Crohn s Digest. The Changing Face of Colorectal Surgery. News and Information about Crohn s from Cleveland Clinic Digestive Disease Institute

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1 Fall 2009 Crohn s Digest News and Information about Crohn s from Cleveland Clinic Digestive Disease Institute In s id e : Learn more about new research in inflammatory bowel disease: Page 2 Dr. Remzi Named Chairman Page 3 Physician Spotlight: Bo Shen, MD Page 4 Walk to Benefit Research Page 5 New Staff The Changing Face of Colorectal Surgery

2 Dr. Remzi Takes Charge of Colorectal Surgery Department Feza H. Remzi, MD, was promoted to Chairman of Colorectal Surgery at the end of 2008, after his predecessor, Victor W. Fazio, MD, was promoted to Chairman of Cleveland Clinic s Digestive Disease Institute. In this Q&A, Dr. Remzi discusses his vision for the department and what he thinks lies ahead in the rapidly evolving field of colorectal surgery. Q: Having trained in colorectal surgery at Cleveland Clinic, you were extensively mentored by Dr. Fazio. How does it feel now to sit at the helm as chairman? A: It is truly an honor. Victor Fazio has built the greatest Department of Colorectal Surgery in the world. During his 33 years as chairman, he maintained the pre-eminence of a department of four colorectal surgeons and expanded it more than four-fold to a staff that now performs more than 5,000 surgeries annually. But Dr. Fazio is more than just a great leader. As a surgeon, he also served as a source of inspiration to many, including myself. I cannot say how fortunate I was to be mentored by such a tremendously skilled surgeon, who has pioneered numerous techniques that have changed the course of colorectal surgery. He not only changed the course of my life for perhaps without meeting him I would have continued upon my original route to become a urologist but also the lives of the generations of colorectal surgeons who studied under him and who have gone on to train others. It has long been my dream to one day lead this department and it is an amazing challenge now to follow in his footsteps. Q: What are your priorities for the Department of Colorectal Surgery? A: My top priority is patient care. Regardless of who we are or what we accomplish, our utmost priority is to take care of the patients making sure we provide the highest-quality care and service. Beyond that, this is a remarkable team. I am very proud to lead them. We have a rich history of being leaders in innovative treatments, and my colleagues and I will strive to continue to add to this legacy. Q: You recently made headlines for innovative procedures, such as performing the first single-port laparoscopic colon resection entirely through a single incision in the navel. Will you continue being active in your specialty as chairman? A: Yes, certainly. All of my partners and I have high-volume colorectal practices, and we all see every condition from simple hemorrhoid problems to complex reoperative pelvic surgery. One of my passions, however, has been and remains treating patients with ulcerative colitis who require ileo-pouch procedures. continued on the next page Crohn s Digest is published twice a year by Cleveland Clinic s Digestive Disease Institute to provide up-to-date information about the department and its services. The information contained in this publication is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician s medical assessment and medical judgment. Please us with questions and comments about this newsletter. We would love to hear from you especially if you have moved or changed phone numbers! Drop us a line; this newsletter is for you! Editorial Staff: Editor Jessica O Connor Managing Editor Linda S. Libertini Contributor Crohn s and Colitis Foundation of America Contact Information: Ripka Family Database for Crohn s Disease Research c/o Linda Libertini Cleveland Clinic 9500 Euclid Ave. DDCRU/JJN4-02 Cleveland, OH ext Crohns_Digest@ccf.org Some articles and images have been adapted from Cleveland Clinic s Digest This, Spring Cleveland Clinic Digestive Disease Institute

