{"id":18104,"date":"2019-01-10T14:41:07","date_gmt":"2019-01-10T19:41:07","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcasts\/inflammatory-bowel-disease-with-millie-long-md-mph\/"},"modified":"2023-06-06T14:12:22","modified_gmt":"2023-06-06T18:12:22","slug":"inflammatory-bowel-disease","status":"publish","type":"episode","link":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcast\/inflammatory-bowel-disease\/","title":{"rendered":"Inflammatory Bowel Disease &#8211; with Millie Long, MD, MPH"},"content":{"rendered":"<div class=\"image-section\">\n<figure class=\"thumbnail wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium\" src=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/inflammatory-bowel-disease-image2.jpeg\" alt=\"image2\" width=\"300\" height=\"200\" \/><figcaption class=\"caption wp-caption-text\">Millie Long, MD, MPH<\/figcaption><\/figure>\n<\/div>\n<p>This is Episode Three of &#8220;Autoimmune Disease: Pieces of the Picture.&#8221; This episode features Dr. Millie Long with an in-depth look at inflammatory bowel disease (IBD) &#8211; what it is, how it&#8217;s different from IBS, and the long journey patients often have on the road to diagnosis. She also discusses what can help patients feel better. Dr. Long is an Associate Professor of Medicine in the Division of Gastroenterology at UNC.<\/p>\n<div class=\"alert alert-grey\">\n<p>&#8220;People that have inflammation in their bowel could also have symptoms of inflammation elsewhere in their body. Common areas of involvement include the skin, joints, eyes or ulcers in their mouths.&#8221;<br \/>\n&#8211; Millie Long, MD, MPH<\/p>\n<\/div>\n<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n\t<div class=\"wp-playlist wp-audio-playlist wp-playlist-light\">\n\t\t\t<div class=\"wp-playlist-current-item\"><\/div>\n\t\t<audio controls=\"controls\" preload=\"none\" width=\"1118\"\n\t\t\t><\/audio>\n\t<div class=\"wp-playlist-next\"><\/div>\n\t<div class=\"wp-playlist-prev\"><\/div>\n\t<noscript>\n\t<ol>\n\t\t<li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/03\/autoimmune-long.mp3'>Full-Length Track<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-whatisit.mp3'>Inflammatory bowel disease and how it's different from IBS<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-redflag.mp3'>Red flag symptoms<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-diagnosis.mp3'>How long it takes to get diagnosed<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-treatment.mp3'>Treatment of inflammatory bowel disease<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-diet.mp3'>The role of diet<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-mental.mp3'>Mental health concerns<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/inflammatory-long-patients.mp3'>Patient involvement in research, and patient resources<\/a><\/li>\t<\/ol>\n\t<\/noscript>\n\t<script type=\"application\/json\" class=\"wp-playlist-script\">{\"type\":\"audio\",\"tracklist\":true,\"tracknumbers\":true,\"images\":true,\"artists\":true,\"tracks\":[{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/03\\\/autoimmune-long.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Full-Length Track\",\"caption\":\"\",\"description\":\"\\\"Irritable Bowel Disease - with Dr. Millie Long\\\" from Autoimmune Disease: Pieces of the Picture by UNC Department of Medicine: Dr. Ron Falk. Released: 2017.\",\"meta\":{\"artist\":\"UNC Department of Medicine: Dr. Ron Falk\",\"album\":\"Autoimmune Disease: Pieces of the Picture\",\"year\":\"2017\",\"length_formatted\":\"23:14\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-whatisit.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Inflammatory bowel disease and how it's different from IBS\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-whatisit\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:17\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-redflag.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Red flag symptoms\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-redflag\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"1:43\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-diagnosis.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"How long it takes to get diagnosed\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-diagnosis\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"3:06\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-treatment.