disease except that it affects
only the colon. The inflamma-
tion involves the entire rectum
and continuously extends up the
colon.
"In ulcerative colitis, there
are no areas of normal intestine
between the areas of diseased
intestine as there are in Crohn's
disease," Silverman said. "In
addition, it affects only the
innermost lining of the colon,
while Crohn's disease can affect
the entire thickness of the
bowel wall."
Johnathon Markus
of West Bloomfield,
a third-year medical
student at Wayne State
University, Detroit,
has enjoyed working
with Silverman, who
is Jewish. "I met Dr.
Silverman through
another physician at
Henry Ford',' he said.
Dr. Cutler
"I'm planning to spe-
cialize in GI [gastroin-
testinal] disease and
was interested in the
research project. When
Dr. Silverman discov-
ered I was Chaldean,
she immediately asked
me to help. "
Currently, Markus
Dr. Yousif
is helping to recruit
more of the Chaldean
American population
for the project and will later
work on analysis of the devel-
oped data.

Behind The Research

There are several theories as
to what causes Crohn's disease.
Research shows factors that
influence this inflammation may
include the genetic background
of the patient, the immune sys-
tem itself and the environment.
The widely accepted theory is
that both Crohn's disease and
ulcerative colitis are marked by
an abnormal response by the
body's immune system; it mis-
takes harmless bacteria, foods
and other substances as foreign
toxins. The immune alarm sys-
tem kicks in and attacks what
the body considers as invaders.
During this process, white blood
cells accumulate, producing
chronic inflammation.
Ulcerative colitis also tends
to run in families. "Similar to

Crohn's disease,' Silverman said,
"10 percent of identical twins
will both develop ulcerative coli-
tis, which is clearly less signifi-
cant than the relationship seen
in Crohn's disease."

Helping Control Effects

Of A Treatable Disease

Ruthan Brodsky! Contributing Write r

Not IBS

By the same token, according
to Silverman, it is important
that neither ulcerative colitis
nor Crohn's disease be confused
with irritable bowel syndrome
(IBS), a disorder that affects
the motility (movement) of the
colon. IBS, sometimes
called "spastic colon:'
is not characterized by
intestinal inflamma-
tion. It is a less serious
disease and has no
direct relationship to
either Crohn's disease
or ulcerative colitis.
Commenting
on the research,
Edward Yousif, M.D.,
a Farmington Hills
gastroenterologist of
Chaldean descent,
said, "Not knowing the
details of the research,
I think it's highly
speculative that genetic
markers of Chaldeans
and Jews can be identi-
fied at this time. Even
so, I support the idea
because if the study
does get results, it will help
researchers make better drugs
that could benefit inflammatory
bowel disease therapy."
Alan Cutler, M.D., of West
Bloomfield-based Digestive
Health Associates, also finds the
research speculative and does
not see a positive impact for
patients in the near future.
"One of the problems the
researchers have is there's
likely to be more than one gene
involved with these diseases,
which will make pinpointing
treatment more difficult.
Treatment possibilities from this
research are decades away.
"In fact:' he added, "the pro-
cess of treating diseases based
on genetic information is in its
infancy. Patients should con-
tinue to work with their physi-
cians and the current treatments
available."
But new treatment will only
follow diligent research. BC

The incidence of inflammatory bowel
disease (IBD) has increased worldwide
over the past 15 years, including emer-
gence in developing countries.
Today, approximately 1-2 of every
1,000 people in developed countries
are affected by IBD, of which the most
common are Crohn's disease (CD) and
ulcerative colitis (UC). This is a signifi-
cant number because there is no cure
for these diseases and quality of life can
be compromised.
The goals of IBD therapy are to elimi-
nate symptoms, prevent flare-ups, main-
tain long-term remission and restore
quality of life. Many new treatments
have made IBD more manageable today
than it was only 10 years ago. However,
it is important to keep in mind that IBD
is a chronic illness and requires proactive
care. Surgery is usually needed only if
medications don't work or if precancer-
ous changes in the colon or other seri-
ous complications occur.
The medical approach for patients
with IBD is usually a stepwise beginning
with the most-benign drugs used first.
If those fail to provide relief, corticoste-
roids and immune-modifying drugs may
be used although cautiously because of
their serious negative side effects.
Scientists are studying biomarkers in
combination with newer genetic tests
to see how well they accurately forecast
the progression of 1BD and its develop-
ment in family members. Studies for
understanding the genetic basis of 1BD
continue to expand because IBD pro-
vides a unique opportunity; both CD
and UC are caused by inflammation of
the intestine, differing by what portion
of the digestive tract is affected. Both
conditions are caused by a combination
of factors, including genetics, lifestyle
and the environment.

Work Of The Genome

It was only 10 years ago, in 2001, that
NOD2 was identified as the first IBD
gene confirming the genetic nature
of &otitis disease. Since that time,
genome-wide association studies
(GWAS) have identified approximately
MO sites significantly associated with
IBD. In addition, population-based
studies provide compelling evidence
that genetic factors contribute to the
development of IBD. Ashkenazi Jews and

Chaldean populations, for example, are
found to be at greater risk for IBD than
other populations.
What is medically important is the
conversion of these basic science
advances to tangible patient benefits.
For instance, since it is well established
that IBD does run in some families,
researchers believe there are a number
of genes that contribute to the devel-
opment of IBD as well as influence its
severity. In other words, a family's health
history is a major factor in determining
the likelihood that you or someone in
your family will develop Crohn's disease
or ulcerative colitis.
Understanding the development of a
disease is important for treating patients
because it helps determine which thera-
peutic approach is appropriate for each
person. The task of researchers, then, is
to take their studies to the next level so
medicine can use these genetic advances
to understand the underlying immune
and functional defects that led to
increased risk of IBD.

Medical Advances

The genetic research also is important
because it may enable physicians to
identify which patients are more likely
to have an aggressive course of disease
and thus should have a more intensive
therapy. It also may let doctors know
what medications a patient is likely to
respond to, creating a more individual-
ized approach patient management with
IBD.
Genetic tests offer a glimpse of what
the future may hold for a person's
health.
Although genetic testing is still in the
experimental stage for IBD, it is some-
thing to think about, particularly if IBD
appears to run in a family's medical his-
tory. However, this look has limitations.
Sorting through all the issues involved
in genetic testing is extremely complex;
it includes medical history details plus
information on the benefits, risks and
limitations of a specific genetic test. BC

The key resource for this article was Ann Silverman. KO.,
at the time director of gastroenterology research for the
Detroit-based Henry Ford Health System

:(11 I CFIALDEAN NEWS I JEWISH NEWS 7