Approximately 1.6 million Americans suffer from inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, and the number of cases has been increasing over the past decade. The AdventHealth IBD program was the first dedicated program of its type in Florida and provides comprehensive, multidisciplinary care for even the most complex cases.
About Crohn’s Disease
Crohn’s disease involves chronic inflammation that can occur anywhere in the gastrointestinal tract but is most common in the lower portion of the small intestine and in the large intestine. A long-term condition typically first diagnosed when people are in their 20s or 30s, it significantly impacts not only physical health, but social, psychological and financial health as well, including the ability to work or attend school, manage relationships and navigate social situations. Many Crohn’s patients are uninsured or underinsured, making it difficult to cover the cost of ongoing treatment. In addition, some patients must confront all of these challenges with little family or caregiver support.
Crohn’s patients tend to experience intermittent periods of active inflammation and symptoms called flares which typically alternate with periods of lesser symptoms or remission. The goal of treatment is to keep patients in remission as much as possible to help avoid more serious complications and the need for surgery.
Medical Complications of Crohn’s
Crohn’s is a progressive disease and tends to worsen over time, especially without proper ongoing treatment. It can lead to serious complications, including the following:
- Strictures and intestinal obstruction — Swelling and formation of scar tissue causes narrowing of the intestine which if severe enough, can obstruct the bowel. Severe obstruction that doesn’t respond to medication may require surgical intervention.
- Fistulae — A breakdown of tissue caused by ulcers within the intestinal tract can turn into an abnormal connection between the bowel and another body part such as the skin, bladder, vagina or anus. Large or multiple fistulae may require surgery.
- Bowel perforation — This is a life-threatening condition where a puncture or tear causes the contents of the bowel to leak into the body.
- Malnutrition — This is caused by malabsorption of nutrients in the small intestine and includes deficiencies in vitamins, proteins and fats.
A Multidisciplinary Approach to Providing Customized Care
Crohn’s is not a disease that one physician can effectively treat alone. That is why AdventHealth's multidisciplinary IBD team works closely together in partnership with each patient admitted to the hospital to create a customized, evidence-based treatment plan. This team includes the following Crohn’s specialists:
- Medical gastroenterologists
- Colorectal surgeons
- Radiologists
- Nutritionists
- Pathologists
- Psychologists
- Wound care (stoma) specialists
- Nurses
- Clinical research team
Medical Treatment of Crohn’s
There are a number of anti-inflammatory drugs and immunomodulators, including biologics, that can help to control Crohn’s inflammation and prevent flares. These are often combined with dietary changes and behavioral therapy to help patients manage their disease.
Surgical Treatment of Crohn’s
Many Crohn’s patients will require surgery at some point to correct a complication of the disease, and AdventHealth has the largest volume of complex IBD surgery patients in Florida. To help remove fear and anxiety and to ensure patients are prepared, the AdventHealth IBD colorectal surgeons educate patients early on in their disease about the potential need for surgical treatment.
AdventHealth offers a wide range of surgical treatment options for complications of Crohn’s, and the surgeons specialize in taking a minimally invasive approach whenever possible to ensure optimal recovery and outcomes. This team is led by colorectal surgeons Matthew Albert, MD, and John Monson, MD, pioneers in laparoscopic and robotic colorectal surgery, with two and a half decades worth of experience.
Surgical treatments include:
- Laparoscopic ileocolic resection
- Laparoscopic small bowel resection
- Minimally invasive strictureplasty
- Laparoscopic colectomy
- Laparoscopic J pouch surgery
- Redo J pouch surgery
- Laparoscopic total protocolectomy
Research
The AdventHealth IBD program also actively participates in clinical research on promising new medical and surgical treatments, including international, multi-hospital clinical trials, for even the most complex Crohn’s cases. This includes a partnership with the Surgical Research Network, the research/grant arm for clinical research in the Crohn’s and Colitis Foundation of America.
Looking Ahead
AdventHealth plans to continue to enhance and expand the services available to patients suffering from Crohn’s. This includes providing centralized access to care throughout all of AdventHealth’s Central Florida campuses as well as adding a team of nurse navigators to help coordinate each patient’s care. The medical team is also growing with the addition of more dedicated IBD gastroenterologists and a new IBD surgeon sub-specialized in re-operative procedures, including re-do pouch construction. The AdventHealth IBD team recognizes that Crohn’s is a challenging journey and believes patients need an expert, specialized team on their side.
To schedule an appointment or refer a Crohn’s patient to the AdventHealth Digestive Health Institute.
About Matthew Albert, MD
Matthew Albert, MD, founded the Center for Colon and Rectal Surgery at AdventHealth Orlando in 2004. A Fellow of both the American Society of Colon and Rectal Surgeons and of the American College of Surgeons, his specialties include laparoscopic and robotic surgery of the colon and rectum, screening and therapeutic colonoscopy, surgery for colon and rectal cancers, inflammatory bowel disease, the treatment of anorectal disease, and stomas. Dr. Albert's wide range of colon and rectal surgical services includes the revolutionary technique known as TAMIS (transanal minimally invasive surgery), which he co-invented at AdventHealth, and Transanal Total Mesorectal Excision (taTME) which he also developed. In addition, he is credited with spearheading the development of an ACGME-accredited subspecialty training program for colon and rectal surgeons at AdventHealth Orlando.
