Read several IBD-related questions and answers that patients frequently ask their physicians regarding medicine, behavioral health, and nutrition.
Jeffrey M. Dueker, MD, MPH
Assistant Professor of Medicine
UPMC IBD Center and Total Care-IBD
Division of Gastroenterology, Hepatology and Nutrition
University of Pittsburgh / UPMC
What is the association between kidney stones and Crohn’s disease?
It is common for patients with Crohn’s disease to develop kidney stones. This is due to inflammation or a prior surgical resection of the end of the small intestine, also called the distal or terminal ileum, where Chron’s disease often occurs. This causes malabsorption of compounds that subsequently bind calcium and increase the amount of oxalate, a naturally occurring compound found in plants that can lead to kidney stones, which is then absorbed in the colon into the body. Treatments to reduce the Crohn’s inflammation may help prevent the formation of kidney stones. If the problem is due to surgical resection or scarring of the terminal ileum, it is best to minimize intake of oxalate.
Does bile affect the colon after surgery to remove the end of the small intestine?
Yes, inflammation of or surgery to remove the end of the small intestine, also called the distal or terminal ileum, impacts the reabsorption of bile. Additionally, patients with inflammation in this area can often have a malfunctioning valve between the small and large intestine (ileocecal valve) or in some cases, this valve may have been surgically removed. The result is bile acids spilling into the colon and causing irritation. Treatments can reduce the amount of bile acids that come from the small intestine to decrease colon inflammation.
Is it safe to take medications to slow the Gastrointestinal tract like loperamide (Imodium)?
Yes, it is important to make sure that loose or frequent stool is not from uncontrolled intestinal inflammation from inflammatory bowel disease (IBD) or an infection. Otherwise, these medications can be useful, especially when someone has had a larger portion of the small intestine removed and needs to slow down movement of food and liquids through the intestine. However, decisions about the safety and appropriateness of these medications need to be discussed with your IBD physician.
How do I choose a therapy to treat IBD?
The risks and benefits of any particular therapy are based on:
Your IBD specialist will answer your questions about treatments and how they compare to one another. Thankfully, there are other options in therapies, and we are hopeful for even more options going forward to meet the needs of patients.
Are there IBD treatments for both my intestinal and joint symptoms?
Yes. Joint inflammation is caused by intestinal inflammation, so getting your IBD under control can help improve your joints. As for other conditions where joint inflammation is not always related to intestinal inflammation, there are multiple medications and combinations of medications that can be used. Some medications are better for certain types of intestinal and joint inflammation than others. Many IBD professionals work with rheumatologists to select medications that are ideal for both conditions.
Is the COVID-19 vaccine safe for IBD patients?
The COVID-19 vaccines are undergoing additional studies to confirm the vaccine’s safety, effectiveness, and possible side effects. Each one of the currently approved vaccinations are considered safe to use even with a diagnosis of IBD or while taking IBD medications. We recommend that you do not schedule your COVID-19 vaccination on the same day as a biologic, but this can be discussed with your IBD physician.
How safe is it to return to activities (gym, store, restaurants, social gatherings, etc.) after receiving a COVID-19 vaccine?
This is a difficult question and is not just for patients with Crohn’s disease and those on immunosuppressants, but for all people. For the most up-to-date information about COVID-19, visit UPMC.com/Coronavirus. Although it is nearly impossible to determine how safe a certain activity is for an individual person or details on overall rates of infection inform the policies about “reopening”. Currently, it remains important to wear a mask in public and to continue social distancing.
Emily Weaver, LCSW
Lead Social Worker
UPMC Total Care-IBD
IBD is impacting my mental health. Who do I go to for help?
IBD can absolutely impact mental health, and help is available. If your mood has worsened related to your health, we would recommend seeing a licensed mental health professional (such as licensed social workers, psychologists, marriage and family therapists, licensed professional counselors, and psychiatrists). The UPMC Total Care-IBD program and the UPMC Program for Gut Brain Health include behavioral health therapists who provide therapy, as well as psychiatrists who can evaluate and recommend psychotropic medication. You can also call the Member Services number on the back of your insurance card to inquire about therapists in your insurance network, or you may browse this website for a listing of therapists: PsychologyToday.com/us/therapists
How do I manage a job while also worrying about my IBD?
Some people with IBD are able to work, and some are not – and for others, this may change over time depending on the severity of their disease. Under the Americans with Disabilities Act, employers are required to make “reasonable” accommodations for disabled workers who are still able to perform their essential job duties. Consider if there are any reasonable accommodations you can ask for at your workplace (potential examples include moving a desk to be closer to the bathroom or changing the timing of your shift). Another option is requesting FMLA (Family Medical Leave Act) from your employer, which is a federal law that protects jobs for eligible employees of covered employers for up to 12 weeks of unpaid time off (either continuous or intermittent) during a 12-month time period. Please keep in mind that you will be disclosing your health information to your employer if you pursue accommodations under the ADA or FMLA. Some individuals with IBD qualify for Social Security Disability. To learn more, visit SSA.gov. Above all, talk to your doctor about the symptoms you are experiencing and how they are impacting you in the workplace.
Therezia Alchoufete, MS, RDN, LDN
Lead Dietitian / Nutritionist
UPMC Total Care-IBD
Are there any new studies about the collagen intake fad?
At this time, there are no new studies about collagen and IBD, and, overall, there are no particular benefits of collagen shown for IBD. Although many believe it to be beneficial for skin, nails, and gut health, this protein is broken down in the digestive tract into amino acids much like other proteins, which are then used as building blocks for what our body’s need. So, it is OK to use collagen as a protein, but there are other options which may be better quality, such as those from animal proteins, soy, dairy, or nut butters.
What is the best way to manage body weight with IBD?
Diets for IBD are truly individualized and the same goes for weight management. Whether the goal is weight gain or weight loss, the first step is to determine what foods are tolerated and then explore individual diets that work for you. Partnering with a gastroenterology dietitian can help to determine the most appropriate diet for each individual while building a positive relationship with food overall, providing additional accountability, and guidance on appropriate goals while optimizing gut health.
How do I know if the Crohn’s Disease Exclusion Diet (CDED) is right for me?
To get more information about whether CDED is right for you, the first step is to speak with your gastroenterologist and gastroenterology dietitian. While some studies do evaluate the efficacy of this diet in the pediatric and adult populations, these are limited to individuals with Crohn’s Disease and not ulcerative colitis.
What is the best diet for IBD?
Unfortunately, there is no one-size-fits all diet for IBD. However, current research is showing a true benefit of combining personalized, therapeutic diets along with medications and behavioral health therapy to allow more individualized management of IBD and to improve disease outcomes. Certain strategies such as texture modification or changing the frequency and size of meals may help to improve certain IBD symptoms. Working with a gastroenterology dietitian can help to navigate foodrelated symptoms, provide you with medical nutrition therapy and determine the best diet for your needs.