Relaxation training for pain management.

Facts About J-Pouch Procedures

What is a J-pouch?

When the colon (large intestine) and rectum are removed (due to chronic colitis, cancer or other colorectal diseases), another method must be devised for solid waste to exit the body. Surgically creating a "J" shaped reservoir, or J-pouch, out of an individual's own small bowel (small intestine) is an alternate way for you to store and pass stool.

What are other names for a J-pouch?

Other commonly used names include ileal pouch and pelvic pouch. Similarly constructed ileal pouch types include the S-pouch and K-pouch (Kock pouch or continent ileostomy). Most patients at Cleveland Clinic receive a J-pouch, which is the current gold standard of surgical procedures.

How is a J-pouch created?

In a surgical procedure called a total proctocolectomy and ileal pouch anal anastomosis (IPAA), the entire colon and rectum are removed. A reservoir is created from the distal small bowel (called the ileum), which is then joined to the anal canal. This pouch serves as a storage place for the stool that the patient is able to pass through the usual route, eliminating the need for a permanent external bag (ostomy).

Who is a J-pouch for?

J-pouch procedures have become the gold standard for treating chronic ulcerative colitis (CUC) in which medical therapy fails to control symptoms. J-pouches also are used for familial adenomatous polyposis (FAP), colon and rectal cancer, and rare cases of Crohn's disease.

What are the benefits of a J-pouch?

In a survey of patients who had J-pouch procedures at Cleveland Clinic, one of the greatest benefits cited was having control over bowel movements and being free from the need to instantly find a restroom.

Why come to Cleveland Clinic?

Cleveland Clinic's Digestive Disease and Surgery Institute's Department of Colorectal Surgery began offering J-pouch surgery in 1983 and performs about 200 IPAA surgeries per year, having performed more than 3,600 to date. Cleveland Clinic has not only completed the greatest number of pouch surgeries of any hospital in the world, it also has the lowest pouch failure rate reported by any institution. Cleveland Clinic offers the traditional open approach, as well as a laparoscopic alternative.

While the procedure is complex and requires multiple steps that may or may not be accomplished with one surgery, the end result provides the majority of patients with positive outcomes that most feel outweigh the risks and possible complications

Quick Facts

  • 11 Number of colorectal surgeons who are experienced in J-pouch procedures.
  • 3,600 Since 1983, Cleveland Clinic has performed more than 3,600 J-pouch procedures, the most in the world.
  • 1 Cleveland Clinic has the only gastroenterologist in the nation who specializes in J-pouch post-operative complications.
  • 2 Cleveland Clinic is currently ranked #2 in the nation by U.S. News & World Report for digestive disorders.
  • Largest Referral Center Cleveland Clinic's Digestive Disease and Surgery Institute is the largest national and international referral center for repairing failed pouches. Patients come from around the world for reoperations.

In addition to performing the most J-pouch procedures in the world, the Department of Colorectal Surgery also is the largest national and international referral center for repairing failed pelvic pouches. Patients come from around the world to the Digestive Disease and Surgery Institute for reoperations.

Cleveland Clinic has established the world's first and largest Pouchitis Clinic at which a variety of pouch-associated disorders, such as pouchitis and Crohn's disease of the pouch, are diagnosed and treated by a team of inflammatory bowel disease specialists, colorectal surgeons, gastrointestinal pathologists and gastrointestinal radiologists. The Pouchitis Clinic has drawn patients from around the country and abroad, seeing 1,000 patients annually and performing 500 pouch endoscopies each year.

About the Digestive Disease and Surgery Institute

Cleveland Clinic Digestive Disease and Surgery Institute (DDSI) is the first of its kind to unite all specialists within one unique, fully integrated model of care - aimed at optimizing patient experience. At DDSI, we offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on the gastrointestinal tract. Our departments include:

  • Gastroenterology and Hepatology
  • Colorectal Surgery
  • Hepato-pancreato-biliary and Transplant Surgery
  • Center for Human Nutrition

Cleveland Clinic's Digestive Disease and Surgery Institute is ranked #2 in the nation for digestive disorders by U.S. News & World Report since 2003, and ranked #1 in Ohio since 1990.

To learn more about the Cleveland Clinic Digestive Disease and Surgery Institute, please visit or call 216.444.7000.