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Treatment of inflammatory bowel disease\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-treatment\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"6:55\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-diet.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"The role of diet\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-diet\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:01\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-mental.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Mental health concerns\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-mental\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:16\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/inflammatory-long-patients.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Patient involvement in research, and patient resources\",\"caption\":\"\",\"description\":\"\\\"inflammatory-long-patients\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"3:14\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}}]}<\/script>\n<\/div>\n\t\n<div class=\"image-section\"><\/div>\n<div>\n<p><b>Dr. Ron Falk:<\/b> Hello, and welcome to the Chair\u2019s Corner from the Department of Medicine at the University of North Carolina. This is our new series where we explore topics related to autoimmune disease, to help patients and their loved ones understand and manage their condition. Today we are going to be talking about inflammatory bowel disease, also known as IBD. IBD describes at least two conditions &#8211; Crohn\u2019s disease and ulcerative colitis.<\/p>\n<p>We welcome Dr. Millie Long who is an Associate Professor of Medicine in the Division of Gastroenterology at UNC, and she sees patients in our Inflammatory Bowel Diseases Center. Dr. Long also serves on the Crohn\u2019s and Colitis Foundation as Chair of the Professional Education Committee. Welcome, Millie Long.<\/p>\n<p><b>Dr. Millie Long:<\/b> Thank you.<\/p>\n<h3><span class=\"blue\">Inflammatory bowel disease and how it&#8217;s different from IBS<\/span><\/h3>\n<p><b>Falk:<\/b> What is inflammatory bowel disease?<\/p>\n<p><b>Long:<\/b> Inflammatory bowel disease refers to ongoing inflammation in the lining of the bowel. There are two main forms of inflammatory bowel disease: there is Crohn\u2019s disease and ulcerative colitis. The difference between the two has to do with the location of where we find the inflammation, and the depth of the inflammation and the type of complications that can arise. Crohn\u2019s disease can affect anywhere, from the mouth to the anus, whereas ulcerative colitis is limited to the colon. However, both of these forms of inflammatory bowel disease are associated with significant ongoing symptoms that can be similar. Symptoms can include diarrhea, abdominal pain, fever, nausea, rectal bleeding\u2014all of these GI symptoms can be a marker that there may be ongoing inflammation.<\/p>\n<p><b>Falk:<\/b> There\u2019s another three-letter acronym that differs from IBD or inflammatory bowel disease, and it has the acronym IBS. What does that stand for, and what are the differences?<\/p>\n<p><b>Long:<\/b> Irritable bowel syndrome or IBS, is actually a completely different disorder. Irritable bowel syndrome is where the bowel is very sensitive; thus driving ongoing symptoms. These symptoms can actually be fairly similar to that of inflammatory bowel disease; the difference is that inflammatory bowel disease can cause damage to the lining of the bowel which consists of actual structural damage, whereas irritable bowel syndrome refers to a collection of symptoms without inflammation or damage to the bowel. They\u2019re managed very differently, in that, for inflammatory bowel disease you really need to focus on medicines that treat inflammation, whereas for irritable bowel syndrome, we work on ways to help to improve symptoms perhaps through dietary management, or medications to help with constipation, diarrhea, or other symptoms.<\/p>\n<p>It\u2019s very important if someone does have symptoms to see a physician, and that physician can help them to determine whether these symptoms may be coming from inflammation which is treated quite differently. p&gt;<\/p>\n<h3><span class=\"blue\">Red flag symptoms<\/span><\/h3>\n<p><b>Falk:<\/b> Is there any other way of figuring this out by oneself? If you\u2019re a patient sitting there listening to this podcast, can you figure out for yourself if you have irritable bowel syndrome or perhaps an inflammatory disorder?