 What is IBD? What causes it? And who gets it? Inflammatory bowel disease is an autoimmune disorder that affects about 1 in 300 Americans. There are two forms of this disease, Crohn's disease and ulcerative colitis. Crohn's disease seems to affect the whole digestive system from the mouth to the anus whereas ulcerative colitis seems to just affect the colon. They also have a different way that they inflame the structures that they affect and that Crohn's seems to affect the whole wall of the digestive tract whereas ulcerative colitis only affects the topmost layer. The people that get it are traditionally thought to be Ashkenazi Jews but there's a large incidence in African Americans and and as America is quite diverse it seems to be affecting all ethnic groups. There's no specific reason people have inflammatory bowel disease. Genetics are part of it but the other aspects are also perhaps environmental or dietary or the bacteria that live inside us. We don't understand any of those specifically but we can say specifically related to the genetic component that monozygotic twins which are born from the same egg have only a 50% chance of having the disease. If one has the disease the other one has only a 50% chance of having it. What are the symptoms of IBD? The symptoms of inflammatory bowel disease are varied. People can complain of weight loss, abdominal cramping, bloody diarrhea, nighttime symptoms, nausea, bloat. Out of the ones that I listed the ones that are most specific for this disease are blood in the stool and waking up at night to go to the bathroom. How is IBD diagnosed? IBD is often diagnosed by a physician. It is hard at home to figure out if you have inflammatory bowel disease or just a bad case of gastroenteritis. There are a lot of clinical symptoms that can make both the patient and the doctor concerned for inflammatory bowel disease but the ultimate confirmatory diagnosis requires tissue. Uncommonly if the disease is in an area that's difficult to biopsy we could also make the diagnosis by radiologic findings such as a CAT scan or an MRI. When should I see a doctor for digestive issues? That is a very good question. If the symptoms have been going on for more than three weeks we consider them chronic and if they are bothersome then at that point they require a physician attention. Specifically related to inflammatory bowel disease the symptoms that I would be most concerned about are weight loss unintentionally especially at a time when you would be expecting to gain the weight as for example in adolescence or during a pregnancy. Other concerning symptoms are blood in the stool, persistent fatigue, joint aches, eye problems on top of the bloody diarrhea and the nighttime symptoms. Often patients don't realize that not only the digestive system is involved in these diseases but also other parts of your body. What is the best treatment for moderate to severely active IBD? Traditionally IBD patients were treated with long courses of steroids interspersed with periods of antibiotics and sporadic endoscopies and colonoscopies. Literature has evolved that demonstrates that patients should actually be treated in a more rigorous and organized way which is something that we could provide here at Winthrop University Hospital. There are two classes of medications which we are very comfortable prescribing here called the immunomodulators and biologics. Immunomodulators typically taken in pill form are used to block the bone marrow production of a specific kind of white cell that would otherwise inflame your digestive system. Biologics which are usually injectable to the same thing in a more targeted fashion. The combination therapy especially in Crohn's disease but perhaps also in ulcerative colitis has been clinically proven to be the most efficacious way to treat patients with moderately to severely active inflammatory bowel disease. What are the consequences of long-term steroid use? Steroids specifically prednisone are a very common medication in inflammatory bowel disease. They are of our armamentarium of medications, one of the fastest acting medications. So when a patient is very uncomfortable in a lot of distress or potentially about to be hospitalized we often use this class of medications as a way to calm their symptoms. The important thing to note about steroids though is that they are not altering the disease course they are just improving symptoms. So the optimal use of steroids in IBD is for a short-term specific clinical situation with the plan to transition them to a more long-term treatment strategy such as immunomodulators, biologics or both. The consequences of taking steroids for prolonged periods of time are multifaceted. In the short-term often my patients become irritable, moody, anxious. There's facial swelling, sometimes fluid retention in the body. There's bloating, easy bruising, the skin becomes thin, there's hair loss. In the moderate to long-term people have an increased risk of diabetes and high blood pressure, a loss of bone density which can translate into osteoporosis as well as fractures and most significantly a decrease in their immune system which makes them vulnerable to any infectious pathogen. What preventative healthcare steps do I need to take when I'm on IBD medications? That is a very good and important question. Patients with IBD should consider perhaps four categories of preventative health measures. Vaccinations, bone health, cancer screening and medication monitoring. Regarding the vaccinations these need to be checked before immunosuppressant medications are started such as immunomodulators or biologics and periodically during the course of treatment. Regarding cancer screening there