Bathroom Talk

Tips for keeping your bowels in good shape

Misconceptions often arise out of a simple lack of information. Take constipation, for instance. You can't possibly know what's "normal" if bowel health is considered taboo to talk about, says Tracy L. Hull, MD, a colorectal surgeon in Cleveland Clinic’s Digestive Disease and Surgery Institute.

"A lot of issues could be avoided or treated if the subject wasn't left in the dark," Dr. Hull says. "We talk about sex education in schools, but we don't talk about bowel health. We have a lot of false impressions out there."

So what is "normal" when it comes to bowel movements? It turns out normal is all over the place, from multiple times a day to twice a week.

"There's a whole spectrum," explains Dr. Hull, who together with her colleagues co-authored one of the first studies examining bowel habits to establish norms in women’s bowel health. "It's not the number that matters. What matters is whether it works for you. Do you feel sick? Are you bloated?"

If your current bowel pattern isn't working for you, there are many potential solutions. Treatments range from simple dietary advice to medication to surgery. Dr. Hull says treatment for constipation depends upon whether the problem is with the colon (large intestine), the rectum (the last 10 inches of the colon), or a combination.

Dr. Hull recommends some simple steps to stay regular:

  • Boost your fiber intake. Aim for 25 to 35 grams daily. Good sources of fiber include whole grains and fruits (enjoy a few breakfast plums, also known as prunes, every morning) and vegetables. But, she says, it's hard to get enough fiber even if you eat a healthy diet. She recommends taking a fiber supplement. Just remember: If your current diet doesn't contain much fiber, increase your intake slowly to avoid bloating and excess gas.
  • Stay hydrated. Not getting enough fluids is one of the most common causes of constipation. Liquids help make stools softer and easier to pass. Drink at least eight cups of water per day.
  • Exercise. A lack of activity can lead to constipation. "We try to encourage patients with constipation to exercise more because we know exercise induces defecation," Dr. Hull says.
  • Limit cheese, bananas and raisins. Certain foods can cause constipation, and cheese is the biggest offender. Limit your consumption of foods known to cause constipation, which also include bananas, raisins and low-fiber, processed foods (such as frozen dinners).
  • Try laxatives. In our society, people are worried about taking medicines for their bowels, Dr. Hull says. "I tell them, 'If you had a problem with your heart, you wouldn’t think twice about taking medicine. Just because it has to do with an organ called your colon, there's no reason you should have an aversion to treating it.'" Medications to treat constipation include over-the-counter laxatives, stool softeners, cathartics and enemas, in addition to a variety of prescription drugs.
  • Leaving on a jet plane? Travel often causes constipation because it disrupts your normal lifestyle. "People also tend to eat richer foods or consume more alcohol than usual," Dr. Hull says. "This can lead to a miserable vacation." Her advice: If you tend to get constipated when traveling, be sure to pack a laxative.

When to See Your Doctor

While there are many variations on "normal" when it comes to bowel health, see your doctor if you have any of the following:

  • Rectal bleeding
  • Bowel habits causing distress
  • Any change in bowel habits, even gradual ones, as this can be a sign of another disorder, such as a thyroid problem
  • Extreme bloating (such as an inability to button pants)
  • Inability to function normally or missing days of work because of constipation

For an appointment with a digestive disease specialist, please call 800.890.2467.

Clinical Research Brochure

What Is A Clinical Trial?

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A clinical trial is a scientific study designed to assess whether a new procedure is better than standard therapy, to compare the value of two standard treatments, or to assess the safety and effectiveness of an experimental therapy.

A clinical trial is not an experiment. The medication or treatment must first be found useful and safe in animals. Testing in humans is allowed only on volunteers who understand and accept the risks and benefits of participating in a study (“informed consent”). Volunteers may choose to leave a study at any time.

Clinical trials may be conducted by a single physician, small group of physicians, single institution or many institutions nationally or internationally. Financial support for a clinical trial is normally provided by organizations such as the National Institutes of Health or a pharmaceutical company or device manufacturer. Also, Cleveland Clinic funds many of its own clinical trials.

At Cleveland Clinic, an ethical oversight group – known as the Institutional Review Board – reviews each written research plan and may request adjustments be made before patients can be recruited for a clinical trial.

Why Participate In A Clinical Trial?

