of 30, with a smaller subset occurring between the ages of 60 and 70. Colitis and Crohn’s are the two most common IBDs and affect males and females almost equally.

They are also spread out among all racial and ethnic groups, although Dr. Tuvlin notes that researchers have found some genetic factors that predispose certain populations to the diseases. Two that have been found are in persons of Ashkenazi Jewish descent, and in identical twins. Dr. Tuvlin says that if a person has a first degree relative – parent, sibling, or child – with an IBD, they have roughly a 10 percent chance of developing one.

Since the symptoms of both Crohn’s disease and colitis are relatively common, gastroenterologists must first rule out a host of other conditions as possible causes. These include food allergies, celiac disease, bacterial overgrowths, and most commonly, irritable bowel syndrome. Irritable bowel syndrome often causes abdominal pain, cramps, and diarrhea, Dr. Tuvlin says, but that intestinal disorder is easily ruled out once a colonoscopy or endoscopy is performed.

The distinguishing characteristic of both ulcerative colitis and Crohn’s disease is chronic inflammation of the intestines, Dr. Tuvlin notes. Both diseases are caused by an overactive, dysregulated immune system response to one of several triggers. With irritable bowel syndrome, the intestines are not inflamed. For patients who may have just contracted a bad case of what Dr. Tuvlin calls “traveler’s diarrhea” while on vacation, the resulting symptoms will eventually recede. Not so with colitis and Crohn’s.

In addition to genetic predisposition, there are a variety of environmental triggers for IBDs, Dr. Tuvlin says. These include infection, certain medications, and smoking. “Smoking is a very big trigger,” Dr. Tuvlin says, “more for Crohn’s than for ulcerative colitis.”

Symptoms of Two Painful Diseases

To help describe the characteristics of these two conditions, Dr. Tuvlin presents three slides of a colon (large intestine) – each showing images of a normal organ, one with colitis, and one with Crohn’s disease. “Ulcerative colitis,” he says, “is a symmetric, continuous inflammation which starts at the end of the colon, which is the rectum, and goes up [through the colon] in continuous fashion.”

Colitis affects only the surface, or most interior, layer of the large intestine, Dr. Tuvlin says. Due to this superficial inflammation, the colon is unable to absorb as much water as normal, and this can result in bloody diarrhea, urgency (when a patient cannot hold in stool), and cramping.

Crohn’s disease, on the other hand, can affect all layers of the large intestine, and in fact can also strike the small intestine and appear even higher in the gastrointestinal (GI) tract. Its visual hallmark is an unequal distribution of inflamed tissue, evident in large ulcers. “In Crohn’s disease, the inflammation is what we call transmural – it can go all the way through the bowel wall,” Dr. Tuvlin says. “It can actually tunnel deeper down, and that leads to the most characteristic feature of Crohn’s disease: pain.”

Since it is embedded throughout the colon wall, Crohn’s disease can also lead to abscesses and/or fistulas. Fistulas are abnormal tissue formations that connect the GI tract to other organs, or to a patient’s skin.

If left untreated, both IBDs can lead to major complications. “Somebody with ulcerative colitis [who has inflammation] that is untreated could develop pre-cancerous changes, and then develop a colon cancer,” Dr. Tuvlin says. “And a patient with Crohn’s who has inflammation in their small intestine that’s getting more narrowed, they could develop something that we call a stricture, a narrowing that could cause an obstruction – which would need surgery.”

Effective Therapies Reduce the Need for Surgery

Both ulcerative colitis and Crohn’s disease are chronic. Dr. Tuckson, a colorectal surgeon, observes that earlier in his career, he would often operate on patients with an inflammatory bowel disease, but that he does so far less often now. What has changed?

Dr. Tuvlin says that over the past 10 years, “we have had an explosion of understanding of the disease process [with IBDs], of the genetics involved, and of the molecules that drive the inflammation. We have created medications that target them, and they’ve been extremely successful.”

These effective drug therapies can spur long periods of remission for both diseases. A variety of drug classes are used to treat colitis and Crohn’s, Dr. Tuvlin says. Lowest on what he terms the “therapeutic pyramid” are mesalamines. These are anti-inflammatory drugs that can be ingested in several different ways depending on where the IBD is most prominent along the GI tract. “They target a site of inflammation and put a coating of treatment on them,” Dr. Tuvlin says.

If mesalamines don’t help the patient, Dr. Tuvlin will prescribe immunomodulators. “These are stronger medicines that are delivered and work on the immune system, and work to decrease the active response to inflammation,” he says. They must be more closely monitored for side effects.

