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Disease Author: Staff Editor Last Updated: Sep 7, 2017 - 10:06:33 PM

Crohn’s Disease and Its Underlying Causes - An Interview with Joel R. Rosh, MD,FAAP, FACG, AGAF

By Staff Editor
Oct 16, 2012 - 1:58:35 PM

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( - What is the latest regarding Crohn’s disease and its underlying causes?

Dr. Joel R. Rosh: The last decade has brought marked advances in our understanding of the etiology of the inflammatory bowel diseases (IBD = Crohn’s Disease and Ulcerative Colitis). Long recognized as conditions that lead to chronic, poorly regulated inflammation of the gastrointestinal tract, recent research has shed light on the underlying causes of IBD.

The gastrointestinal tract normally has a very active, local immune system. Our intestines are inhabited by 10 times more bacteria than human cells! The cross talk between the bacteria that live in our bowels and our local immune system is a dynamic and closely regulated process that finds its roots in our genes.

There are now more than 90 IBD susceptability genes that have been identified. Individuals with such genetic susceptability have an innate immune system (what you are born with) that is predisposed to loss of regulation. In such an individual, enviornmental factors that are yet to be fully described, affect this “hard-wired” immune system and the consequent adaptation is poorly controlled leading to the chronic inflammtion of IBD. -Who is more at risk and how does Crohn’s disease affect the daily lives of patients?

Chronic gastrointestinal inflammation leads to symptoms such as abdominal pain, diarrhea and fever and weight loss. In pediatric patients, this can have a profound effect on growth and development. Such unrelenting symptoms can have a profound affect on quality of life issues including secondary anxiety and depression, lost work and school productivity, etc.

HND: - What are the complications of Crohn’s disease?

Dr. Joel R. Rosh: The inflammatory process in Crohn’s disease (CD) starts in the lining of the intestine but can involve all layers of the wall, that is, full thickness changes. This can lead to long term complications which can require multiple surgical interventions and hospitalizations. Such complications include scarring of the wall (strictures) and perforation through the wall leading to infection (abscess) or abnormal connections (fistulas) to other structures including the abdominal wall, other loops of intestine, bladder and uterus. Such perforations could also be spontaeous, profound and life-threatening leading to emergent operations.

HND: - Based on a recent study published in The American Journal of Gastroenterology, most patients with Crohn’s disease will require major abdominal surgery within 20 years of being diagnosed. What can be done to help provide better outcomes for these patients?

Dr. Joel R. Rosh: - While mild disease can respond to topical anti-inflammatory therapy, patients with moderate disease activity or a relapsing course have been identified as those who should receive immune modifying agents. The short-term goal of therapy remains the relief of clinical symptoms while the long-term goal is to improve quality of life while changing the natural history of the disease by decreasing the incidence of adverse outcomes such as the need for surgical intervention. Careful disease monitoring, including assessment for ongoing inflammatory activity even in the absence of gastrointestinal symptoms, is likely to be our best strategy to alter the natural history of Crohn’s disease.

HND: With the advent of new technologies such as PillCam SB, how has it impacted your practice in diagnosing and monitoring patients with Crohn’s disease? Also, many are concerned about radiation exposure over time with certain tests. What is your advice to patients?

Dr. Joel R. Rosh: - New technologies such as PillCam SB provide us with a non-invasive means to look at the mucosa (lining) of the gastrointestinal tract. In this way, we have opened a whole new world of monitoring both disease activity and response to therapy.

Classically, most of the small intestine could only be diagnosed with contrast X-rays. While this could show full thickness changes in the wall of the intestine, the fine detail of the lining could not be seen by this method. Additionally, repeat X-ray exams would expose the patient to an appreciable dose of diagnostic, ionizing radiation. Video capsule endoscopy allows for excellent assessment of the intestinal lining without exposing the patient to radiation. This diagnostic tool has real promise of assisting clinicians in monitoring disease activity to a degree of accuracy not previously available.

For More Information: GoryebChildren'sHospital

Associate Professor of Pediatrics
University of Medicine and Dentistry of New Jersey
Director, Pediatric Gastroenterology
Goryeb Children’s Hospital/Atlantic Health
Morristown, New Jersey

Joel R. Rosh completed a medical degree at Albert Einstein College of Medicine in New York. His postdoctoral training included an internship and residency in the Babies Hospital–Columbia Presbyterian Medical Center Department of Pediatrics and a fellowship in pediatric gastroenterology at Mt. Sinai Hospital in New York. Prior to joining the faculty at University of Medicine and Dentistry of New Jersey, Dr. Rosh served in the Department of Pediatrics at Mt. Sinai Hospital and Columbia Presbyterian Hospital in New York.

Certified by the American Board of Pediatrics in pediatric gastroenterology and nutrition, and by the

National Board of Medical Examiners, Dr. Rosh is a member of several professional societies, including the American Academy of Pediatrics (AAP), the Crohn’s & Colitis Foundation of America (CCFA), and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). He has served on numerous advisory bodies, including as, National Chairman of the CCFA Pediatric Education Committee and National Councilor for NASPGHAN and has served as an advisor to the FDA. Among Dr. Rosh’s many honors and awards are CCFA Physician of the Year, New Jersey Chapter (2004); New Jersey Pediatric Society Physician Recognition Award (2002); and selection to several best-doctors lists, including Castle Connolly’s New York Metro Area Top Doctor (1998–2012). Dr. Rosh is widely published in the field of pediatric IBD with interests in safety and efficacy of current and emerging pharmacotherapy. He is a frequent peer-reviewer for many journals and a member of the editorial boards of the Journal of Pediatric Gastroenterology and Nutrition and the Journal of Clincal Gastroenterology.


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