Treating the Child in Pediatric IBD, with Riha Bhatt, MD

Inflammatory bowel disease (IBD), characterized by subset conditions ulcerative colitis and Crohn’s disease, affects approximately 1 - 2 in every 1,000 children in the United States. About one-fourth of all cases worldwide first present in patients prior to their 20th birthday, as the chronic disease often first presents with symptoms of pediatric weight loss, affected growth, abdominal pain and diarrhea.

Pediatric IBD is just prevalent enough to be considered a perceptible threat to the average person, but still uncommon enough to be diagnosed infrequently and its treatment delayed. Even when quickly recognized and addressed, the long-term effects of IBD require new patients and their parents / caregivers are well equipped to manage it beyond the doctor’s office.

In a recent interview with The Educated Patient, Riha Bhatt, MD, assistant professor of pediatric gastroenterology, hepatology and nutrition at the Vanderbilt University Medical Center, discussed the comprehensive care strategies for pediatric-onset IBD. Bhatt’s discussion is broken into two segments, as displayed in the video playlist above and in the navigable list below:

1. How to Fully Treat Pediatric IBD
2. 3 Daily Steps to Minimize Pediatric IBD

Here are some key takeaways from Bhatt on managing pediatric IBD.

On dietary strategies

“We've had studies that show two types of diets—specifically the partial enteral diet or the polymeric diet, as well as the Crohn's disease elimination diet—are just as good as steroids in those who have small bowel Crohn's. And in the polymeric diet, we often use a certain percentage. For example, 80% of the child's diet would come through better tasting formulas that are a little bit more palatable, and 20% of their diet may come from table foods. The Crohn's disease elimination diet does something very similar, but we tailor the foods that are more anti-inflammatory—so, less animal fats, less red meats, decreasing gluten and doing a lot of anti-inflammatory food.”

On the impact of exercise

“They found pediatric patients with IBD, not only did they feel better and their fatigue was decreased, but it actually decreased inflammatory markers. Their (C-reactive protein) rate went down, and their protein level in the body improved. And there are studies that looked at both diet and exercise together, and that intervention together also has shown to improve symptoms.”

On the importance of addressing mental health

“We know that patients, children and teenagers with IBD have higher rates of anxiety and depression than kids who have other chronic diseases. We know that there is a direct lineage between anxiety, depression and inflammation. It drives the inflammatory cytokine response, and so by being open to discuss it, we as physicians need to do a good job about addressing it and identifying it so that we can intervene to help. And most of the time, that intervention is not medications. It's rather something using something like cognitive behavioral therapy, which many counselors are very adept in, that has the most robust evidence to show that can really help with symptoms of anxiety and depression, and that can help decrease inflammation.”

On how pediatric IBD inflammation can be “silent or loud”

“The symptoms will knock you in the face—with the belly pain, the diarrhea or the loose stools—but not all the time. And by recognizing that, it helps us understand this is why we want to see our GI doctor regularly and get the labs that we do. Sometimes we have to take a look with the scope at certain times, even when we're feeling good, to make sure there's not smoldering inflammation.”