<\/p>\n<p><b>Long:<\/b> There are some red flag symptoms for which you should see a doctor to rule out inflammation. If you have bleeding in your stool, that can be a sign of ulcerations in the lining of the bowel, and that is something that may be a marker for inflammation. If you have weight loss, that\u2019s a sign that you may not be absorbing well from what you\u2019re eating and that could be a marker of inflammation. So particularly with those two symptoms, I would really encourage you to seek a medical provider.<\/p>\n<p>That said, these conditions do overlap. I think talking to your physician\u2014even starting with your primary care physician is absolutely appropriate. They can help you to determine whether your symptoms need further evaluation.<\/p>\n<p><b>Falk:<\/b> And by blood, you don\u2019t mean just red blood \u2013 you mean different colors, right?<\/p>\n<p><b>Long:<\/b> Exactly. So blood, as it goes through the GI tract, can actually change colors. We gastroenterologists will often ask the shade of that blood in your stool, because if you were bleeding from an ulcer in your stomach, your bowel movement might actually look black, which occurs as the blood is digested throughout the GI tract. If the blood was arising from somewhere very low in the GI tract, like the rectum, that might be bright red blood. For example, hemorrhoids cause bright red bleeding.. The color helps us to determine where the blood might be coming from. But I would say, regardless, if you have bleeding, it\u2019s worth talking to your doctor.<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"blue\">How long it takes to get diagnosed<\/span><\/h3>\n<p><b>Falk:<\/b> So many autoimmune diseases take a long time to get diagnosed. Many times patients jump from physician to physician, problem to problem, without necessarily coming up with a specific diagnosis. I think that pertains to the inflammatory bowel diseases as well. How long does it take for a patient usually to figure out that there is an inflammation that is the cause of symptoms? What\u2019s the usual experience that patients have?<\/p>\n<p><b>Long:<\/b> Well, I think you hit the nail right on the head, in that, often, unfortunately, many of my patients take a long time to come to that diagnosis. One of the reasons is that there are much more common causes of having GI symptoms. When someone first starts to have diarrhea, they may think it\u2019s something they ate, they may think they\u2019ve caught a bug. As symptoms progress, patients realize, <i>\u201cMaybe I should get this checked out.\u201d<\/i> Sometimes that initial evaluation may be unrevealing, they may be reassured, and they can be on a long journey until diagnosis.<\/p>\n<p>My recommendation is if someone has ongoing GI symptoms, for over a month, including diarrhea, abdominal pain, these sort of symptoms, an evaluation is very important with their primary care doctor so that they can understand whether this may something more than just something they ate. Or it could be a sensitivity \u2013 it certainly could be that, something like lactose intolerance. These are things that the physician can help them sort through. I hate it when people have had symptoms for sometimes even years before coming to attention. At that point, they can have complications from their inflammation as well.<\/p>\n<p><b>Falk:<\/b> When the patient comes to see the doctor, in addition to describing the current symptoms, it\u2019s really important to make sure there\u2019s a record, even a written one, that describes all the problems and for how long they\u2019ve had them.<\/p>\n<p><b>Long:<\/b> Absolutely, that\u2019s very helpful to have a diary of symptoms and understand how long things have been going on \u2013 and other factors too, to think about things like weight loss. Believe it or not, to think about other associated symptoms. Autoimmune diseases are not always just one set of symptoms. For example, with inflammatory bowel disease, there\u2019s something called \u201cextraintestinal manifestations.\u201d What this means is it\u2019s outside the gut. People that have inflammation in their bowel could also have symptoms of inflammation in their joints or in their eyes or in their mouths with oral ulcers&#8211;even in their skin. Inflammation can be present really throughout the body. I think that being aware of all of their symptoms can be helpful and that communication and discussion with your doctor. Don\u2019t leave off something just because it\u2019s outside the digestive symptom.