Inflammatory Bowel Disease Program Enhanced by Expertise, Research
Raymond Cross, M.D., M.S., A.G.A.F., champions the idea that people with inflammatory bowel disease (IBD) shouldn't just be able to lead more normal lives with treatment, but that the right therapies should enable these patients to function completely normally.
That's a tall order when dealing with IBD, which comprises ulcerative colitis and Crohn's disease and produces gastrointestinal symptoms such as diarrhea, rectal bleeding and abdominal pain. But Dr. Cross, director of the Inflammatory Bowel Disease Program at University of Maryland School of Medicine, understands how the arsenal of medical and surgical IBD treatments available at University of Maryland Medical Center (UMMC) is enhanced by the program's multidisciplinary approach, high level of expertise and cutting-edge research.
Affecting nearly 1.5 million people in the United States, IBD occurs when the body's immune cells attack the intestinal lining, causing inflammation and ulcerations. About 1,500 patients from a five-state referral area are treated regularly at UMMC's IBD Program, which is located within the Digestive Health Center, and another 250 new patients seek out these services each year.
"I like to think the growth of the IBD program reflects its quality," says Dr. Cross, also an associate professor of medicine and co-director of the Digestive Health Center at the University of Maryland Medical Center. "The care of patients with Crohn's and colitis has become more complex, so referrals are more frequent. In addition, given that a fair number of patients come to us by self-referral, I think the word of mouth is that our services are excellent."
Women's Health 'Dream Team'
Originating in 2004 with Dr. Cross' arrival at UMMC, the IBD Program is set apart by several features, including its multidisciplinary approach to care. Most clinic sessions include gastroenterologists and surgeons working side by side, Dr. Cross says, and weekly multidisciplinary rounds are conducted along with national rounds monthly with doctors from other academic centers. In addition to nutritionist-guided evaluations, other resources on-site include infusion services, smoking cessation counseling, capsule endoscopy, and wound ostomy care.
"These are some special services that many places have, but they don't necessarily have all of them in one place like we do," he explains.
Another key feature of the IBD Program is what Dr. Cross describes as its "women's health dream team" – three female gastroenterologists, which is a major advantage in gastroenterology, where women tend to prefer being treated by clinicians who are also women. IBD is typically diagnosed in young people ages 25 to 35, and while women are as likely to develop the condition as men, fertility and childbearing concerns often factor into their treatment, Dr. Cross notes.
"Since many of our patients are of childbearing age, they have questions about fertility, conceiving, intimacy and taking medications during pregnancy," he says. "We offer awesome resources and work closely with the high-risk maternal-fetal medicine group as well as a female surgeon and dietitian."
Advances in Telemedicine for IBD Patient Outcomes
Among the IBD Program's many ongoing research efforts, a standout project will determine whether a smartphone-based telemedicine system lowers disease activity and improves quality of life over one year. Known as the TELE-IBD study, it has enrolled nearly 200 patients who have experienced a flare-up of IBD over the past two years, randomizing them into three groups. One group will receive no intervention, while the other two will receive either weekly or bi-weekly text messages to answer questions about symptoms and side effects, check body weight and receive medication reminders and educational content. Individual treatment plans will be set up with patients based on the information gathered.
Many of the program's research projects involve collaboration among multiple academic centers to improve IBD patient outcomes, Dr. Cross says. Optimizing those outcomes also depends on the team's shared decision-making approach with patients experiencing a wide spectrum of symptoms, from mild to severe.
"No longer is there this paternalistic aspect of care, where the patient passively receives information and leaves the office," he says. "We explain what's happening, give him or her a list of options, go over the pros and cons and really let the patient make the decision in collaboration with us."
"Patients with IBD should expect to live a normal life and feel normal with therapy and/or surgery," he adds. "With most patients, we have very good outcomes."