Participants can play a more active role in their own healthcare, gain access to new research treatments before they are widely available and help others by contributing to clinical research trials.

Examples of recent clinical trials that have lead to changes in patient care at Cleveland Clinic include a study of the stapled hemorrhoidectomy for prolapsed hemorrhoids, a technique that has been incorporated into our overall approach to treating hemorrhoids. Similarly, a series of other clinical trials led to the development of a Pouch Disorder Classification system, which has since been used worldwide for patient care management.

How To Begin

A large number of clinical trials is ongoing in Cleveland Clinic’s Digestive Disease and Surgery Institute at all times. If you qualify for a clinical trial, your physician will explain why you might want to participate. In all cases, the procedure, technique, device or drug under investigation, and details of what your participation will require, will be carefully explained to you. Enrollment will take place only after you have given consent.

You can be assured that every clinical trial has been approved by the Cleveland Clinic Institutional Review Board and complies with federal regulations regarding patient privacy. Many patients welcome the opportunity to participate in a project designed to benefit patient care. However, if you are uncomfortable participating, simply say “no thanks.” It will not affect the care you receive at Cleveland Clinic in any way.

Selected Registries and Databases

Cleveland Clinic’s Digestive Disease and Surgery Institute is a world leader in the creation and maintenance of healthcare registries and databases. The use of state-of-the-art information gathering methods enables physician-researchers to track patients over time and assess the long-term impact of treatment on health and quality of life.

Colorectal Cancer Database (established 1975)

Included: Patients treated for colorectal cancer
Goal: To provide information in the search for new diagnostic and treatment options

David G. Jagelman Inherited Colorectal Cancer Registries (established 1979)

Included: Family members of patients diagnosed with familial adenomatous polyposis (FAP), Puetz-Jeghers syndrome (PJS), juvenile polyposis (JP) and hereditary non-polyposis colon cancer (HNPCC)
Goal: To alert family members at high risk for disease and encourage them to be screened

Intestinal Rehabilitation Database (established 2002)

Included: Patients diagnosed with short bowel or intestinal failure
Goal: To track medical, surgical and nutritional history of patients to determine best course of treatment

Irritable Bowel Disease DNA Database (established 2004)

Included: Patients diagnosed with either Crohn’s Disease or Ulcerative Colitis
Goal: Identify underlying genetic factors of these diseases to allow better treatment for IBD patients

Laparoscopic Database (established 1991)

Included: Patients undergoing laparoscopic procedures
Goal: To enhance patient care by tracking the success of these procedures

Pelvic Floor Database (established 2007)

Included: Patients seen at the Colorectal Center for Functional Bowel Disorders
Goal: To improve functionality and quality of life

Pelvic Pouch Database (established 1983)

Included: Patients undergoing pelvic pouch surgery (ileal pouch, anal anastomosis)
Goal: To evaluate long-term pouch function and quality of life

Ripka Family Database for Crohn’s Disease Research (established 2001)

Included: Patients being treated for Crohn’s disease
Goal: To identify optimal treatment options

Of the top digestive disease centers in the United States, the Cleveland Clinic Digestive Disease and Surgery Institute (DDSI) is the first of its kind to unite all specialists in gastroenterology and hepatology, colorectal surgery, hepato-pancreato-biliary and transplant surgery, and nutrition services within one unique, fully integrated model of care – aimed at optimizing the patient experience.

Our institute is dedicated to finding newer, more effective ways to treat diseases of the digestive system. This is primarily accomplished by evaluating new techniques and protocols in clinical trials (also called clinical research studies). As a patient in our institute, you may be offered the opportunity to participate in a clinical trial. This brochure explains clinical trials, and tells you what you need to know in order to make an informed decision about participating.

Colon Cancer Awareness

What is Colon Cancer?

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Often referred to as colorectal cancer or bowel cancer, it is one of the most preventable cancers. Almost always colon cancer starts as non-cancerous growth called a polyp that forms on the lining of the colon and rectum.

How Can it Be Prevented?

If polyps are found and removed early enough through an exam called a colonoscopy, the cancer can be prevented before it gets started. If cancer is detected and found early, 90 percent of these cases are curable.

What are the Symptoms of Colon Cancer?

Colon cancer often has no symptoms at all! However, the following symptoms may indicate the need for a colonoscopy. If you experience the symptoms below, call your doctor right away.

