A new center focused on inflammatory bowel disease brings high-quality care to Rhode Islanders.
Melissa Cote started feeling sick a few days after her 40th birthday in 2017. At first, she thought it was the stomach virus making its way around the office. But as the abdominal pain and diarrhea persisted, she worried it was something more serious.
Cote’s primary care doctor referred her to gastroenterologist Abbas Rupawala, MD, a physician at Brown Medicine’s Division of Gastroenterology. He scheduled a colonoscopy, and found severe inflammation that extended into the small intestine.
That confirmed a diagnosis of Crohn’s disease. “He said my case was the worst he had ever seen,” Cote says.
Rupawala and Sean Fine, MD, both assistant professors of medicine, established a center for inflammatory bowel disease (IBD) in 2017—the first of its kind in Rhode Island. IBD services are designed around a three-pronged approach: clinical care, research, and education.
“The idea is to create a patient-centered medical home,” similar to those for other chronic diseases that require input from a number of different disciplines, Rupawala says. “We want to create a one-stop shop where we can treat psychosocial issues, nutrition issues, and so on.”
The clinic’s unique focus on IBD is a huge benefit to patients, Fine and Rupawala say, because treatment options are rapidly evolving.
“There are 50 new drugs [to treat IBD]in the pipeline. It’s hard to keep up unless you are totally devoted to learning everything about these diseases,” Rupawala says.
That’s where research comes in. The IBD service is becoming a site to enroll
patients in clinical trials. This is a great option for patients, Fine says, who won’t have to travel to participate in studies.
The third prong is education. Fine and Rupawala are working with medical
residents on research projects related to IBD. They plan to develop a fellowship program focused solely on IBD, similar to the one Fine completed at Beth Israel Deaconess Hospital in Boston.
Fortunately for patients like Cote, there are a number of treatments available for Crohn’s. Rupawala started her on a course of prednisone to bring down the severe inflammation. She takes one immunosuppressant drug daily and every eight weeks gets an intravenous infusion of another.
“It’s a complete lifestyle change,” Cote says. “I have Crohn’s disease, but it doesn’t define me. I don’t let it become who I am.”
That mentality mirrors how Fine and Rupawala approach their patients. “We know they have a whole life outside of this doctor’s office,” Rupawala says. They focus on keeping patients well so that the disease doesn’t disrupt their entire lives.
By focusing on IBD, Fine says, they can also be there at times when patients
need closer attention. For example, he says, “I tell my female patients to talk with me as soon as they are thinking about getting pregnant.” For the most part, women can safely stay on their medications through pregnancy.
Another critical time is when young adult patients begin receiving care at the center, which only treats adults, after transitioning from their pediatric gastroenterologists. They want to ensure that kids are ready to assume responsibility for their own care and don’t fall through the cracks. “We’re working out the best practice model,” Fine says.
The patient-centered medical home model should help patients access the care that is part of successful IBD management. It’s something Melissa Cote appreciates.
“Everything is at the East Providence building,” she says. “The infusion center and lab for bloodwork are on the first floor, my primary care doctor and Dr. Rupawala are on the second floor, and my nutritionist is on the third floor. It’s so convenient.”