Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And joining me today is Amanda Hall. She's an advanced practice registered nurse at Gastroenterology Specialties, and she's here to tell us about Crohn's disease and ulcerative colitis. Amanda, thank you so much for joining us today. Can you start by defining inflammatory bowel diseases? Explain what they are and how Crohn's and ulcerative colitis fit under this umbrella term.

Amanda Hall, APRN: Good morning. Yes, thank you for having me. Crohn's disease and ulcerative colitis are categorized as inflammatory bowel disease. These diseases impact the gastrointestinal tract. The body's immune system sees the tissues as being foreign, therefore attacks itself. These diseases are very similar, in that both diseases are defined in the gastrointestinal tract, but the pattern at which the disease is displayed is what separates them.

So with ulcerative colitis, it impacts the large intestine only. Some patients are found to have disease just in one small area, whereas other patients are found to have it in the entire colon. This differs from Crohn's disease, in which it can impact anywhere in the GI tract from your mouth to your stomach to your small intestine and then, as well as your colon. So, these are defined during a colonoscopy. Ulcerative colitis is found in more of a continuous pattern, whereas Crohn's disease kind of skips around.

Melanie Cole, MS: Thank you for that comprehensive answer and explaining the differences and how these two really fit under this whole term of inflammatory bowel diseases. Now, what confuses a lot of people, and I've seen this in my many years in the healthcare field is irritable bowel syndrome, IBS, which affects many people, but people don't understand the difference between inflammatory bowel diseases and an irritable bowel syndrome. Can you explain just a little bit about that?

Amanda Hall, APRN: Yeah. So, as a person has inflammatory bowel disease, during a colonoscopy, you will see ulcerations, inflammation. People will get different manifestations in their skin, such as rashes. They might have arthritic pains in any of their joints. With an irritable bowel syndrome, you have many symptoms. You can have diarrhea, you can have discomfort. However, when we do a colonoscopy, there is no changes in the gastrointestinal tract.

Melanie Cole, MS: So, it's not quite really the same things. Now, tell us about risk factors because I know from my mother and my sister and my brother who all have Crohn's, that it is genetic, there is a genetic component to it. Can you speak a little bit about those risk factors? Are there anything that we do, lifestyle, any of that kind of thing that puts us at risk for Crohn's or colitis?

Amanda Hall, APRN: Yeah. So, nothing that you do can make you develop Crohn's or ulcerative colitis. Once you have the diseases, people that smoke, poor sleep hygiene; taking NSAIDs, so aspirin, ibuprofen, can actually increase or worsen a patient's disease. There has not been anything proven that can cause the disease. And then, you just mentioned genetics and hereditary. So, it's interesting in that many patients have no family members with ulcerative colitis or Crohn's disease. However, if you do have a first-degree relative, you are three to twenty times more likely to have ulcerative colitis or Crohn's disease.

Melanie Cole, MS: Yeah, that's so interesting. Now, symptoms, what would send somebody to a doctor and what sort of physician would they see? This is gastroenterology, yes? Tell us a little bit about symptoms. What would someone notice? Would we notice it in a child? Because children do get Crohn's disease. Tell us what are we looking for.

Amanda Hall, APRN: There's two kind of age ranges in which people are textbook to be diagnosed with ulcerative colitis or Crohn's disease. The first age group is between 15 to 30. And then, again, later in life between 50 and 80 years of age. Symptoms, usually, patients will start with their general practitioner or a primary care provider who will then guide them to see a gastroenterologist to get the further workup. Some of those symptoms, diarrhea, blood in their stools, abdominal pain. Some people have significant weight loss, fevers, chills and even some non-GI symptoms, which could be arthritic pain, skin rashes, mouth sores.

Melanie Cole, MS: Now, you've mentioned colonoscopy a few times as a way to diagnose. So, is that always what we're going to do? I'd like you to speak about diagnosis. And then, go right into first line treatment, Amanda, because I think that's really what people want to hear. What can we do for this?