<\/p>\n<p><b>Falk:<\/b> It\u2019s always useful for patients to come in with a written record of <i>\u201cHere are all of the things that are bothering me\u201d<\/i> \u2013 it clues the physicians and other providers in that there\u2019s something systemic going on.<\/p>\n<h3><span class=\"blue\">Treatment of inflammatory bowel disease<\/span><\/h3>\n<p><strong>Falk:<\/strong> There\u2019s been an incredible explosion of therapy for inflammatory bowel disease, remarkable progress in all kinds of therapy, including what are now called biologic therapies. What kinds of therapies are available at this time?<\/p>\n<p><b>Long:<\/b> What is wonderful is that we do have now a whole menu of options. Even twenty, thirty years ago, we really didn\u2019t have effective therapies for the treatment of inflammatory bowel diseases. Often patients were treated with recurrent courses of steroids. Steroids are medications that have been around a long time, such as prednisone, and they do treat inflammation acutely, but the problem is that medications like prednisone, when used long term can have serious complications for the patients. So they\u2019re really only meant to be a short term reduction of inflammation and now we have other medicines that can take over for that prednisone with better side effect profiles, with better data on using over the long term. One of the things about inflammatory bowel diseases, like many other autoimmune diseases is these are chronic diseases, meaning that we don\u2019t yet have a cure for inflammatory bowel disease.<\/p>\n<p>We have great medications that can help to put a patient in remission. What I mean by remission is get them symptom-free and get the inflammation healed up in their bowel. But it\u2019s important to recognize that they will need to continue to take medications to treat that to prevent the inflammation from coming back. The biologic medications that you mentioned are one class of drugs that we now have many different options of for treatment of inflammatory bowel diseases.<\/p>\n<p>There are now three main classes of these medications, all of which treat the inflammation in a different fashion. I often will tell patients we have to think of different ways to treat; some of these medicines turn off the inflammation at a systemic level, meaning they turn off inflammation all over the body. That\u2019s why some of the medicines we use are often used in other conditions you\u2019ll be highlighting on this podcast. We also have a newer class of biologic medications that are gut-specific, meaning that it actually targets only the gut itself. So there are a broad array of options and I often will individually tailor the medicine choice based on the patient in front of me.<\/p>\n<p><b>Falk:<\/b> So the first class was drugs that target an inflammatory mediator called tumor necrosis factor or TNF. There are several options now. And the gut specific one\u2014give me some examples of those.<\/p>\n<p><b>Long:<\/b> Sure. There\u2019s a new class of medications for the treatment of both Crohn\u2019s and ulcerative colitis called anti-integrin therapy. One of these is vedolizumab. This is a gut-specific medication that blocks how inflammatory cells stick to the lining of the gut, and by blocking this gut-specific integrin, called alpha 4 beta 7, we\u2019re able to selectively block inflammation in the gut without having the medicine treat inflammation elsewhere. That can be very advantageous in scenarios where we don\u2019t want to have someone have more systemic immunosuppression drop their inflammation and suppress their immune system.<\/p>\n<p>We also have another class of medications now, not only just the TNF alpha-inhibitors, we have a class of medicines that block interleukin 12 and 23, which is another mechanism of systemic inflammation. This medicine, ustekinumab, or Stelara, is also approved in psoriatic arthritis, an inflammatory joint and skin condition, but it\u2019s now been approved in Crohn\u2019s disease. So what\u2019s very nice is that we now have several options. Not everyone responds to the first medication we try, and it\u2019s very important that we find the right medication for the right patient, and I think emphasizing to patients that there are all these options, so if we fail one class of medications, there still options for treatment that can be quite effective.<\/p>\n<p><b>Falk:<\/b> Most of these are infusions that patients get at varying intervals, and the vast majority of them have untoward side effects. By definition they\u2019re suppressing the normal response to inflammation. The question then comes, can one ever stop? When do you stop them for a patient with Crohn\u2019s disease? Or if you start one of these does it mean you\u2019re going to take it for life?