Corinn Cross, MD: Welcome to Peds Cast, a podcast brought to you by Children's of Alabama. I'm your host, Dr. Cori Cross. Today we are joined by Dr. Traci Jester, who is an Associate Professor of Pediatric Gastroenterology, Hepatology, and Nutrition at the University of Alabama at Birmingham. She is also the Co-Director of the Pediatric Inflammatory Bowel Disease Clinic at Children's of Alabama. Dr. Jester, thank you for being here with us today.

Traci Jester, MD: Thank you so much for having me.

Host: The Crohn's and Colitis Foundation received a grant from the CDC to support a comprehensive five year project partnering with the University of Alabama at Birmingham. With this grant, they will identify and address barriers to diagnose and care for patients with inflammatory bowel disease. This will be a three part project, with the first part being a study conducted at both the Pediatric Inflammatory Bowel Disease Clinic at Children's of Alabama, as well as the UAB Gastroenterology Inflammatory Bowel Disease Clinic. Dr. Jester, could you start by giving us a broad overview of what inflammatory bowel disease is and what the prevalence is in the community?

Traci Jester, MD: Inflammatory bowel disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract. The two main diagnoses that fit under this umbrella are Crohn's disease and ulcerative colitis. Crohn's disease can impact any part of the GI tract from the mouth to the rectum, whereas ulcerative colitis is generally focused on inflammation in the colon.

Host: Got it. And this is common both in adults and children?

Traci Jester, MD: Both adults and children can be diagnosed with inflammatory bowel disease. The incidence in diagnosis is actually rising in the pediatric population, and we are seeing younger and younger patients being diagnosed. Approximately 25 percent of all patients with inflammatory bowel disease are diagnosed under the age of 18.

Host: Do we have any idea why it's becoming more prevalent?

Traci Jester, MD: At this point in time, we do not have an exact reason that is being seen here in the United States as well as worldwide. Of course, there are multiple hypotheses on why this is, but we do not know an exact reason at this time.

Host: Got it. And so I'd assume that some doctors who were trained in the past might not expect to see it at the prevalence that they're seeing it and that this could delay their referral.

Traci Jester, MD: That is exactly right, and we do also often hear from my adult trained colleagues that a lot of physicians are actually surprised to sometimes learn that young patients can be diagnosed with inflammatory bowel disease at the rates that they are.

Host: Got it. So, obviously, not being aware of how prevalent it is, is one of the barriers to diagnose and care for these patients. But this study is really going to address all of the barriers to diagnose and care for these patients. So tell us, what are the other barriers that these patients face for being diagnosed and cared for?

Traci Jester, MD: Well, some of the barriers we know are related around just being aware of their symptoms and when they should seek out a doctor's care. The other barrier might be more in the social determinants of health in regards to transportation and income and resources and the ability to visit a physician. And then the next barrier, as you mentioned, would be perhaps having a provider who is aware of what symptoms might necessitate them referring a patient to a gastroenterologist.

Host: Got it. And so the study that you're doing, will be looking at all of this. Tell us a little bit about what data will be collected .

Traci Jester, MD: The first part is a component more survey-based that will be conducted in our Pediatric Inflammatory Bowel Disease Clinic as well as the Adult Inflammatory Bowel Disease Clinic, and this will be information looking at psychological resiliency, as well as transportation, income, education levels, insurance type. And so we'll be looking at those factors and how they might impact a patient's diagnosis and treatment. The second part of information collection, will be looking at a cohort of the patients recruited from the first part of the study and specifically doing focus groups to try to really gain a deeper understanding of what are some of those challenges for those patients, but also to help those patients or to have those patients help us with identifying potential solutions for some of those issues.

Host: So I'd imagine that there's a wide variation of causes as to what leads to barriers in diagnosis and then also caring for patients. What type of interventions do you foresee coming from this study?

Traci Jester, MD: Well, this is a five year study and so the third and final piece of the study once we have collected this information from the first part of the study and then the second part being the focus groups, the third part is really focused on developing and testing potential interventions and those interventions would focus around not only disease awareness education here in Alabama, for all of the population, but specifically perhaps geared towards our African American population and partnering with community groups for disease education awareness of what symptoms that patients should look for, what should make them want to go see their physician or their primary care physician.

There's also going to be a component of the education likely geared towards primary care providers within our state to understand what symptoms might perhaps lead them to needing to refer a patient to a gastroenterologist or even more specifically perhaps an IBD specialist.

Host: That makes sense cause timely referral is so important.

Traci Jester, MD: Yes.

Host: Tell us a little bit about the Crohn's and Colitis Foundation and why UAB was chosen as the site for this collaboration with the foundation.

Traci Jester, MD: Yes, the Crohn's and Colitis Foundation is a leading non-profit organization centered on improving the quality of lives of patients with inflammatory bowel disease, but also research into inflammatory bowel disease and finding ultimately a cure. And we have partnered here at UAB with the Crohn's and Colitis Foundation previously on another research study that specifically was looking at early childhood stress in relationship to pediatric inflammatory bowel disease.

And so, because of that collaboration and our previous success with that study, we were asked by the Foundation to partner with them on this particular study. And so, we were excited to be able to do that and to hopefully test these interventions here with our population in Alabama.

Host: And what's special about UAB? What makes it the right site for this project?

Traci Jester, MD: Well, UAB is a leading research university nationally here in our medical school, and the state of Alabama also has a population of patients that were right for this study because we do have a larger and more diverse population here compared to some leading university medical centers. We also have had proven success and track record in studies looking at health disparities and multiple diagnoses.

Host: In summary, is there anything else you'd like to share with our listeners today?

Traci Jester, MD: I would just share that we're very excited about this project here at UAB and being in partnership with such a national organization as the Crohn's and Colitis Foundation, and we're very much looking forward to how we can improve care for all of our patients.

Host: Dr.Jester, thank you so much for taking the time to share your expertise with us today.

Traci Jester, MD: Thank you so much for having me. I've enjoyed our time.

Host: If you would like more information or to refer patients to Children's of Alabama, please visit www.childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might be of interest to you.

Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Children's of Alabama Peds Cast. I'm your host, Dr. Cori Cross.