Feature

Expert raises awareness of misunderstood GI symptoms following Pat Sajak’s health scare

Tonight, Jan. 13, Pat Sajak is expected to make his permanent return to Wheel of Fortune. The 73-year-old’s hosting schedule had been sporadic recently as he underwent and recovered from surgery for a blocked intestine, according to reporting by The Philadelphia Inquirer.

Sajak told Good Morning America that doctors are not sure what led to his blocked intestine. Paul Feuerstadt MD, FACG, AGAF, gastroenterologist at the Gastroenterology Center of Connecticut, told Healio Primary Care that there are several conditions that can trigger a blocked intestine. including small bowel masses, intussusception, small bowel diverticulitis and post-operative adhesions. One of the more common conditions is inflammatory bowel disease (IBD).

Although a 2017 review forecasted that there will be about 2.2 million Americans and about 0.5% of Western Europeans living with IBD in 2025, other reports suggested that the disease is not universally understood in primary care.

“There are a lot of misunderstandings about IBD,” Feuerstadt said.

Capello M and, Morreale GC. Clin Med Insights Gastroenterol. 2016;doi:10.4137/CGast.S38203.
Sossai P, et al. Clin Exp Gastroenterol. 2010;doi:10.2147/ceg.s9334.

For example, a survey of 409 general practitioners in Australia showed that 37% felt uncomfortable managing IBD. In a separate poll of 39 general practitioners in central Italy, 71.8% said they “needed better instruction regarding IBD.”

To help educate its readers about IBD, Healio Primary Care explored some of its risk factors, symptoms and treatments.

Umbrella disease

Feuerstadt noted that confusion around IBD usually stems from the “umbrella” disease encompassing two separate conditions — ulcerative colitis and Crohn's disease — and their multiple similarities.

According to the Mayo Clinic’s website, individuals most at risk for ulcerative colitis and Crohn’s disease are those aged younger than 30 years, with Ashkenazi Jewish ancestry and a family history of the disease. The risk factors that are more unique to Crohn’s disease include smoking cigarettes and consuming a diet high in fat or refined foods. Patients with ulcerative colitis and Crohn’s disease both experience abdominal pain and cramping, bloody stools, fever, fatigue and weight loss. However, patients with ulcerative colitis also tend to report rectal pain and an inability to defecate despite the urgency to do so, while patients with Crohn’s disease typically report mouth sores, pain or drainage near the anus and inflammation of skin, eyes, joints, liver and/or bile ducts.

PCPs that are concerned about abdominal pain in a patient with inflammatory bowel disease can conduct one of several tests to help tell which condition is afflicting their patient, according to Feuerstadt.

Paul Feuerstadt
Paul Feuerstadt

"The best test to determine the source of a patient’s abdominal pain is an abdominal CT scan,” he said. “If the test shows dilation throughout the small bowel and a decompressed colon, then the patient likely has small bowel Crohn’s disease that is either inflammatory or fibrotic. If it shows continuous inflammation of the colon starting in the rectum, the patient likely has ulcerative colitis. If there is inflammation of the colon without rectal involvement or segmental colonic involvement, Crohn’s disease might be the culprit.”

Treatments

According to the Mayo Clinic, patients — regardless of whether they have ulcerative colitis or Crohn’s disease — can take corticosteroids such as prednisone, prednisone intersol and budesonide to control an acute flare of their IBD symptoms. An acute flare might be the source of a small bowel obstructive process.

“Usually within 24 or 48 hours of a corticosteroid treatment, the obstruction opens up, leading to a passing of gas and of a bowel movement,” Feuerstadt said. “Those are signs that their obstruction has been relieved.”

There are a variety of more chronic treatments for inflammatory bowel disease. The immunomodulators azathioprine and mercaptopurine, and immune system suppressors such as Remicade (infliximab, Janssen) and Humira (adalimumab, AbbVie), can also be used in patients with either ulcerative colitis or Crohn’s disease.

Other treatments that are targeted toward patients with ulcerative colitis include biologics such as Simponi (golimumab, Janssen Biotech) and Entyvio (vedolizumab, Takeda); 5-aminosalicylic acids like sulfasalazine, balsalazide, Dipentum (olsalazine, Alaven Pharmaceuticals) and mesalamine; and the immunomodulator Xeljanz, (tofacitinib, Pfizer Pro), according to the Mayo Clinic.

