MORGANTOWN -- Although they may not discuss it with even their closest friends, many West Virginians suffer from inflammatory bowel disease. Researchers at the Robert C. Byrd Health Sciences Center at West Virginia University are studying the problem.

Inflammatory bowel disease, or IBD, is a debilitating condition that affects millions of Americans.

"It's a lifelong disease that somebody gets in their 20s, typically," explained Uma Sundaram, director of the IBD Center and chief of the digestive diseases section in the WVU School of Medicine.

"It starts out with a significant amount of diarrhea because the intestine is not absorbing water, chemicals, vitamins, the nutrients in the food," Sundaram said.

Patients lose weight and become malnourished, he said. Children with early-onset IBD don't grow. Fever, chills, nausea and vomiting may eventually follow, and some patients die.

It's a widespread problem in West Virginia, Sundaram said, even if it's not much talked about.

"We probably see a good 400 patients a year if not more from throughout the state," he said -- far more than he saw when he previously was at Yale University. "This condition is rather prevalent in West Virginia. We don't know why it's so prevalent."

Sundaram, who came to WVU about three years ago and started the IBD Center, directs four faculty members in a $5 million IBD research grant from the National Institutes of Health.

Researching IBD

Although the cause is unknown, researchers do know that in IBD, the immune system is both "upregulated," or increased in sensitivity, and "dysregulated" -- simply not working properly.

What the IBD Center studies, though, is the mechanisms of nutrient absorption.

"It is well known that a person with IBD, as an example, has trouble absorbing fat and fat-dependent vitamins," Sundaram explained. "One of the things that's going on in the lab is to specifically look at this one protein that is responsible for absorbing fat and fat-soluble vitamins in the intestine."

Patients with IBD also do not absorb enough protein, resulting in weight loss and malnutrition.

"One thing we've found in the lab is that there are specific parts of the immune system that affect how the intestine is absorbing these building blocks" -- a very new finding, he said.

Bench to Bedside

Sundaram's research takes a translational, or a "bench-to-bedside," approach in which he spends about half of his time with patients and 40 percent on research, with 10 percent left for teaching and administration.

"We see the patients (with a fat absorption problem, for example), and what we're trying to do in the lab is to find out exactly what part of the immune system ... is specifically affecting that absorptive process," he said.

"The hope would be, between the patients and what we see in the lab, we can figure out exactly what is causing this problem so we can try to reverse it," he said.

The research benefits: "When we do endoscopic procedures, with the patients' approval we can get a small biopsy and take that to the lab," Sundaram said. "Without causing additional pain or risk, we're actually studying real tissue."

And the patients benefit: Procedures with names like enteroscopy, capsule endoscopy and Endoscopic Retrograde Cholangiopancreatography that were never before performed in Morgantown now attract patients from as far away as Cumberland, Md., and Zanesville, Ohio, Sundaram said.

"The number of endoscopic procedures we do has literally tripled in the last three years, and the number of patients we see in clinic has quadrupled," he said. "When I came here, we had one clinic per week; now we have 14 clinics every week. So you can see there's a huge demand for these services."

Sundaram likes the physician-scientist approach for getting results that matter.

"A lot of research, as you might know, starts out in the lab, and then it goes searching for a human condition that may or may not be there," he said. "So I think starting with the human question is much, much more translational."

Although it is less than three years old, the center already is doing research of national interest, Sundaram said.

Before the center was formed, WVU never presented at the international Digestive Disease Week, the premier gastroenterology conference. But at this year's conference, taking place in Washington, D.C., this month, WVU scientists will make seven presentations, he said, and will lead two scientific sessions.

"So clearly we're starting to make advances," he said.