3 Physician Highlight: Bo Shen, MD Department of Gastroenterology & Hepatology Digestive Disease Institute, Cleveland Clinic Bo Shen, MD, is the only gastroenterologist in the nation who specializes in pouch complications. Together with colleagues, Victor Fazio, MD, Feza Remzi, MD, and Ian Lavery, MD, Dr. Shen founded Cleveland Clinic Digestive Disease Institute s Pouchitis Clinic. An average of 20 to 35 patients a week from around the United States and the world are seen at the Pouchitis Clinic the first of its kind in the nation with an average of 1,000 pouch patient visits and 500 pouch endoscopies per year. It has become a national and international referring center for ileal pouch disorders. Because pouchitis and other pouch disorders are difficult to diagnose and treat, the Pouchitis Clinic has been instrumental in researching and developing accurate diagnostic criteria, diagnostic classification systems, management algorithms, cost-effective evaluation of symptomatic patients and examining the pathophysiology of the pouch. What s more, Cleveland Clinic continuously explores treatment options such as balloon dilation and endoscopic needle knife treatment of pouch strictures, 5-aminosalicylic acid suppositories for cuffitis, innovative antibiotic, probiotic and carbon microsphere regimen for pouchitis, biological therapy for Crohn s disease of the pouch and amitriptyline for irritable pouch syndrome. Dr. Shen earned his medical degree from Nantong Medical College in Jiangsu, China. He completed an internship and residency in internal medicine at Nantong Medical College Hospital in China and a residency in internal medicine at University of Illinois at Urbana-Champaign in Urbana, Ill. He also completed a gastroenterology fellowship at Cleveland Clinic. He has secured federal and societal grants for multiple research projects including an investigation of clinical approach to ileal pouch dysfunction, pouchitis, inflammatory bowel disease and optical coherence tomography in GI disorders. He also has published more than 100 peer-reviewed articles on pouchitis, Crohn s disease and irritable bowel syndrome, among many others. For an appointment with Dr. Shen, please call continued from page 2 Dr. Remzi Takes Charge of Colorectal Surgery Department Q: The volumes seen by your department are among the highest in the nation. Can you describe what makes its patient care unique? A: While the mainstay of our business is treating patients with colorectal diseases, we see a high volume of patients who are referred to us with difficult problems, rare diseases or serious complications. We excel in taking care of uncommon conditions/problems. Q: How has laparoscopic surgery revolutionized the types of procedures being performed today and how is your department positioned to continue leadership in this field? A: Colorectal surgery is clearly changing. Over the past decade, we have led the world in laparoscopic colorectal surgery. We have one of the highest volumes at any single center in the nation more than 450 cases a year. The future is to push the envelope: smaller incisions, fewer ports, different extraction sites. We also are very excited about the prospects of robotic colorectal surgery and defining how this may play an evolving role in the surgeries that we perform. Feza H. Remzi, MD, specializes in surgical treatment for mucosal ulcerative colitis, pelvic pouch procedures for mucosal ulcerative colitis and familial adenomatous polyposis, sphinctersparing operations, surgery for colon and rectal cancer and complex reoperative abdominopelvic surgery. For an appointment with Dr. Remzi, please call Cleveland Clinic Digestive Disease Institute 3

4 Psychosocial Reaction to Crohn s Disease Can Be Challenging Crohn s disease affects virtually every aspect of a person s life. If you or someone you care about has Crohn s, you are bound to have questions about the relationship of psychosocial and emotional factors to these illnesses. Here are some of the questions the Crohn s and Colitis Foundation of America (CCFA) is asked most frequently: Can tension and anxiety cause Crohn s? There is no evidence for this. Crohn s disease is a biological disorder. Tension and anxiety can modify how people with Crohn s experience it, but they do not cause the disease. Can the symptoms, such as severe pain and chronic diarrhea, cause emotional difficulties? Indeed they can. Everyone copes with physical illness in different ways. Some people can cope with severe illness without extraordinary emotional reaction while others experience emotional distress when they develop a serious organic and chronic illness like Crohn s disease. What are some of the responses of individuals to Crohn s? Some people will find it difficult to cope. Crohn s can pose a threat to their health-related quality of life, including their physical and emotional well-being, social functioning and even self-concept. Individuals may feel anxiety, depression, denial or a need for dependence. These reactions are a response to the illness and not its cause. When this interferes with daily functioning, it is important for the patient to improve their psychological response. This may be accomplished individually, with family or friends, their physician, or a mental health counselor. CCFA offers resources and support to make day-to-day life with Crohn s more tolerable. It has established local support groups where you can talk with other patients and their family members, and offers an online community ( to provide support in managing your condition. CCFA information specialists can be reached at 888.MY.GUT.PAIN ( ) or Cleveland Clinic Supports Walk to Benefit Crohn s & Colitis Research On Saturday, June 6, walkers at Cleveland s Progressive Field joined the Take Steps walk to help the Crohn s and Colitis Foundation of America (CCFA) raise money to find cures for Crohn s disease and ulcerative colitis. These debilitating diseases affect the lives of more than 1.4 million Americans and often require hospitalization and surgery. There is no known cure. This is the second year the event was held in Northeast Ohio. In 2008, 750 walkers took part in the two- to three-mile walk; more than 1,000 participated this year, says Patty Kaplan, Development Manager of CCFA s Northeast Ohio chapter. In all, this year s event raised nearly $140,000. Of the 108 teams, four were from Cleveland Clinic. As an academic medical center that cares for more than 3,000 patients with Crohn s and ulcerative colitis each year, it is extremely important to us to support CCFA, says Victor W. Fazio, MD, Chairman of Cleveland Clinic s Digestive Disease Institute. Kaplan says that many of the walk participants wore T-shirts bearing their team names, including Spill Your Guts and Me and My Crohnies. A Solon High School drum line kept the crowd of all ages fired up. Since its inception in 1967, CCFA has invested about $136 million in research worldwide. While many significant treatment advances have been made, Dr. Fazio says it is critical to continue the research that may one day find a cure for these disorders. We whole-heartedly encourage our patients to join CCFA, which provides unmatched educational resources for patients suffering from Crohn s and ulcerative colitis, Dr. Fazio says. Learn more at Cleveland Clinic Digestive Disease Institute 4

