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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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
Disease
(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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What Causes Ulcerative Colitis Flares?

uclersWhat causes Ulcerative Colitis (UC) flares is a mystery that University of Michigan researchers are working to solve.

It’s a challenging topic to study because flares can be unpredictable. We do know that when someone with Ulcerative Colitis has a specific infection, a Clostridium difficile infection, often called c.diff, they have a 50 percent chance of developing a flare in the next 180 days. We are studying why some people experience a flare and some do not.

C.diff infections are treated with antibiotics, which affect the normal diversity of bacteria in the gut. It’s believed that those who have flares do not reconstitute a normal level of bacteria in their gut after the treatment. Without that healthy balance of bacteria, they are more prone to a flare.

If we can determine exactly what is causing flares in this specific situation, we may be able to create a probiotic to help prevent those flares. We’re just getting started with this research and expect to be done in three years.

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