About 2 million U.S. adults may have inflammatory bowel disease, including ulcerative colitis (UC) and Crohn's disease.
In a WebMD Reddit AMA about living with inflammatory bowel disease, gastroenterologist Puja V. Khanna, MD, discussed a variety of topics, from how biosimilars work to the latest treatments and the era of precision medicine.
Khanna, the clinical director of women's health of the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center, researches inflammatory bowel disease (IBD), such as UC.
Here are Khanna's answers to some of the questions asked during the Reddit AMA. The answers have been lightly edited for length and clarity.
What are the next advances in treatment?
Khanna: There are a number of drugs in the pipeline for UC. We’re also approaching the era of precision medicine, which is when you can do testing to help determine risk and severity of IBD, and our hope is that we’ll be able to use all that information to understand what drug is best for you.
What dietary changes would you recommend for someone with mild ulcerative proctitis [ulcerative colitis that affects only the rectum]?
Khanna: Your diet plays a powerful role in protecting your gut, maintaining remission, and supporting a healthy, balanced microbiome. Research shows that certain foods can lower the risk of developing inflammatory bowel disease (IBD) and promote long-term gut health.
A diet linked to lower IBD risk includes:
- More fiber-rich foods: whole grains, fruits, vegetables, beans
- More dairy: yogurt, kefir, and low-fat milk products
- Less total fat and less animal fat
- Fewer sweets and ultra-processed foods
To feed your good gut bacteria, eat food rich in fiber that promotes the production of short-chain fatty acids, such as:
- Inulin: asparagus, chicory root, and garlic
- Pectin: apples and citrus fruits
- Resistant starch: green bananas, beans, and lentils
- Beta-glucans: oats, barley, and mushrooms
Also, focus on fermented foods like:
- Yogurt
- Kefir
- Kimchi
- Sauerkraut
- Miso
- Kombucha
What are the best everyday lifestyle approaches for fatigue?
Khanna: Fatigue is considered to be an extraintestinal manifestation of IBD. Make sure your labs are checking micronutrient levels. Your diet and vitamin supplements – especially if you have micronutrient deficiencies – can help fatigue. Many centers have an IBD dietitian that can help incorporate diet and supplements as part of your treatment plan. Sleep hygiene is also very important.
As an IBD specialist, do you often ask your patients about their extraintestinal manifestations, apart from their digestive symptoms?
Khanna: Yes, extraintestinal manifestations – complications that happen outside the gut – are extremely important. Many centers, including ours, focus on looking at the whole picture and treating the whole person, not just their GI tract. We often work in multidisciplinary models (with rheum and derm and others) to manage all the symptoms related to IBD.
Do biologics all fail eventually?
Khanna: No. I've had several patients that have achieved long-term remission for decades on a single medication.
How can a patient best communicate to help their doctor understand they're struggling and that the symptoms are reducing their quality of life?
Khanna: It's important to have a relationship with your physician where you feel heard, and a relationship that's built upon trust so that they'll address your concerns. If you feel like your symptoms are being dismissed, discuss that with your physician. Many patients also seek out second opinions.
Do you think there's a movement toward making dual-targeted therapy (DTT) the standard of care in refractory UC? Do we need to wait until certain drugs go generic?
Khanna: Yes, there's a greater movement towards dual biologic therapy. I don't think we need to wait for meds to go generic. Often, pharmaceutical companies have patient assistance programs if the meds are denied by insurance companies.
Do biosimilars truly function as generics for biologics?
Khanna: Yes, biosimilars work the same as their brand counterparts. It's rare to have a patient fail a drug after switching. I have seen a patient develop an intolerance to the biosimilar.
What's the expectation for remission?
Khanna: I think the goal should be endoscopic remission for patients (no evidence of inflammation seen by the eye on colonoscopy). I think sometimes, there's a gut reset after achieving remission, so your bowel movements may not be exactly the same as prior to diagnosis. The goal, however, is for you to lead a good quality of life.
At what point would you recommend hospitalization rather than a doctor call/visit?
Khanna: I recommend hospitalization in patients that have severe ongoing rectal bleeding, worsening abdominal pain, high fevers, or signs and symptoms of dehydration.
Is there data that people with UC are at higher risk for developing colon cancer?
Khanna: Yes, there's data showing that long-standing, uncontrolled inflammation can increase your risk for colon cancer. It's important to control the inflammation and have regular surveillance colonoscopies, especially after eight years of diagnosis.
How do you treat a mild flare during pregnancy?
Khanna: Discuss this with your doctor. It's important to control inflammation during pregnancy. We know that inflammation in the mom is the greatest predictor for adverse outcomes in pregnancy.
Do you think there will be a cure for IBD someday?
Khanna: I'm not sure about a cure, but I'm hopeful we'll be able to prevent the development of IBD. We are in a phase of prediction and prevention, and so if we can predict who is at risk for developing IBD, maybe we can intervene early to help prevent it.
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Photo Credit: E+/Getty Images
SOURCES:
Puja V. Khanna, MD, gastroenterologist; clinical director of women's health, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles.
Preventive Medicine Reports: "Inflammatory Bowel Disease Prevalence: Surveillance data from the U.S. National Health and Nutrition Examination Survey."