Most exciting to Dr. Tuvlin are new developments in biologic therapy. “Biologic therapy is a whole category of medicines that target the actual triggers of inflammation. … They can be given as injections, [or] as infusions, and are working very well to decrease these triggers.”

As for steroids, Dr. Tuvlin regards them as a “necessary evil” of the treatment regime. He will prescribe them for patients who are very sick because they work fast and well to alleviate symptoms, and are inexpensive. But he considers the long-term side effects of steroids prohibitive and mainly uses them as a bridge to other therapies.

Overall, Dr. Tuvlin estimates that new drug therapies for colitis and Crohn’s disease have reduced the number of patients he recommends for surgical consultations by over 60 percent in the past decade. He says that patients with Crohn’s disease are more likely to be recommended for surgery. Surgery options for both diseases usually involve removing part or all of the colon.

Dr. Tuvlin says that no particular diet has been proven to prevent an IBD or heal a flare-up. He says that anecdotally, patients indicate that avoiding roughage such as raw fruits and vegetables helps them manage symptoms. Several of his patients say that following a Paleo diet (no processed foods) is another effective option.

Sponsored by:

Connections host Renee Shaw smiling in a gray suit along with the show logo and a "Check Schedule" button.Connections host Renee Shaw smiling in a gray suit along with the show logo and a "Check Schedule" button.

Season 11 Episodes

Oral Health in Rural Kentucky

S11 E27 Length 27:35 Premiere Date 06/19/16

Addiction's Impact on the Family

S11 E26 Length 28:36 Premiere Date 06/05/16

Oral Health for Seniors

S11 E25 Length 27:14 Premiere Date 04/17/16

Complications of Pelvic Surgery

S11 E24 Length 27:45 Premiere Date 04/10/16

Common Eye Disorders

S11 E23 Length 28:17 Premiere Date 04/02/16

Hospice Care

S11 E22 Length 27:53 Premiere Date 03/27/16

Cervical Cancer: A Global Epidemic

S11 E21 Length 27:29 Premiere Date 02/28/16

PTSD: Not Limited to the Military

S11 E20 Length 27:09 Premiere Date 02/21/16

African American Health Care in Louisville

S11 E19 Length 27:26 Premiere Date 02/14/16

Human Trafficking

S11 E18 Length 28:20 Premiere Date 02/07/16

Preterm Infants and Their Care

S11 E17 Length 28:06 Premiere Date 01/31/16

Help for Teenage Parents

S11 E16 Length 27:32 Premiere Date 01/24/16

Health News We Need to Know

S11 E15 Length 28:06 Premiere Date 01/17/16

Diagnosing and Treating Dyslexia

S11 E14 Length 28:12 Premiere Date 01/10/16

The Diabetes Epidemic

S11 E13 Length 28:53 Premiere Date 01/03/16

Cancer in Kentucky: Are We Winning the War?

S11 E12 Length 27:27 Premiere Date 12/27/15

Adult Orthodonture

S11 E11 Length 27:24 Premiere Date 12/20/15

Stress and Adolescence

S11 E10 Length 27:11 Premiere Date 12/13/15

Crohn's Disease and Colitis

S11 E9 Length 27:04 Premiere Date 11/22/15

Advances in Telemedicine

S11 E8 Length 26:14 Premiere Date 11/15/15

Lung Cancer in Kentucky

S11 E7 Length 26:44 Premiere Date 11/08/15

Greater Louisville Medical Society

S11 E6 Length 26:49 Premiere Date 11/01/15

Cervical Disc Surgery

S11 E5 Length 27:03 Premiere Date 10/25/15

Training New Doctors

S11 E4 Length 28:37 Premiere Date 10/18/15

Best Practices for Prenatal Care

S11 E3 Length 27:19 Premiere Date 10/11/15

Knee Replacement

S11 E2 Length 26:28 Premiere Date 10/03/15

Chemotherapy: New Advances, a New Age

S11 E1 Length 26:22 Premiere Date 09/26/15

See All Episodes

caret down

TV Schedules

Jump to Recent Airdates

Upcoming

Supplies Over Seas: Meeting Medical Supply Needs at Home and Overseas

“Supplies Over Seas” is rescuing medical devices, medications, and supplies, shipping them to communities in need, both at home and abroad. Denise Sears, president and C.E.O. of SOS International, talks about the group’s work.