  • Change in bowel habits
  • Diarrhea, constipation or a combination of both
  • Bleeding from the rectum
  • Red blood in stool or blackened stool
  • Thin stools
  • Frequent gas pains
  • Constant tiredness
  • Unexplained weight loss
  • Abdominal pain (bloating, gas, cramps)
  • Vomiting

How Common is Colon Cancer?

More than 140,000 Americans will be diagnosed with colon cancer this year. That is 1 out of 18 people in the United States.

Colon cancer is the second leading cancer killer for men and women in North America, second only to lung cancer. Colon cancer claims over 50,000 lives every year.

Both women and men are at risk of developing colon cancer.

Up to 5 percent of all colorectal cancers are inherited.

Are you at increased risk?

The average risk of developing colon cancer in the North American population is 1 out of 18 (5.6 percent). Some people are at a higher than average risk. Having a parent, child, brother or sister with colon cancer increases your risk of colon cancer by two to three times.

To find out your risk, call 888.503.0988 and a healthcare professional will guide you through an easy, 10-minute quiz to determine your colon cancer risk score. Take this first step today to score against colon cancer.

Colonoscopy Concerns

What's Stopping You?

A Colonoscopy CAN Save Your Life

Everyone has reasons for not getting a colonoscopy, and Carol A. Burke, MD, Director of the Center for Colon Polyp and Cancer Prevention in Cleveland Clinic's Digestive Disease and Surgery Institute, has heard them all. But nothing changes the fact that colon cancer is one of the most preventable cancers. Below, Dr. Burke shares her wisdom, based on 15 years as a gastroenterologist, about why adults need to have a colonoscopy.

"I'm not at risk for colon cancer."

The truth is: Everyone is at risk. One in eighteen American men and women will get colon cancer in their lifetime.

"I don't have any symptoms."

In nearly all cases, colon cancer starts as a precancerous growth in the colon called an adenomatous polyp, which usually doesn't cause symptoms. A colonoscopy detects polyps so they can be removed before they turn into cancer and cause symptoms. On average, 15 percent of women and 25 percent of men over age 50 will have precancerous polyps detected on colonoscopy.

Risk Factor Stats

  • Having a personal or family history of precancerous polyps or colorectal cancer can increase your risk by two or three times.
  • Being overweight or obese increases your risk of colon cancer twofold.
  • Having Crohn's or ulcerative colitis increases your risk of colon cancer by 15 to 40 percent.
  • Heavy smoking (pack of cigarettes for 20 years or its equivalent) increases your risk of colon cancer by 30 percent.
  • Blacks more often have advanced-stage colon cancer and more often die from the disease.

If you're a high risk, see your doctor for advice on beginning colorectal cancer screening earlier.

"I can't drink the prep stuff!"

Drinking a bowel preparation is one of the leading deterrents to having colonoscopy. The good news: Today's bowel prep is easier than before. Rather than having to choke down a gallon of solution, patients can choose half-gallon options. What's more, many physicians prescribe a split dose, where half the prep is taken the night before and the other half on the morning of the procedure.

"A colonoscopy isn't accurate."

A recent Canadian study reporting that colonoscopies may not completely protect against getting colon cancer received a lot of media attention. But in that study, many colonoscopies were not complete and were performed by general internists and family physicians who may not have had the experience to do the colonoscopy well. Improve your odds of having a high quality colonoscopy by making sure your physician has specialized training in performing colonoscopies and tracks his or her outcomes as part of performance improvement.

"A colonoscopy is too painful!" or "I can't be sedated enough."

Actually, 99 percent of patients should be able to be adequately sedated through conscious sedation or twilight sleep to be comfortable during their colonoscopy. Most patients don't even remember the exam! Cleveland Clinic offers monitored anesthesia care for patients who require deeper sedation.

"It's too risky. My friend had his colon perforated during a colonoscopy."

When performed by specially trained professionals, colonoscopies are safe. The risk of perforation is less than 1 in 1,000 cases, and the risk of bleeding is less than 1 percent.

"If I get colorectal cancer, then it was meant to be."

Not true. Colon cancer is preventable. Here's how: Begin screening for colon cancer (colonoscopy is the preferred screening strategy) at age 50, or earlier if you have risk factors. Change your lifestyle now: improving your diet, maintain a normal body weight, exercise and avoid smoking.