are some specific cancers such as cervical cancer or melanoma which IBD patients are more vulnerable to and require careful attention. Regarding bone health, steroid use as well as protracted inflammation can decrease bone density and require careful observation for bone density. And regarding all the medications that we recommend IBD patients each one of these categories of medications has its own criteria for blood monitoring both in terms of efficacy of the drug and in terms of potential toxicity to the patient's body. Does this disease impact fertility? This is a question a lot of my patients ask me. It is a question that both my male and female patients ask me. I will address the female aspect of that question first. When there is ongoing inflammation in the pelvis this prevents adequate fertilization of the egg. So frequently my female patients who have inflammatory bowel disease have a difficult time getting pregnant. Once pregnancy is achieved whether naturally or through in vitro fertilization another concern that I have for my IBD patients is their ability to carry the pregnancy to term. I would like to specifically underline here that control of the inflammatory bowel disease it is the most important factor to consider in the health of the pregnancy. And because a lot of people are concerned about the medication side effects to emphasize that whatever medication was able to control your symptoms sufficiently to allow you to get pregnant is the correct medication for you to stay on during pregnancy with very few exceptions. Most of the IBD medications are safe during pregnancy. Regarding male fertility apart from the consistent inflammation and the fatigue that the disease causes there are very few medications that are contraindicated during the conception period. And a conversation with your gastroenterologist is necessary for those specific concerns. Is it necessary for me to change my diet if I have IBD? I get this question almost as soon as I tell a patient that they have inflammatory bowel disease. What can I do in terms of what I eat to control these symptoms? And it makes conceptual sense that you notice an increase in your bowel movement frequency with specific kinds of food. Unfortunately there is no universal answer that I could provide to all my patients and there is no such thing as a specific IBD diet. Though there are many sources of information on the internet that would say otherwise IBD is so multifaceted that the right diet is as individual as each patient. The only restriction that I have in terms of diet is if you have stricturing disease from Crohn's most likely you will have a harder time tolerating fiber. So in that patient population which is a unique subset of my IBD patients I recommend that they peel their fruit and cook down their vegetables. There is still a good source of fiber in their diet in terms of digestible fiber such as for example oatmeal. So I don't recommend completely restricting fiber just controlling the amount of undigestible fiber ingested. And this is again specifically only for patients who have strictures because of their inflammation. People that just have inflammation of their colon or certain portions of their, the rest of their digestive tract do not necessarily respond well to this diet and there is no such thing as gluten free, lactose free, FODMAP that applies to all IBD patients. How concerned are you about lymphoma risk with somebody with IBD? This is a concern and actually a fear in a lot of my patients before they start immunomodulators or biologics. And I do my best in meeting with them and also in webinars that I provide for them to assure them that the risk of lymphoma is exceedingly small and significantly less of an impact on their daily life than the risk of the disease being untreated. The numbers we quote in terms of incidence of lymphoma in patients on treatment for IBD are in the order of five to at most nine out of ten thousand patients. The chance of having a recurrent flare after a flare has not been completely treated is approximately 25% a year. What makes Winthrop's IBD center different from other centers? Winthrop University Hospital strives to be the place where you would be comfortable discussing this chronic and often debilitating disease with a person who will be vested in your care. We provide the latest biologics, including some that are not on the market yet. As for example, we use telera for ulcerative colitis. We are part of several clinical trials that are designed to either bring new therapies to IBD patients or provide information better in terms of their disease course. We benefit from a close partnership with our infusion center where we can infuse both biologics as well as iron and potentially blood. We are also affiliated with Winthrop University Hospital, which has a state-of-the-art endoscopy suite. Among other techniques we perform there is chromoendoscopy, which is a novel technique for detecting colon cancer in IBD patients in terms of surveillance protocol. We also benefit from a close partnership with our colorectal surgery colleagues. When a surgery is necessary, we work together to coordinate the care and assure the best outcome possible for that procedure. We're also interested in your disease course after a surgery, so we continue to keep in touch and make sure you keep your appointments, do your routine health maintenance, and address all your other concerns with this chronic illness. Where can I get more information about IBD? If you'd like any additional information or if you'd like to schedule an appointment with us at Winthrop Gastroenterology, please call us at 866 Winthrop or find us online at winthrop.org. Thank you.