  • Friday December 2, 2022 1:30 pm ET on KETKY
  • Friday December 2, 2022 12:30 pm CT on KETKY
  • Sunday December 4, 2022 12:30 am ET on KETKY
  • Saturday December 3, 2022 11:30 pm CT on KETKY
  • Sunday December 4, 2022 9:00 am ET on KETKY
  • Sunday December 4, 2022 8:00 am CT on KETKY

Over-the-Counter Medications: What's Safe and Are They Effective?

The cost of medical care is one reason some people turn to over-the-counter medications that appear to be equivalent to medications that require a prescription. Dr. Angela Sandlin, pharmacy director at Baptist Health La Grange, discusses supplements, minerals, vitamins, and other over-the-counter medications.

  • Sunday December 4, 2022 5:30 pm ET on KETKY
  • Sunday December 4, 2022 4:30 pm CT on KETKY
  • Monday December 5, 2022 2:00 pm ET on KET2
  • Monday December 5, 2022 1:00 pm CT on KET2
  • Friday December 9, 2022 1:30 pm ET on KETKY
  • Friday December 9, 2022 12:30 pm CT on KETKY
  • Sunday December 11, 2022 12:30 am ET on KETKY
  • Saturday December 10, 2022 11:30 pm CT on KETKY
  • Sunday December 11, 2022 7:00 am ET on KET2
  • Sunday December 11, 2022 6:00 am CT on KET2
  • Sunday December 11, 2022 9:00 am ET on KETKY
  • Sunday December 11, 2022 8:00 am CT on KETKY

Wastewater Surveillance: Community-Wide Swabbing for Infections

Infectious diseases can be tracked using wastewater. Dr. Eric Rouchka discusses wastewater epidemiology.

  • Sunday December 11, 2022 12:30 pm ET on KET
  • Sunday December 11, 2022 11:30 am CT on KET
  • Sunday December 11, 2022 5:30 pm ET on KETKY
  • Sunday December 11, 2022 4:30 pm CT on KETKY
  • Monday December 12, 2022 2:00 pm ET on KET2
  • Monday December 12, 2022 1:00 pm CT on KET2
  • Friday December 16, 2022 1:30 pm ET on KETKY
  • Friday December 16, 2022 12:30 pm CT on KETKY
  • Sunday December 18, 2022 12:30 am ET on KETKY
  • Saturday December 17, 2022 11:30 pm CT on KETKY
  • Sunday December 18, 2022 7:00 am ET on KET2
  • Sunday December 18, 2022 6:00 am CT on KET2
  • Sunday December 18, 2022 9:00 am ET on KETKY
  • Sunday December 18, 2022 8:00 am CT on KETKY

Diet and Nutrition: The Halos and Horns of Our Food

Do we have the information to make the best choices when deciding what to eat? Dr. Tuckson discusses the "halos and horns of food" with registered dietician Marianne Smith Edge.

  • Sunday December 18, 2022 12:30 pm ET on KET
  • Sunday December 18, 2022 11:30 am CT on KET
  • Sunday December 18, 2022 5:30 pm ET on KETKY
  • Sunday December 18, 2022 4:30 pm CT on KETKY
  • Monday December 19, 2022 2:00 pm ET on KET2
  • Monday December 19, 2022 1:00 pm CT on KET2
  • Friday December 23, 2022 1:30 pm ET on KETKY
  • Friday December 23, 2022 12:30 pm CT on KETKY
  • Sunday December 25, 2022 12:30 am ET on KETKY
  • Saturday December 24, 2022 11:30 pm CT on KETKY
  • Sunday December 25, 2022 7:00 am ET on KET2
  • Sunday December 25, 2022 6:00 am CT on KET2
  • Sunday December 25, 2022 9:00 am ET on KETKY
  • Sunday December 25, 2022 8:00 am CT on KETKY

COVID-19 and Monkeypox: Deja Vu All Over Again

Dr. Tuckson discusses COVID-19, monkeypox and the resurgence of sexually transmitted diseases with infectious disease specialist Dr. Mark Burns.

  • Sunday December 25, 2022 12:30 pm ET on KET
  • Sunday December 25, 2022 11:30 am CT on KET
  • Sunday December 25, 2022 5:30 pm ET on KETKY
  • Sunday December 25, 2022 4:30 pm CT on KETKY
  • Monday December 26, 2022 2:00 pm ET on KET2
  • Monday December 26, 2022 1:00 pm CT on KET2
  • Friday December 30, 2022 1:30 pm ET on KETKY
  • Friday December 30, 2022 12:30 pm CT on KETKY
Jump to Upcoming Airdates

