BOBÌåÓý

GAINESVILLE, Fla. � Patients with Crohn’s disease commonly undergo medical imaging to determine the extent and severity of their condition. Now, it turns out that one previously underappreciated finding can predict future complications and offers a window of hope.

A new study from researchers at the UF College of Medicine suggests internal fistulas may point to a possibility of advanced complications of Crohn’s disease � and merit attention.

Crohn's disease, an inflammatory disease of the gastrointestinal tract that falls under the knotty umbrella of inflammatory bowel diseases (IBD, not to be confused with irritable bowel syndrome, or IBS), has a reputation as one of the more complex GI conditions.

It typically rears its head during a time already full of upheaval � adolescence and young adulthood � and results in patients having to contend with a new, lifelong shift. To start, they need a GI specialist for regular visits and a pharmacotherapy regimen that works to manage the intense inflammation that occurs throughout the gut wall, leading to ulcers and worse.

“There is no cure, but there are really good medicines,� said , M.D., whose work in the division of gastroenterology, hepatology and nutrition has been dedicated to advancing IBD treatments. “Not only do they make people feel better, but they also change the long-term outcomes of this disease. Patients lead happier lives and can avoid a lot of the complications that may occur if your disease goes untreated.�

An internal fistula is simply an irregular connection or “tunnel� that develops between two body structures, like two loops of bowel or the bowel and the bladder. Sometimes fistulas are subtle, and patients may not even realize they have one. Other times, they bring a slew of complications, like pain and blockages, that Zimmermann’s team tries to help patients avoid.

In the study, the team reviewed data from 2007 to 2017 in patients who had cross-sectional imaging, like an MRI or a specialized CT (computed tomography) scan of the small intestine, as part of their ongoing care. If an intra-abdominal fistula were identified � a type of fistula that is not quite benign, but not always noticed by the patient � researchers looked forward in time to see if its presence predicted the development of long-term problems.

It did.

“When we jumped forward, we saw the devastating complications we’re always trying to avoid patients from developing � blockages, bowel rupture and abscesses,� Zimmermann said. “If you had one of these internal fistulas, it predicted that you might develop one of these or have a higher likelihood in the future.�

Knowing this, Zimmermann said, can highlight the importance of getting the patient’s disease under control, not just controlling their symptoms, but improving the health of the intestinal tissue.

“The idea is that you could act quickly once you see this,� Zimmermann said. “Shift your treatment course toward something that is working better, as a disease that is well-managed is not one that is showing these in the first place.�

Intervening ahead of complications is key, especially in chronic diseases, Zimmermann said. Patients are managing their condition for the rest of their life and will inevitably deal with highs and lows.

The UF IBD clinic’s goal is open communication and support â€� and likely why it was rated No. 1 in patient experience across all BOBÌåÓý clinics earlier this year, which is especially rare for those living with an involved chronic illness.

“Our patients� lives are complicated, and I’m lucky to work with an incredibly talented, interdisciplinary team that puts their continued well-being forward,� Zimmermann said.