<\/p>\n<p><b>Long:<\/b> That\u2019s a very common question. The answer is, for right now, we know that these medications are something called a monoclonal antibody. Once we start it, if we are to stop it, we may not be able to come back to the same class of medication. The patient may actually develop something called antibody, where the medication will no longer be effective. So I often will talk to my patients and say, <i>\u201cWe want to find the right combination that puts your disease in remission, under control, and you feeling well.\u201d<\/i> Once we do that, we address every six months \u2013 <i>How are you? How are you tolerating this medication? How is your inflammation?<\/i> We judge the risks and the benefits of that therapy. Often, it\u2019s the benefit to keep going and to stay on that therapy in order to keep that inflammation under control and keep that patient doing well. Obviously it\u2019s a matter of readjusting, reassessment, and more therapies become available, it may be that there\u2019s an alternate therapy that may be better for that patient. I do think, right now, with Crohn\u2019s disease and ulcerative colitis, it\u2019s important to recognize that likely a medication will be required to keep that inflammation under control and keep that patient doing well.<\/p>\n<p><b>Falk:<\/b> It\u2019s also important for the patient to figure out what symptoms they\u2019re having while on the medication, to keep a record of that too, because that may prompt a trial of another drug.<\/p>\n<p><b>Long:<\/b> Absolutely. We ask our patients not only to document their symptoms, but we will also monitor other factors, things like levels of C-reactive protein, which is an inflammatory marker in their blood. Or sometimes we assess stool markers of inflammation. Ways for us to understand is this therapy still working, not only are they feeling well, but have there been any changes in these biomarkers along the way? Sometimes we actually need to repeat a colonoscopy or an endoscopy or a GI procedure to assess how the inflammation is doing on therapy to help us make those decisions.<\/p>\n<h3><span class=\"blue\">The role of diet<\/span><\/h3>\n<p><b>Falk:<\/b> Are there supportive care, or other things, that patients can do themselves, to help? What about diet? Is diet important, are dietary supplements useful?<\/p>\n<p><b>Long:<\/b> Diet can be very important. One example is, in the pediatric inflammatory bowel disease literature for Crohn\u2019s disease \u2013 in young kids, if they\u2019re started on something called elemental diet, meaning the diet is the purest form of supplements, that can be equivalent to steroids in terms of inducing remissions. It\u2019s the equivalent to prednisone, without having to take it.<\/p>\n<p><b>Falk:<\/b> But you have to be a young person, right?<\/p>\n<p><b>Long:<\/b> It\u2019s been shown to be for young children, that has been shown to be effective. We do think diet plays a role. The problem is that we haven\u2019t been able to isolate one diet for all people with Crohn\u2019s disease, or one diet for all people with ulcerative colitis. What we do in our practice is, often we\u2019ll have our patients work with a nutritionist. Just as you mentioned about keeping a diary of symptoms, keeping a diary is very important as they\u2019re eating and trying new foods, to help to have an individualized list of foods that may help or worsen their symptoms. So we work on an individualized approach. Now I am excited in that there will be a new study that we will be taking part of at UNC that\u2019s sponsored by Crohn\u2019s disease and Colitis Foundation, where for the first time there will be something called a randomized controlled trial with dietary intervention, where we\u2019re going to be looking specifically at one diet called the \u201cSpecific Carbohydrate\u201d diet. Some patients feel that this might make their symptoms better. We don\u2019t necessarily have the evidence yet to understand what it does to inflammation of the gut. This study will be one way we\u2019re trying to assess that. I do think as we\u2019re getting more medications for IBD, I think understanding the role the diet can play is the next frontier of how we\u2019re going to manage the disease.