Like our other Expert Jennifer, I too listened to the Children's Digestive Health & Nutrition Foundation web cast last month. While she has already given a good overview of the discussions that took place I thought it worth going over some of the basics about IBD diagnosis and treatment options that were discussed.
Dr. Maria Oliva-Hemker (Johns Hopkins University) works mainly with children who have IBD and Dr. Joshua Korzemik (Harvard Medical School) works primarily with adults. Both physicians agreed that today there are about 1 million adults who have been diagnosed with IBD and approximately 100,000 children.
To properly understand IBD - Inflammatory Bowel Disease - you need to know that it is comprised of two illnesses, Ulcerative Colitis (UC) and Crohn's disease, with some people now being diagnosed with Crohn's colitis. Patients diagnosed with UC typically present with diarrhea, often with blood in the stool. UC affects only the colon, or parts of the colon, and not the small intestine. UC is typically found to be left-sided, in the rectum, or in the entire colon (called pan-colitis). Crohn's disease, on the other hand, can affect any part of the digestive tract. In patients who are diagnosed with Crohn's there is not as much blood or diarrhea present as in UC patients but they do tend to have more problems with low energy, anal abscesses, and fistulas, which are not found in UC patients. Today, Crohn's disease is more commonly found in children than adults.
In children who are diagnosed with IBD, they typically present with only one symptom, abdominal pain (or a chronic tummy ache). In other children the only symptom they have could be a failure to thrive and grow. In both children and adults, other symptoms that can point to IBD beyond the gastrointestinal tract include: joint pain, skin rashes, mouth sores, low-grade fever, liver inflammation, irritated or red eyes, and weight loss.
Both Dr. Oliva-Hemker and Dr. Korzemik agreed that other diseases can mimic IBD, making a complete history and tests necessary for a doctor to come to a proper diagnosis. Tests should include a medical history, a physical exam, lab and blood studies, an endoscopic study, colonoscopy, and radiologic studies as deemed necessary.
Treatment options for children and adults are similar. Today, doctors are seeing the efficacy of combining medication with nutrition (in my personal experience this was not the case 10 years or more ago and I'm glad to hear that the medical community is embracing the idea that diet and nutrition play a role in treating IBD). In severe cases of IBD surgery also becomes a viable treatment option.
Medications used in treating IBD include the following:
For Mild IBD -
- 5-ASA drugs are typically used to treat Ulcerative Colitis and include prescription medications such as: Asacol, Pentasa, Canasa, Rowasa, and Azulfidine.
- Antibiotics like Metronidazole are typically used to treat Crohn's colitis, but not colitis.
For Moderate to Severe IBD -
- Steroids have been used for many, many years to treat IBD because they can be very effective but today are being used less often because of adverse and severe side effects like bone loss, severe mood swings, and weight gain.
- Immunomodulators are a newer class of drugs being used to treat both UC and Crohn's disease. This class of drugs includes medications like 6-Mercaptopurine, Azathioprine, methotrexate, and Cyclosporine.
- Biologic Agents are the final class of drugs currently, and most recently, being used to treat severe cases of IBD, but especially Crohn's, and include medications such as: Infliximab, Adalimumab, Natalizumab, and Cerolizumab.
- Surgery used to be a last resort sort of treatment for IBD, but today when used properly surgical intervention can be extremely helpful to seriously ill patients who do not respond to prescription medication and diet changes.
Nutrition's role in treating IBD
Depending on where you are in your disease, nutrition can be a tricky topic for IBDers. When I was at my sickest ten years ago I couldn't eat anything beyond yogurt, toast, white rice, applesauce, and baked chicken for months. Just looking at a vitamin made me run to the bathroom, and gone were my days of eating out. As you've read in my earlier blogs I embarked on an Elimination diet and found which foods were making my symptoms worse, and slowly was able to bring my diet and nutrition back into line. By slowly I'm talking years. It has only been in the past few years that I don't constantly think about what I'm eating.
As my symptoms improved I was also able to include some vitamins in my weekly routine. I couldn't take vitamins on a daily basis at first, but am now able to take a variety of vitamins daily and find that I'm no longer getting the cold or flu at the drop of the hat, and generally feeling healthier.
According to Drs. Oliva-Hemker and Korzemik IBD patients should try to eat as well-rounded and balanced a diet as they can tolerate. This will change as your symptom patterns change and as many of you already know diligence and patience are both key in learning to successfully live with IBD. The doctors also discussed the vitamins that most IBDers need like a multi-vitamin, calcium, vitamin D, zinc, folic acid, B12, and iron. However, they were quick to point out that this is not a one-size-fits-all vitamin package and that discussing your individual nutrition and vitamin needs with your doctor or nutritionist is important.
If you are interested in reading more about my journey of learning to live with IBD you can visit my web site: . Learning to live with any illness or disease is a process and a journey. And I believe one factor that is key to being successful on your personal journey is patience. Be patient with your body, patient with your mind, and patient with your doctors. IBD is much better understood today than when my father was diagnosed with UC back in the 1960s, but treatments and how patients react to them are still very individualized and it can take time to figure out the right combination of treatments for each patient. So, remember, patience will keep you sane and help to make you well.