An estimated 3 million U.S. adults have an inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis. These conditions can cause diarrhea (in some cases, constipation), bloody stool and abdominal pain, along with fatigue, weight loss and reduced appetite. Symptoms of IBD frequently interrupt and even control patients’ lives.
UC Davis Health gastroenterologist Jesse Stondell specializes in treating IBD. Here, he discusses his approach to helping patients resolve their symptoms.
What is IBD?
Stondell: IBD is a chronic inflammatory condition of the bowel. Unfortunately, we do not know what causes IBD, but we do know that it is often controllable with lifelong treatment.
Is IBD the same as IBS, or irritable bowel syndrome?
Stondell: On the surface, IBD can sometimes have similar symptoms to IBS such as diarrhea (or constipation) and abdominal pain. IBD can be much more severe and has measurable inflammation in the bowel that can be dangerous and lead to hospitalization and surgery.
What happens in the guts of those with IBD?
Stondell: Our best theory is that an unknown trigger — something in the diet, an environmental toxin, a virus, antibiotic use or leaky gut — causes the immune system to react as if normal bowel bacteria is an infection. The dysfunctional immune system then tries to fight that "infection" all day, every day, leading to common IBD symptoms and, in some cases, gut ulcerations.
How do you treat IBD?
Stondell: Current medications such as steroids, TNF inhibitors or anti-integrin therapies can address the inflammation associated with IBD and help control symptoms. It can take a while, however, to find the best medication — or combination of medications — for each patient. The biggest research need right now is to find interventions for those whose symptoms do not respond to current treatments, which is about 10% to 30% of IBD patients. Some patients who don’t respond well to current medical therapies may need surgery to remove portions of the bowel targeted by the immune response.
What about diet?
Stondell: So far, no diet consistently and reliably reduces the inflammation associated with IBD. There are diets that help, such as the low-FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet, which reduces short-chain carbohydrates that can easily ferment in the intestine. This diet does not lead to remission, but can dramatically improve symptoms. It should be combined with standard medical therapy for excellent, long-term control of IBD and to prevent complications.
What do you recommend for your patients?
Stondell: I usually recommend the low-FODMAP diet in combination with standard medication therapy. My patients are sometimes interested in other diets, such as the specific carbohydrate diet, paleo diet or fasting mimicking diet. I encourage them to experiment with diet as long as they maintain adequate overall nutrition and, ideally, combine that diet with standard medication therapy.
UC Davis Health has an exemplary team of physicians, specialized nurses and technicians who team up with patients to manage and cure complex gastrointestinal and liver diseases. Our gastroenterology team is known for using a broad range of state-of-the-art endoscopic procedures to view, diagnose and treat GI conditions. For information, visit the division’s website.