<\/p>\n<h3><span class=\"blue\">Mental health concerns<\/span><\/h3>\n<p><b>Falk:<\/b> Many patients with autoimmune disease and many patients with inflammatory bowel disease have real trouble adjusting to the disease, adjusting to the medication, adjusting to the idea, as anyone of us would \u2013 <i>\u201cOh my goodness, I\u2019m starting on a medication, and I\u2019m going to be on this medication for a long, long time. In fact for life.\u201d<\/i> How does the patient\u2019s mental health play into this whole care pathway.<\/p>\n<p><b>Long:<\/b> It\u2019s huge. It can be so difficult to adjust to these diagnoses and to deal with symptoms. Depression and anxiety can be common; in fact, it\u2019s shown in numerous studies to actually exacerbate the disease. We as gastroenterologists will often try to help patients from a mental health standpoint as well, because we recognize not only the impact on the patient on the day to day life from having the underlying depression, anxiety, and this can also complicate the course of disease. So there are medications we can use to help with that. Equally as important if not more important is working with a psychologist. In fact, here at UNC at our Inflammatory Bowel Disease Center, we have a psychologist who sees patients in our GI clinic, because we recognize the importance of mental health. They often will work on relaxation techniques, or something called cognitive behavioral therapy, ways to minimize pain and sensitivity. It\u2019s really become a mission at the national level as well. Other IBD centers have moved to this model. I would encourage any patient with underlying Crohn\u2019s disease or ulcerative colitis to reach out to their physician\u2014 often the gastroenterologist is the physician they see the most \u2013 and talk about these mental health aspects, because there are things we can do to help.<\/p>\n<p><b>Falk:<\/b> Many of these are mental health issues that are expected.<\/p>\n<p><b>Long:<\/b> Absolutely.<\/p>\n<p><b>Falk:<\/b> They\u2019re not unusual \u2013 patients have trouble adjusting to all sorts of things that they\u2019re forced to deal with. You mentioned that you\u2019re using all of these wonderful drugs, but that you can\u2019t look at a patient and say they\u2019re cured. You tell them they\u2019re in remission on therapy, and there are other therapeutic vines in the jungle. But you can\u2019t look at them and say they\u2019re cured. In order to be able to do that, you need to do, as a community, a lot of research to get that next step. How do patients get involved in research activity? Because that\u2019s how your community has learned so much about this group of diseases.<\/p>\n<h3><span class=\"blue\">Patient involvement in research, and patient resources<\/span><\/h3>\n<p><b>Long:<\/b> I can\u2019t stress this enough that this is a wonderful community of patients, that when given the opportunity, many not only want to participate in research to try to hopefully help themselves in terms of ways to treat Crohn\u2019s or ulcerative colitis, but that the knowledge gained could help other patients as well. One example is a study that we have here at UNC that\u2019s actually an international study. It\u2019s a study called CCFA Partners, or Crohn\u2019s and Colitis Foundation study, where anyone, across the country with inflammatory bowel disease, can join. They fill out surveys every six months. It includes information about their disease, it includes information about prior surgeries, current medications, but it also includes information about some of these other aspects that we\u2019re mentioning. Something called patient reported outcomes \u2013 things like their mood, things like if they\u2019re able to get out of the house and do the things they want to do. Aspects about fatigue, pain, all of these factors play a huge role in the course of inflammatory bowel disease, and we need to better understand how the patient is living as a whole. That\u2019s the focus of this study.