To schedule a colonoscopy at Cleveland Clinic, please call 216.444.7000.

Liver Transplantation Program

Bringing you world renowned surgeons and world-class care

Why should I come to the Cleveland Clinic?
Because you deserve…

The most experienced Liver Transplant team in the nation

The Cleveland Clinic Transplant Center recently celebrated the 25th anniversary of its first liver transplantation. Our internationally renowned liver transplantation surgeons have more combined experience than any other transplantation team in the nation - nine specialized surgeons with more than 100 years of experience. Our program performs the 4th largest amount of liver transplants in the nation, approximately 150 per year, and offers the most options for pediatric patients in the region. Here, our expert hepatologists, skilled in diagnosing and treating all forms of liver disease, work hand-in-hand with our surgery team to manage your care through the entire transplantation process.

Higher than expected survival rates

Cleveland Clinic's liver transplant one-year survival rate of 90.9 percent exceeds the national average for expected survival rate. Our three-year survival rate of 83 percent far exceeds the national expected survival rate of 76 percent.

A shorter wait time

Patients on our wait list receive transplants nearly twice as fast as the average expected national rate. The national average time to transplant is 11.7 months, compared to the Cleveland Clinic average time to transplant of 6.7 months. This allows for more timely transplants, helping us ensure better outcomes and longer survival rates for our patients.

Personalized help through this complicated process

Our team is dedicated to making your liver transplant as easy as possible. To help you and your family through this process, we provide a dedicated transplant coordinator, hepatologist, social worker, transplant psychiatrist and financial coordinator. We also provide a group patient education class, participation in clinical trials (should you qualify), and a multi-disciplinary Liver Tumor Clinic.

How does the transplant process work?


A liver transplant is considered when the liver no longer functions adequately (liver failure). A potential cause of liver failure is a sudden (acute) failure from infection or complications from certain medications. Long-term liver failure is more common and can be a result of the following conditions:

  • Chronic hepatitis
  • Primary biliary cirrhosis
  • Sclerosing cholangitis
  • Biliary atresia
  • Alcoholism
  • Wilson's disease
  • Hemochromatosis
  • Amyloidosis
  • Liver cancer

Evaluations by specialists from a variety of fields are needed to determine if transplantation is appropriate. Experts in all areas of liver transplantation will conduct these evaluations at our Liver Transplantation Clinic. This clinic helps improve your experience by eliminating multiple appointments with a different physician at various locations and creating a customized treatment plan.

The wait list

If you become an active liver transplant candidate, your name will be placed on a national waiting list. Patients are listed according to blood type, body size and medical condition (how ill they are). Each patient is given a priority score based on national guidelines according to the acuity of his or her condition.

A full range of options

Cleveland Clinic offers the most comprehensive range of liver transplant options, including liver donor and standard cadaveric transplant. When an organ has been identified for you, our transplant coordinator will contact you by telephone and begin the process for your liver transplant.

After your transplant

Cleveland clinic provides life-long follow-up and cutting-edge therapies for our patients. Our multidisciplinary transplant team is dedicated to putting patients first to ensure the best possible results and help them resume a healthy and productive life. Our team follows more than 900 post-liver transplant patients each year.

About the Digestive Disease and Surgery Institute

Cleveland Clinic Digestive Disease and Surgery Institute (DDSI) is the first of its kind to unite all specialists within one unique, fully integrated model of care - aimed at optimizing patient experience. At DDSI, we offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on the gastrointestinal tract. Our departments include:

  • Gastroenterology and Hepatology
  • Colorectal Surgery
  • Hepato-pancreato-biliary and Transplant Surgery
  • Center for Human Nutrition

Cleveland Clinic Digestive Disease Institute is ranked #2 in the nation for digestive disorders by U.S. News & World Report since 2003, and ranked #1 in Ohio since 1990.

Understanding Liver Disease

Treatments and Options

Your liver is the largest internal organ in your own immune system. At Cleveland Clinic’s Digestive Disease and Surgery Institute, our liver specialists have the experience and expertise to accurately diagnose and offer world-class treatments for all forms of liver disease, including viral hepatitis, fatty liver, alcoholic liver disease, autoimmune liver diseases, genetic liver diseases and liver cancer. Our experts in Cleveland Clinic's Digestive Disease and Surgery Institute were ranked second in the nation by U.S. News & World Report in its 2016-2017 Best Hospitals Survey.

