Improving care for children with inflammatory bowel disease

C.S. Mott Children's Hospital IBD TeamChildren and young adults who have inflammatory bowel disease (IBD) like Crohn’s disease, indeterminate colitis, or ulcerative colitis require careful and diligent medical management to minimize and prevent flare-ups of symptoms, complications, surgeries, and days spent in the hospital.

IBD is a challenging disease to have because right now there is no cure, and symptoms tend to wax and wane over time. For children especially, this can mean they look “normal” on the surface to their peers, but they may be struggling off and on with abdominal pain, vomiting, diarrhea, and fatigue that prevent them from participating in the activities they would like to pursue.  As a result, IBD can be uncomfortable, discouraging, and socially isolating.

IBD is relatively common, affecting about 1 million Americans; the majority of cases are diagnosed in people less than 30 years old. Here at the pediatric GI program at University of Michigan C.S. Mott Children’s Hospital, we take care of approximately 500 children and young adults with inflammatory bowel disease.

Helping end a symptomatic flare of IBD and stay in remission can be a process of trial and error, but it is important to get right so children with IBD can live normal and healthy lives. We believe there is always room for improvement, and there’s so much more we want to know about how we can help manage pediatric IBD more effectively.

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IBD and College: Do the two play nicely?

Inflammatory bowel disease and collegeCollege students across the country are well into their second semester, bunkered into dorms and libraries and riding out the winter weather. Hopefully, especially for those first-year students, the challenges of navigating school and managing priorities seem a little less daunting. After all, adjusting well to college life is critical for success in school and is closely tied to graduation rates. So, it should come as no surprise when I say that successful college adjustment has lifelong implications for career opportunities, earning potential and future successes.

While this transition is difficult for all students, students with inflammatory bowel diseases (IBD) — like Crohn’s disease and ulcerative colitis — can attest to added challenges, such as maintaining their treatment regimen, avoiding common infections, and adjusting to shared bathrooms.

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Monitoring medications in IBD patients

In patients suffering from ulcerative colitis and Crohn’s disease, an overactive immune system affects the gastrointestinal tracts, leading to inflammation, pain, and several other symptoms. Steroid like prednisone control inflammation and help patients’ symptoms in the short term. However, patients should not remain on steroids for an extended period of time as long-term exposure causes problems such as weakening of the bones (osteoporosis), diabetes, and weight gain, which can outweigh the symptom relief. 200214568-001

We use another class of medications called immunomodulators to help regulate the immune systems of patients with Inflammatory Bowel Disease (IBD). The two main medications are azathioprine, also known as Imuran®, and mercaptopurine (Purinethol®). These medications prevent your body from making certain kinds of white blood cells that cause inflammation in the gut. They are immunosuppressive medicines, which means they partially block the action of the immune system, but do not completely turn it off. Most of the risks associated with these medications seem to be related to latent viral infections and non-melanoma skin cancers. Patients taking azathioprine/mercaptopurine need to have their blood tested on a routine basis to check blood cell counts and liver function.

Anti-TNF (tumor necrosis factor) medications such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab pegol (Cimzia®), are another type of medication used for IBD patients. These medications block the activity of TNF, which contributes to inflammation in the GI tract. These medications are very effective for controlling IBD. Like all medications, allergic and other reactions can occur, though there are some special considerations with this class of medicine. Like other immunomodulators,  Anti-TNFs can increase the risk of infections, mostly bacterial infections like pneumonia and fungal infections like histoplasmosis. This risk is higher if you take steroids along with an anti-TNF. Lymphoma and other cancers have been associated with their use as well, though this is a rare occurrence.  However, unlike azathioprine and mercaptopurine, anti-TNF agents do not require routine monitoring. Your physician may recommend labs every six to 12 months to assess for rare liver reactions. You should also inform your doctor if you experience fever, muscle pain or yellowing of the skin.

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Akbar Karim Waljee, MD, is an assistant professor of internal medicine who specializes in gastroenterology and internal medicine. He graduated from the Emory University School of Medicine and completed his residency and fellowship at the University of Michigan Health System. Dr. Waljee sees patients at the Taubman Center and at the University Hospital.



The University of Michigan Digestive and Liver Health HS_180x180services is one of the largest programs in the country, providing prevention, diagnosis and treatment of diseases involving the gastrointestinal tract and liver. Our 60-plus physicians are experts in the diagnosis and treatment of all diseases of the gastrointestinal system.

Are energy drinks wreaking havoc on your digestive system?

178856680Monster, Red Bull and Rock Star are just some of the energy drinks on the market. These drinks are loaded with caffeine (any where from 75 to 200 milligrams — about the same as a cup of coffee), sugar/artificial sweeteners and other ingredients. Another way people get a quick hit of caffeine is from 5-Hour Energy drinks that concentrate up to 200 milligrams of caffeine into a two ounce drink.

So what impact do all those ingredients have on your digestive system? Caffeine is a stimulant that increases your motility, or the contraction of the muscles that propel contents in your gastrointestinal tract. Caffeine is also a diuretic that can cause dehydration especially for those who are prone to diarrhea. For some people, this can cause diarrhea. Caffeine can also make you jittery and anxious. Anxiety worsens symptoms of many gastrointestinal conditions, such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD).

There are about 30 grams of sugar in most eight-ounce servings of an energy drink. That’s the equivalent of more than seven teaspoons of sugar in one small eight-ounce can. For those with IBS and IBD, consuming excess amounts of refined sugar at one time may not be absorbed well in the intestines. The GI tract then draws water into the bowel to dilute and flush out the excess sugar, leading to diarrhea.

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Eating Healthy with IBD

raw food2When someone has an Inflammatory Bowel
(IBD), such as Crohn’s disease or ulcerative colitis, it can seem like food is the enemy and the cause of many problems. The truth is that when patients are doing well and not experiencing inflammation, typically their diet needs to be no different than any other person — with or without IBD. Many people incorrectly believe that eating foods that irritate their condition during a flare can actually bring on a flare. That is not true.

When you are experiencing a flare, it is often helpful to stick to a bland diet — rice, bread, toast, bananas, applesauce, etc. Avoid caffeine, sugar and protein, which can aggravate an already irritated bowel. Once you are feeling better, gradually start eating foods that you have been avoiding. It’s important when you are feeling well to have a well-balanced diet complete with a variety of foods.

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What is Inflammatory Bowel Disease (IBD)?

stomachInflammatory bowel disease (IBD) is an umbrella term used for diseases that involve chronic inflammation of all or part of the digestive tract. Crohn’s disease and ulcerative colitis are two most common forms of IBD. IBD is different from IBS (irritable bowel syndrome), which can have some of the same symptoms, but does not cause inflammation or permanent damage to the digestive tract.

Symptoms of IBD include rectal bleeding, abdominal cramping, fatigue, weight loss and diarrhea. Most people with IBD begin experiencing symptoms before the age of 30. It is more common in Caucasians, but can occur in any ethnic group. Those with family members with IBD are also at higher risk. There may be environmental factors involved as well, as people who live in an urban area or industrialized country are more likely to develop IBD.

IBD is diagnosed after ruling out many other potential causes of the symptoms. Doctors may use several diagnostic tests, including blood tests, stool samples, colonoscopy, sigmoidoscopy, and various imaging tests.

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