Treatments more geared toward patients with Crohn’s disease include immune system suppressors like mercaptopurine, Cimzia (certolizumab pegol, UCB) and antibiotics such as ciprofloxacin and metronidazole.

Feuerstadt added that in the rare instances in which the inflammatory bowel disease obstructing lesion is fibrotic, and “not amenable to corticosteroid treatment, then surgery will be necessary.” – by Janel Miller

References:

Capello M, Morreale GC. Clin Med Insights Gastroenterol. 2016;doi:10.4137/CGast.S38203.

GMA.com. “Wheel of Fortune host opens up about health scare in exclusive interview. https://www.goodmorningamerica.com/culture/story/wheel-fortune-host-pat-sajak-opens-health-scare-67843737. Accessed Jan. 2, 2020.

Kaplan GG, Ng SC. Gastroenterology. 2017;doi:10.1053/j.gastro.2016.10.020.

Mayo Clinic. Diagnosis and treatment of Crohn’s disease. https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309. Accessed Dec. 27, 2019.

Mayo Clinic. Diagnosis and treatment of ulcerative colitis. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331. Accessed Dec. 27, 2019.

Mayo Clinic. Symptoms and causes of Crohn’s disease. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304. Accessed Dec. 27, 2019.

Mayo Clinic. Symptoms and causes of ulcerative colitis.https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326. Accessed Dec. 27, 2019.

Sossai P, et al. Clin Exp Gastroenterol. 2010;doi:10.2147/ceg.s9334.

Tan M, et al. Intern Med J. 2012;doi:10.1111/j.1445-5994.2011-02586.

Tornoe, R. When is Pat Sajak returning to Wheel of Fortune? It’s complicated. https://www.inquirer.com/entertainment/tv/wheel-of-fortune-pat-sajak-vanna-white-illness-schedule-christmas-20191219.html. Accessed Dec. 27, 2019.

Disclosures: Feuerstadt reports no relevant financial disclosures.

Tonight, Jan. 13, Pat Sajak is expected to make his permanent return to Wheel of Fortune. The 73-year-old’s hosting schedule had been sporadic recently as he underwent and recovered from surgery for a blocked intestine, according to reporting by The Philadelphia Inquirer.

Sajak told Good Morning America that doctors are not sure what led to his blocked intestine. Paul Feuerstadt MD, FACG, AGAF, gastroenterologist at the Gastroenterology Center of Connecticut, told Healio Primary Care that there are several conditions that can trigger a blocked intestine. including small bowel masses, intussusception, small bowel diverticulitis and post-operative adhesions. One of the more common conditions is inflammatory bowel disease (IBD).

Although a 2017 review forecasted that there will be about 2.2 million Americans and about 0.5% of Western Europeans living with IBD in 2025, other reports suggested that the disease is not universally understood in primary care.

“There are a lot of misunderstandings about IBD,” Feuerstadt said.

Capello M and, Morreale GC. Clin Med Insights Gastroenterol. 2016;doi:10.4137/CGast.S38203.
Sossai P, et al. Clin Exp Gastroenterol. 2010;doi:10.2147/ceg.s9334.

For example, a survey of 409 general practitioners in Australia showed that 37% felt uncomfortable managing IBD. In a separate poll of 39 general practitioners in central Italy, 71.8% said they “needed better instruction regarding IBD.”

To help educate its readers about IBD, Healio Primary Care explored some of its risk factors, symptoms and treatments.

Umbrella disease

Feuerstadt noted that confusion around IBD usually stems from the “umbrella” disease encompassing two separate conditions — ulcerative colitis and Crohn's disease — and their multiple similarities.

According to the Mayo Clinic’s website, individuals most at risk for ulcerative colitis and Crohn’s disease are those aged younger than 30 years, with Ashkenazi Jewish ancestry and a family history of the disease. The risk factors that are more unique to Crohn’s disease include smoking cigarettes and consuming a diet high in fat or refined foods. Patients with ulcerative colitis and Crohn’s disease both experience abdominal pain and cramping, bloody stools, fever, fatigue and weight loss. However, patients with ulcerative colitis also tend to report rectal pain and an inability to defecate despite the urgency to do so, while patients with Crohn’s disease typically report mouth sores, pain or drainage near the anus and inflammation of skin, eyes, joints, liver and/or bile ducts.

