Maintaining Good Health
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1 Pediatric Inflammatory Bowel Disease Maintaining Good Health Ghassan Wahbeh MD Professor Pediatric Gastroenterology Seattle Children s Hospital Director IBD Center University of Washington
2 1. IBD treatment goals are clear Remission No symptoms Normal growth* Normal labs Normal bone density Normal psychosocial development Normal productivity Steroid free remission Mucosal healing EARLY! * Children & Adolescents
3 Diet Must keep up with fruit and vegetables 5-7 portions daily Limiting fruit/veggie fiber is WRONG! More plant protein Less animal protein Less refined sugar Model after SCD
4
5 What are IBD patients eating? Mean of 5.4 ± 2.7 additives/day fresh fruit/vegetable calorie (BMI) protein Processed food Additives: emulsifiers stabilizers Frozen desserts 66% carrageenan 52% soy lecithin 45% xanthan gum Meat/poultry/fish 66% carrageenan, 52% soy lecithin 45% xanthan gum Grains and Breads 72% soy lecithin 21% xanthan gum Dale Lee et al. Manuscript In progress
6 Bones
7 Bones Bone density Active inflammation Repeat Steroid/Prednisone course Low physical activity Low Vitamin D/calcium Family history
8 Keeping bones healthy Complete inflammation control Avoiding steroids Balanced nutrition for Vit D/Calcium Exercise Weight bearing IBD is not a reason to limit when well treated Bone density monitoring
9 Gums Causes of gum inflammation in IBD Crohn s disease Vitamin deficiencies Diet Dental hygiene Frequent/prolonged steroid exposure Habit: gum biting
10 Keeping Healthy Gums Inflammation control Steroid avoidance Tooth brushing / flossing regularly Avoiding refined sugar (?artificial sweeteners) Avoid gum biting See dentist regulary No issue with dental procedures when IBD stable
11 Skin IBD related skin conditions Erythema Nodosum Pyoderma Gangrenosum Possible increase risk of skin malignancy Can be treatment related Medication Related Psoriasis and Anti-TNF therapy Allergic rashes
12 Skin Remember common rashes can happen Eczema Pilaris keratosis Tinea (ringworm) Molluscum Sun burns Skin cancer
13 Joints IBD Related Arthritis Peripheral Axial Enthesitis IBD nonspecific Osgood Schlatter Growing Ankle/foot/knee aches Back pain More muscular
14 Eyes Inflammation Uveitis/Episcleritis/Retinitis Usually matches IBD inflammation control Steroid related Cataract/Glaucoma
15 Keeping Eyes Healthy Avoiding steroids Healthy nutrition w vitamins Screening
16 Emotions 1/3 patients have symptoms of anxiety and depression May not be recognized easily by child/family Steroids can worsen symptoms Sleep can be a factor Sleep disorders very common in IBD
17 Emotions: ABCs of care IBD is nobody s fault Work with a professional IBD expert psychologist Build child s confidence to open up Protect sleep: quality & quantity Medications might be needed
18 Social activity IBD can be isolating Symptoms Growth Anxiety
19 Vaccines Window before starting treatments Complete live and non live vaccines Recommended PCV 13 and 23 vaccines Hep A HPV Meningococcal vaccines After therapy: Concern about live vaccines Non live vaccines are safe Annual flu vaccine
20 Vaccines Consider following titers Hepatitis B Varicella
21 Over-the-counter & Prescription Medications NSAIDS Frequent use associated with flares Limited use is safe Esp. when IBD well controlled Antibiotics Use when needed Avoid when not needed No particular type preferred Probiotics?
22 Summary Excellent inflammation control is key good health Diet plays a significant role in IBD and non-ibd related health Keep it simple and tasty! Taking care of whole body
23 Thank You!
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