Recent

Supplies Over Seas: Meeting Medical Supply Needs at Home and Overseas - S18 E1

  • Monday November 28, 2022 2:00 pm ET on KET2
  • Monday November 28, 2022 1:00 pm CT on KET2
  • Sunday November 27, 2022 5:30 pm ET on KETKY
  • Sunday November 27, 2022 4:30 pm CT on KETKY

Insects: Most Are Good, But Watch the Bad - S18 E8

  • Sunday November 27, 2022 9:00 am ET on KETKY
  • Sunday November 27, 2022 8:00 am CT on KETKY
  • Sunday November 27, 2022 12:30 am ET on KETKY
  • Saturday November 26, 2022 11:30 pm CT on KETKY
  • Friday November 25, 2022 1:30 pm ET on KETKY
  • Friday November 25, 2022 12:30 pm CT on KETKY
  • Monday November 21, 2022 2:00 pm ET on KET2
  • Monday November 21, 2022 1:00 pm CT on KET2
  • Sunday November 20, 2022 5:30 pm ET on KETKY
  • Sunday November 20, 2022 4:30 pm CT on KETKY
  • Sunday November 20, 2022 12:30 pm ET on KET
  • Sunday November 20, 2022 11:30 am CT on KET

Melanomas: The Consequence of Too Much Sun - S18 E7

  • Sunday November 20, 2022 9:00 am ET on KETKY
  • Sunday November 20, 2022 8:00 am CT on KETKY
  • Sunday November 20, 2022 7:00 am ET on KET2
  • Sunday November 20, 2022 6:00 am CT on KET2
  • Sunday November 20, 2022 12:30 am ET on KETKY
  • Saturday November 19, 2022 11:30 pm CT on KETKY
  • Friday November 18, 2022 1:30 pm ET on KETKY
  • Friday November 18, 2022 12:30 pm CT on KETKY
  • Monday November 14, 2022 2:00 pm ET on KET2
  • Monday November 14, 2022 1:00 pm CT on KET2
  • Sunday November 13, 2022 5:30 pm ET on KETKY
  • Sunday November 13, 2022 4:30 pm CT on KETKY
  • Sunday November 13, 2022 12:30 pm ET on KET
  • Sunday November 13, 2022 11:30 am CT on KET

Healthy Practices: Inform, Cajole or Mandate, Whatever Works - S18 E6

  • Sunday November 13, 2022 9:00 am ET on KETKY
  • Sunday November 13, 2022 8:00 am CT on KETKY
  • Sunday November 13, 2022 7:00 am ET on KET2
  • Sunday November 13, 2022 6:00 am CT on KET2
  • Sunday November 13, 2022 12:30 am ET on KETKY
  • Saturday November 12, 2022 11:30 pm CT on KETKY
  • Monday November 7, 2022 2:00 pm ET on KET2
  • Monday November 7, 2022 1:00 pm CT on KET2
  • Sunday November 6, 2022 5:30 pm ET on KETKY
  • Sunday November 6, 2022 4:30 pm CT on KETKY
  • Sunday November 6, 2022 12:30 pm ET on KET
  • Sunday November 6, 2022 11:30 am CT on KET

Diverticulosis: Little Pouches, Big Problems - S18 E5

  • Sunday November 6, 2022 9:00 am ET on KETKY
  • Sunday November 6, 2022 8:00 am CT on KETKY
  • Sunday November 6, 2022 7:00 am ET on KET2
  • Sunday November 6, 2022 6:00 am CT on KET2
  • Sunday November 6, 2022 12:30 am ET on KETKY
  • Saturday November 5, 2022 11:30 pm CT on KETKY
  • Friday November 4, 2022 1:30 pm ET on KETKY
  • Friday November 4, 2022 12:30 pm CT on KETKY
  • Monday October 31, 2022 2:00 pm ET on KET2
  • Monday October 31, 2022 1:00 pm CT on KET2
  • Sunday October 30, 2022 5:30 pm ET on KETKY
  • Sunday October 30, 2022 4:30 pm CT on KETKY
  • Sunday October 30, 2022 12:30 pm ET on KET
  • Sunday October 30, 2022 11:30 am CT on KET

Down Syndrome: Chromosome Number 21 is Just the Beginning - S18 E4

  • Sunday October 30, 2022 9:00 am ET on KETKY
  • Sunday October 30, 2022 8:00 am CT on KETKY
  • Sunday October 30, 2022 7:00 am ET on KET2
  • Sunday October 30, 2022 6:00 am CT on KET2
  • Sunday October 30, 2022 12:30 am ET on KETKY
  • Saturday October 29, 2022 11:30 pm CT on KETKY
Top

Explore KET