<\/p>\n<p>What I also love about this study is that patients are really citizen scientists. They log on to our community and propose research questions. We take those research questions and we\u2019ll go from there, often including the patient, and try to answer these important questions. One of the studies that I mentioned earlier, a diet study, is being done through the <a class=\"external-link\" title=\"\" href=\"http:\/\/www.crohnscolitisfoundation.org\" target=\"_blank\" rel=\"noopener\">Crohn\u2019s and Colitis Foundation<\/a>, is actually an idea proposed by a patient through this platform. That patient is working with us to help us understand this important question that we\u2019ve now been able to receive funding for, and are moving forward nationally. So I would encourage patients to visit the web site, \u201c<a class=\"external-link\" title=\"\" href=\"https:\/\/ccfa.med.unc.edu\" target=\"_blank\" rel=\"noopener\">CCFA Partners.org<\/a>\u201d At this site, they\u2019ll be given instructions on how to join from the comfort of their home, over any internet connection. I think it\u2019s an important project moving forward in that it truly pairs patients, researchers, and clinicians together to try to answer some of these important questions about what it\u2019s like to live with inflammatory bowel disease and how we as a community can work together to improve outcomes.<\/p>\n<p><b>Falk:<\/b> So the Crohn\u2019s and Colitis Foundation is a good source also for patient information. Where else should patients turn?<\/p>\n<p><b>Long:<\/b> The CCFA is a wonderful resource. Often their own physician will have resources, for example, here at UNC, on our web site, if you go to the <a class=\"external-link\" title=\"\" href=\"http:\/\/www.med.unc.edu\/gi\/specialties\/ibd\" target=\"_blank\" rel=\"noopener\">UNC IBD web site<\/a>, we have links to educational resources as well. There are other national resources. There is an ostomy foundation resource for people that have an ostomy bag, that can be wonderful. There are links to all of these sites through both the CCFA and through UNC.<\/p>\n<p><b>Falk:<\/b> Thank you so much, Dr. Long. And thank you to our listeners. If you enjoy this series, you can <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/unc-department-of-medicine-chairs-corner\/id1076686662?mt=2\" target=\"_blank\" rel=\"noopener\">subscribe to the Chair\u2019s Corner on iTunes<\/a> or <a href=\"https:\/\/www.facebook.com\/UNCDeptMedicine\" target=\"_blank\" rel=\"noopener\">like us on FaceBook<\/a> so you\u2019ll know when we post our next episode. Thanks so much for listening.<\/p>\n<p class=\"MsoNormal\"><span style=\"line-height: 1.43em\">*<\/span><\/p>\n<div class=\"alert alert-blue width:100% \">\n<p><strong>Visit these sites for information referenced in the podcast conversation.<\/strong><\/p>\n<ul>\n<li><a class=\"external-link\" title=\"\" href=\"http:\/\/ccfa.org\" target=\"_blank\" rel=\"noopener\">Crohn&#8217;s and Colitis Foundation<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"https:\/\/ccfa.med.unc.edu\" target=\"_blank\" rel=\"noopener\">CCFA Partners<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"\/gi\/faculty-physicians\/millie-d-long-md-mph\" target=\"_self\" rel=\"noopener\">Dr. Millie Long&#8217;s UNC School of Medicine profile<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"\/gi\/specialties\/ibd\" target=\"_blank\" rel=\"noopener\">UNC Inflammatory Bowel Diseases Center<\/a><\/li>\n<\/ul>\n<\/div>\n<p>\/\/<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p><!-- description --> <\/p>\n<p class='lead'>This is Episode Three of &#8220;Autoimmune Disease: Pieces of the Picture.&#8221; This episode features Dr. Millie Long with an in-depth look at inflammatory bowel disease (IBD) &#8211; what it is, how it&#8217;s different from IBS, and the long journey patients often have on the road to diagnosis. She also discusses what can help patients feel better. Dr. Long is an Associate Professor of Medicine in the Division of Gastroenterology at UNC.<\/p>\n","protected":false},"featured_media":3961,"menu_order":0,"template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","_links_to":"","_links_to_target":""},"podcast-category":[634,639],"class_list":["post-18104","episode","type-episode","status-publish","has-post-thumbnail","hentry","podcast-category-podcast-autoimmune-disease-series","podcast-category-podcast","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inflammatory Bowel Disease - with Millie Long, MD, MPH | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/medicine\/news\/\/news\/chairs-corner\/podcast\/inflammatory-bowel-disease\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Inflammatory Bowel Disease - with Millie Long, MD, MPH | Department of Medicine\" \/>\n<meta property=\"og:description\" content=\"This is Episode Three of &quot;Autoimmune Disease: Pieces of the Picture.&quot; This episode features Dr. Millie Long with an in-depth look at inflammatory bowel disease (IBD) - what it is, how it&#039;s different from IBS, and the long journey patients often have on the road to diagnosis. 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