Improving treatment for Crohn’s disease

150409_001Professor Michael Kamm and his team are winning international acclaim for a groundbreaking global study which is transforming medical practice and giving people with Crohn’s disease the hope of a better life. Building links between research, teaching and treatment underpins Professor Kamm’s approach to medicine. ‘We need to be constantly learning about pathogenesis of the diseases we’re treating, evaluating the results of treatment, questioning treatments, and improving on them. All the secrets and clues lie in the patients you treat. It is essential to understand this in order to drive your research and effect change in medical practice.’

Crohn’s disease most commonly affects the small bowel and colon, causing inflammation, abdominal pain, diarrhoea and other symptoms such as fever and weight loss. Most patients first experience symptoms in childhood through to early adulthood. Curiously, Australia has equal to the highest incidence and prevalence of Crohn’s in the world – the reasons are unknown.

Professor Kamm says 80 per cent of patients with Crohn’s disease will be operated on at some stage in their lifetime, and of those, 70 per cent will have at least one other operation. ‘You don’t really get off the surgical dance floor once you are on it,’ he says. ‘We wanted to see if we could change that.’

Despite the high incidence of surgical intervention there has been no strategy to prevent the disease recurring. ‘I’d had the idea for about 10 years to look at postoperative care to see if we could improve outcomes. It then took about 18 months to design the study specifics and protocols for the research.’

The POCER study was the largest investigator-led study into Crohn’s disease postoperative management in the world, involving 17 hospitals and 174 patients in Australia and New Zealand. More like a platform of studies, there were several facets to POCER, many of which are ongoing. This included collecting tissue from each patient’s bowel, looking at the faecal markers through stool samples to detect inflammation and cross check with colonoscopy results, regular blood tests, as well as investigating which drugs would be the most effective at preventing the disease recurring.

Professor Kamm says the highly complex study was multifaceted. ‘The POCER study looked at what could be done to reduce recurrences of the disease, whether there were early indicators of the disease recurring, identified less invasive ways to detect inflammation, and pinpointed factors that predict who is going to have trouble.’

‘To do this we needed to evaluate the risk of the disease coming back, and then stratify treatment according to the patient’s risk category. For example, if you’ve had a previous operation or if you are a smoker, you have an increased risk of recurrence,’ he says.

The findings also showed that most disease returns within weeks or months of the initial surgery. Where early changes were detected, proactive drug treatment to reduce inflammation could prevent tissue damage and reduce the need for more surgery.

The study also found that faecal markers were a good indicator of inflammation, which is a far less invasive test than a colonoscopy. ‘Thanks to this finding alone, at least half our patients would not require a colonoscopy,’ Dr Emily Wright says.

‘Patients in the study saw immediate benefits. In addition to accessing high level care, they experienced fewer recurrences of the disease and needed fewer additional surgical episodes as a result,’ Dr Wright says.

‘The POCER study has changed the way we treat Crohn’s disease, with more proactive patient management, less invasive testing which decreases the need for colonoscopies, and very few patients requiring additional surgery,’ Professor Kamm says.

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