PCPs that are concerned about abdominal pain in a patient with inflammatory bowel disease can conduct one of several tests to help tell which condition is afflicting their patient, according to Feuerstadt.

Paul Feuerstadt
Paul Feuerstadt

"The best test to determine the source of a patient’s abdominal pain is an abdominal CT scan,” he said. “If the test shows dilation throughout the small bowel and a decompressed colon, then the patient likely has small bowel Crohn’s disease that is either inflammatory or fibrotic. If it shows continuous inflammation of the colon starting in the rectum, the patient likely has ulcerative colitis. If there is inflammation of the colon without rectal involvement or segmental colonic involvement, Crohn’s disease might be the culprit.”

Treatments

According to the Mayo Clinic, patients — regardless of whether they have ulcerative colitis or Crohn’s disease — can take corticosteroids such as prednisone, prednisone intersol and budesonide to control an acute flare of their IBD symptoms. An acute flare might be the source of a small bowel obstructive process.

“Usually within 24 or 48 hours of a corticosteroid treatment, the obstruction opens up, leading to a passing of gas and of a bowel movement,” Feuerstadt said. “Those are signs that their obstruction has been relieved.”

There are a variety of more chronic treatments for inflammatory bowel disease. The immunomodulators azathioprine and mercaptopurine, and immune system suppressors such as Remicade (infliximab, Janssen) and Humira (adalimumab, AbbVie), can also be used in patients with either ulcerative colitis or Crohn’s disease.

Other treatments that are targeted toward patients with ulcerative colitis include biologics such as Simponi (golimumab, Janssen Biotech) and Entyvio (vedolizumab, Takeda); 5-aminosalicylic acids like sulfasalazine, balsalazide, Dipentum (olsalazine, Alaven Pharmaceuticals) and mesalamine; and the immunomodulator Xeljanz, (tofacitinib, Pfizer Pro), according to the Mayo Clinic.

Treatments more geared toward patients with Crohn’s disease include immune system suppressors like mercaptopurine, Cimzia (certolizumab pegol, UCB) and antibiotics such as ciprofloxacin and metronidazole.

Feuerstadt added that in the rare instances in which the inflammatory bowel disease obstructing lesion is fibrotic, and “not amenable to corticosteroid treatment, then surgery will be necessary.” – by Janel Miller

References:

Capello M, Morreale GC. Clin Med Insights Gastroenterol. 2016;doi:10.4137/CGast.S38203.

GMA.com. “Wheel of Fortune host opens up about health scare in exclusive interview. https://www.goodmorningamerica.com/culture/story/wheel-fortune-host-pat-sajak-opens-health-scare-67843737. Accessed Jan. 2, 2020.

Kaplan GG, Ng SC. Gastroenterology. 2017;doi:10.1053/j.gastro.2016.10.020.

Mayo Clinic. Diagnosis and treatment of Crohn’s disease. https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309. Accessed Dec. 27, 2019.

Mayo Clinic. Diagnosis and treatment of ulcerative colitis. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331. Accessed Dec. 27, 2019.

PAGE BREAK

Mayo Clinic. Symptoms and causes of Crohn’s disease. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304. Accessed Dec. 27, 2019.

Mayo Clinic. Symptoms and causes of ulcerative colitis.https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326. Accessed Dec. 27, 2019.

Sossai P, et al. Clin Exp Gastroenterol. 2010;doi:10.2147/ceg.s9334.

Tan M, et al. Intern Med J. 2012;doi:10.1111/j.1445-5994.2011-02586.

Tornoe, R. When is Pat Sajak returning to Wheel of Fortune? It’s complicated. https://www.inquirer.com/entertainment/tv/wheel-of-fortune-pat-sajak-vanna-white-illness-schedule-christmas-20191219.html. Accessed Dec. 27, 2019.

Disclosures: Feuerstadt reports no relevant financial disclosures.