About Us

At Cleveland Clinic’s Digestive Disease and Surgery Institute, we’ve designed our services so that all of the specialists you need – including hepato-pancreato-biliary and liver transplant surgeons – work together as a team. One call puts you in touch with our multidisciplinary team that will work with you to develop the appropriate treatment plan aimed at preserving liver function and quality of life.

You can trust the experts in the field: Cleveland Clinic is a national leader in caring for patients with cirrhosis and its complications and has one of the most innovative and experienced transplant programs in the country. But our patients not only benefit from our clinical experience. They also have the advantage of an active research team, which continues to play key roles in the development and testing of new treatments. This means our patients benefit from having access to clinical trials, should they qualify. These research studies not only provide treatments otherwise unavailable, but they also help us expand our overall understanding of liver disease.

What we treat

Common liver diseases treated by hepatologists at Cleveland Clinic’s Digestive Disease and Surgery Institute include:

Viral Hepatitis

Viral hepatitis is an inflammation of the liver caused by one of three virus forms, A, B or C.

  • Hepatitis A (Hep A) – This infection is usually caused by consuming contaminated food or water. This form of hepatitis usually clears without lasting problems within six months and does not lead to a chronic infection. Typically, you cannot get it more than once since it causes lifetime immunity after first infection. A vaccine to prevent infection is available.
  • Hepatitis B (Hep B) – This virus is transmitted through bodily fluids that triggers an immune reaction, causing low-level inflammation and liver damage. It is normally successfully treated with oral medications that have few side effects or pegylated interferon injections. In a small number of cases, Hep B can develop into a chronic infection, which can lead to more serious liver diseases. A vaccine to prevent infection is available.
  • Hepatitis C (Hep C) – Spread through contact with infected blood, Hep C infection can be very serious. Most people infected experience no symptoms and the virus may remain in the liver for years and it is not discovered until much damage is done. It is increasingly successfully treated with pegylated interferon injections along with oral drugs. Up to 50 percent of those infected with Hepatitis C are able to fight off the virus within six months. However, many patients develop a chronic infection. A liver biopsy can determine the extent of injury and damage to the liver. Treatment includes antiviral medicines, such as pegylated interferon and ribavirin, to limit liver damage. Clinical trials of new treatments are available for those who qualify. Our team works closely with patients to help them best manage their disease, provide emotional support and aid with lifestyle decisions. Eligible patients may qualify for enrollment in one of several novel clinical trials led by our hepatologists.

Fatty Liver Disease

Fatty liver disease is an excess buildup of fat in the liver – or more than 5 to 10 percent of the liver’s total weight. This condition is most common in those who are overweight, diabetic or have metabolic syndrome. If unrelated to alcohol consumption, it is known as nonalcoholic steatohepatitis, or NASH. Otherwise, it is known as alcoholic liver disease. Excess liver fat can lead to inflammation, progressing to scarring (or cirrhosis) in 20 percent of patients.

Treatment includes weight loss, exercise, diabetes control, regulating blood pressure and cholesterol, limiting or eliminating alcohol consumption and not smoking. Cleveland Clinic hepatologists are experts in treating fatty liver disease and were the first to establish a scoring system that helps predict which patients will progress to develop cirrhosis. Eligible patients may be able to enroll in a national clinical trial aimed at determining why the disease progresses in some patients, but not in others.

Genetic Liver Diseases

Our Digestive Disease and Surgery Institute hepatologists have extensive experience diagnosing and treating these and other forms of hereditary genetic liver disease. In addition, our group is committed to counseling families with genetic liver diseases about the risk of their children and first degree relatives to have the same genetic disease of the liver and appropriate screening tests:

  • Hereditary Hemochromatosis – The most common adult genetic liver disease in which a specific genetic defect leads to iron accumulation in the liver, leading to liver cirrhosis and liver cancer in some patients. Iron accumulation may go beyond the liver affecting the heart, joints and pancreas. Specific and effective treatments are available. Liver transplantation may be required in some of these patients.
  • Alpha-1 antitrypsin deficiency (Alpha-1) – This inherited disease may affect the liver and/or the lungs in children and adults. It is caused by an inability to produce enough of a particular protein, called Alpha-1 antitrypsin, which is used to prevent the breakdown of enzymes in various organs. Management of Alpha-1 antitrypsin deficiency includes patient education, maintaining normal nutrition, and closely monitoring patients so that any complications can be treated early. There are potential clinical trials for medical therapies. Liver transplantation successfully cures the condition.
  • Wilson’s disease – A rare genetic disorder that causes excessive buildup of copper in the liver and brain. Treatment is managed by both a hepatologist and neurologist and includes oral medication, which binds to the copper and removes it from the body. Therapy is continued to prevent its reaccumulation.
  • Hereditary amyloidosis – A condition in which the liver produces an abnormal protein that builds up in other organs, causing problems in the nerves and kidneys. Treatment includes medications or other therapies to avoid protein buildup, or a liver transplant to stop disease progression and prevent further damage to other organs.

Autoimmune Liver Disease

Cleveland Clinic hepatologists have extensive expertise in treating autoimmune liver diseases, or conditions that occur when the body’s immune system attacks the liver. Eligible patients may qualify for enrollment in one of several novel clinical trials led by our hepatologists.

  • Primary sclerosing cholangitis (PSC) – This disease causes the liver’s bile ducts to become inflamed, scarred and eventually blocked. This can lead to cholangitis, a condition of bacterial infection of the bile, and cirrhosis. Treatment includes medication to relieve itching, antibiotics, anti-inflammatories, bile thinners and vitamin supplements. PSC is often associated with inflammatory bowel disease (IBD), which may require treatment on its own. Cleveland Clinic is a leader in the management of IBD. PSC can cause liver failure and also is a risk factor for developing bile duct cancer, thus close followup is required.
  • Primary biliary cirrhosis (PBC) – PBC is another disease that destroys the liver’s bile ducts, causing bile to accumulate in the liver and damage liver tissue. Initial treatment is usually aimed at providing symptom relief and includes vitamin therapy, calcium supplements and drugs to treat itching. Bile thinners and anti-inflammatory medications are also commonly used. While the disease cannot be cured, its progression may be delayed. However, if the liver becomes severely damaged, a transplant may be necessary.
  • Autoimmune hepatitis – This is a condition in which the body attacks the liver, causing the liver to become inflamed and scarred (hepatitis). If diagnosed and treated early, autoimmune hepatitis can usually be effectively controlled. Treatment typically includes a combination of medications and corticosteroids to slow down the overactive immune system and prevent the disease from getting worse, and perhaps reverse some of the damage.

Celiac Disease

Celiac disease is a digestive disease in which the body attacks the lining of the small intestines, preventing proper absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, which is found in some grains (such as wheat, rye and barley), vitamins and medicines. Research being done at Cleveland Clinic is shedding light on how this process affects the liver. Celiac disease can be effectively treated by avoiding gluten. Without gluten, the anatomy returns to normal and liver disease regresses. In some patients with liver disease, particularly PBC, celiac disease can coexist.

Liver Cancer (Hepatocellular Carcinoma)

At Cleveland Clinic, liver cancer is diagnosed and treated by a multidisciplinary team that includes our hepatologists and experts from a number of other departments, including hepato-pancreato-biliary surgery, interventional radiology and medical oncology. As with any cancer, early diagnosis is critical. Patients with certain liver diseases are susceptible to liver cancer and should be screened regularly. Cleveland Clinic hepatologists have experience in determining who needs to be screened and how often. In collaboration with Cleveland Clinic Taussig Cancer Institute, patients are provided a wide variety of treatment options, including access to appropriate clinical trials.

Liver Transplantation

Cleveland Clinic’s liver transplant program is an essential component of a broad medical and surgical strategy to manage all patients with liver disease with the therapy most appropriate to that patient. Experts in all areas of liver disease participate in the evaluation, management, treatment and follow-up of liver transplant patients. Our liver transplant program has performed more than 1,000 liver transplants since its inception in 1984. Cleveland Clinic’s liver transplant program is a member of the Ohio Solid Organ Transplant Consortium (OSOTC) and the United Network For Organ Sharing (UNOS), meeting all their requirements for liver transplants. In addition, Cleveland Clinic has an approved and very active living-donor program. The liver transplantation program at Cleveland Clinic has been recognized by outside professional groups for its growing volume and excellent patient outcomes.