5 New Staff Ahmed Kandiel, MD Gastroenterology and Hepatology Cleveland Clinic Main Campus Beachwood Family Health Center Cleveland Clinic s Digestive Disease Institute welcomes Ahmed Kandiel, MD, to the Department of Gastroenterology and Hepatology. Dr. Kandiel is a graduate of New York University School of Medicine. He completed his residency training in internal medicine at Hospital of the University of Pennsylvania and a gastroenterology fellowship at Cleveland Clinic, and obtained a masters degree in public health at Johns Hopkins School of Hygiene & Public Health. He joined the Cleveland Clinic staff in His specialty interests include Crohn s disease and ulcerative colitis. Cleveland Clinic IBD Factoids 635 Number of patients seen for Crohn s disease in Number of patients seen for ulcerative colitis (UC) in ,200 Number of J-pouch operations for UC performed to date 192 Number of IPAA surgeries performed in Number of gastroenterologists in the nation who specialize in pouch complications (Cleveland Clinic s Bo Shen, MD. See Page 3) clevelandclinichealth.com Stay informed. Stay connected. Stay well. Special Assistance for Out-of-State Patients Cleveland Clinic s Medical Concierge program is a free service for patients who travel to Cleveland Clinic from outside Ohio. Patient care representatives facilitate and coordinate the scheduling of multiple medical appointments; provide access to discounts on airline tickets and hotels, when available; make reservations for hotel or housing accommodations; and arrange leisure activities. For more information, call , ext , visit clevelandclinic.org/services or medicalconcierge@ccf.org. Interested in calculating how many calories you burned walking the dog? Or taking a behind-the-scenes look at our face transplant team? Or learning the latest information on digestive health? You can get all this and more from Cleveland Clinic s new consumer health website, clevelandclinichealth.com. In addition to stories about amazing medical advances, you can ask our medical experts questions, keep up with medical news with health headlines, get quick health tips, find healthy recipes, view videos and slideshows on various health topics, take a peek into Cleveland Clinic s research and innovations, and much more. Be sure to bookmark clevelandclinichealth.com, and tell us what you think! 5 Cleveland Clinic Digestive Disease Institute

6 Service Spotlight: Inflammatory Bowel Disease Crohn s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) that can present with a myriad of manifestations. Cleveland Clinic s Digestive Disease Institute (DDI) gastroenterologists and colorectal surgeons work together to identify the optimal approach to managing their patients disease, collaborating with colleagues in nutrition support, intestinal rehabilitation, transplant nutrition, and hepato-pancreato-biliary and transplant surgery, when necessary. Highlights: Innovative therapies many pioneered at Cleveland Clinic allow IBD patients to lead higher quality lives. The DDI, with its participation in clinical trials and excellent surgical outcomes, receives worldwide referrals, particularly for complex and severely affected patients. DDI is the largest national referral center for repairing failed pelvic pouches. Patients come here from around the world for reoperations. The optimal surgical procedure for these patients is IPAA, although our surgeons offer several other surgical treatments, including continent ileostomy, for patients who fail IPAA or do not qualify for repeat IPAA. We performed our first adult intestinal transplant in June 2008, becoming one of only a few hospitals in the country that perform this procedure. Our Nutrition Support Team offers comprehensive care for one of the nation s largest cohorts of home parenteral nutrition patients. The Cleveland Clinic Foundation 9500 Euclid Avenue / DDCRU/JJN4-02 Cleveland, Ohio Non-Profit Org. U.S. Postage PAID Cleveland, OH Permit No DDI-026