Amanda Hall, APRN: Colonoscopy is going to be the best way to diagnose a patient with ulcerative colitis and Crohn's disease, in that, one, we need to establish the difference between IBS and the inflammatory bowel disease. Are there changes within the gastrointestinal lining when they take biopsy? Is there evidence of chronicity or longevity of this disease, because it impacts it deep. It's not just irritation that you can sometimes get just from a colonoscopy prep.

So, unfortunately, there's only a "cure" for ulcerative colitis and that's very life-impacting. It's getting your entire colon out. So, most people for ulcerative colitis or Crohn's disease, they tend to go to medicinal treatments. The treatment of choice, it just depends on, one, if you have ulcerative colitis or you have Crohn's disease, just because it can impact different areas of the gastrointestinal tract. But it also depends on the severity of the disease. Some people have just very mild changes in which the treatment is significantly different than people that have severe disease.

Melanie Cole, MS: Well, then, tell us a little bit about what you do for patients that have these diseases. I know that my sister and my brother were on some infusions. But my mother and hers was a long time ago, you know, she had to have major surgery. What are you doing for patients now?

Amanda Hall, APRN: So, again, there's many options available. Some of them still are oral agents, that they all act to just heal the gastrointestinal tract. The patients that have more severe disease, they probably are on an infusion or an injection, because they're intended to impact the autoimmune system that's kind of fighting back in these patients. But luckily, these agents can put a patient into remission where future colonoscopies, we may never know that they have these diseases. These treatments are long term. So, a patient will have to stay on them for the rest of their life to some extent. Some patients have to escalate therapy, but some patients can be on one therapy their entire life.

Melanie Cole, MS: Well, it's really an exciting time in this particular field with biologics and immunotherapies. I mean, there's so much going on. Tell us a little bit about right when it happens and diet. Because a lot of people know their bodies, especially if they've had Crohn's or colitis for a long time. They know what their triggers are. Tell us where diet impacts and how this is something that's really being looked at for flareups or to prevent them.

Amanda Hall, APRN: So, diet's an interesting topic. Many people feel that what they're eating is causing their disease. And again, it's nothing that will cause your disease, but it can impact your symptoms if you're in a flare. For everybody, they all have their individual triggers. Some people, it's sugars. Some people, it's vegetables. And so, we just guide them in that if it is impacting your symptoms when you consume those products, to just stay away from it until we get you in a better spot, where your disease is lessened or you are in remission, and sometimes those foods may not impact you.

Melanie Cole, MS: So, I'd love you to finish, Amanda, with some great advice for people that are living with one of these conditions. People look to holistic care. They look to alternative therapies, but tell us how in the medical community we're really recognizing the complexity of inflammatory bowel diseases and looking at the whole person, because there are so many angles to these conditions. Your best advice, Amanda, what would you like people to know?

Amanda Hall, APRN: My biggest advice is that as a patient, you are not alone. These diseases can be very isolating. Many patients that I see, whether they have inflammatory bowel disease or not, they just simply don't feel that they can talk about their poop, right? And that's a big part of these diseases.

So, know that your gastrointestinal providers, your primary care providers, your dieticians, they're your team. They'll help to guide you into feeling the best that you possibly can, give you additional resources if you need it. The Crohn's and Colitis Foundation is a fabulous resource for patients if they need to reach out to someone in their community just to establish kind of that normalcy, like, "Hey, I have this going on too." Like, "You are not alone. Let's talk." They also have awareness walks in Nebraska typically twice a year, in Omaha once in the spring, and then in Lincoln once in the fall.

Melanie Cole, MS: Well, thank you so much, Amanda, for joining us. And I know that the specialists at Gastroenterology Specialties can really help with these conditions. Thank you so much. And I'd also like to thank our Bryan Foundation partner, NRC Health. To listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. I'm Melanie Cole. Thanks so much for joining us today.