Stanford Children’s Inflammatory Bowel Disease Program

09/18/2020

Connect with the Pediatric IBD Community during the free, virtual online conference hosted by ImproveCareNow. A few members of the Stanford team will be presenting on our virtual engagement events on September 25th. We hope to see you there!

On September 24 & 25 we will be hosting our 𝗙𝗮𝗹𝗹 𝟮𝟬𝟮𝟬 𝗟𝗶𝘃𝗲 𝗢𝗻𝗹𝗶𝗻𝗲 𝗖𝗼𝗺𝗺𝘂𝗻𝗶𝘁𝘆 𝗖𝗼𝗻𝗳𝗲𝗿𝗲𝗻𝗰𝗲. We plan to 'all teach and all learn' about topics including diversity & equity, patient & family engagement, the effects of COVID-19 on health and care, and our path forward with new ICN leadership. The event is open to all so we hope to 'see' you there 💚💙

Download the agenda and make a plan to join us: https://www.improvecarenow.org/fall_2020_community_conference

03/17/2018

Check it out, friends! Our IBD Center produced a Cooking Night Video at Sur La Table in Palo Alto!

Patients, Parents, & Stanford Providers cooking together...

https://vimeo.com/260461665/f7be605f0d

This is "Final short video" by ZWEEN WORKS on Vimeo, the home for high quality videos and the people who love them.

01/29/2018

Showcasing our latest study now published.

We want to deliver the right medication dose to the right patients.

One size-fits-all approach to drug dosing is not appropriate (especially in young patients) since each patient is different.

Check out our free, open-access manuscript here:

https://academic.oup.com/ibdjournal/article/24/2/227/4816939

BackgroundInadequate infliximab (IFX) drug exposure remains a clinical challenge and leads to high loss of response rates and therapy failure in inflammatory bowel disease (IBD). We aimed to determine the feasibility and pilot effectiveness of a novel, web-based, mobile IFX dosing calculator (mIDC)....

01/26/2018

Members of our IBD Center presented and co-lead several components of last week's inaugural Crohns & Colitis Congress: http://www.crohnscolitiscongress.org/CCC1/Public/Content.aspx?ID=31&sortMenu=102001

Many exciting scientific frontiers presented, and here's a snippet of what we saw/heard on diet & IBD:
http://www.crohnscolitiscongress.org/CCC1/Public/Content.aspx?ID=31&sortMenu=102001

Join the Crohn’s & Colitis Foundation (formerly known as the CCFA) and American Gastroenterological Association (AGA) for the inaugural Crohn’s & Colitis Congress™. Expand your knowledge, network with IBD leaders across multiple disciplines, and get inspired to improve patient care.

01/06/2018

Happy New Year everyone!

Two really interesting articles to share:

1) A western diet high in salt may cause imbalances in gut bacteria, decreasing beneficial Lactobacillus species. Hypertension and autoimmunity (via T-helper 17 cells) could be *triggered* via this proposed pathway.

https://www.nature.com/articles/nature24628

2) A diet high in carbohydrates (collectively called FODMAPs) could induce intestinal inflammation by activating gram-negative bacteria to produce lipopolysaccharides (LPS) - endotoxins that are found on certain pro-inflammatory bacteria walls that may illicit our human immunity.

https://www.jci.org/articles/view/92390

These two articles REITERATE the importance of what we eat, especially if have or disease.

High salt intake changed the gut microbiome and increased TH17 cell numbers in mice, and reduced intestinal survival of Lactobacillus species, increased the number of TH17 cells and increased blood pressure in humans.

12/22/2017

More research on how what we eat can affect IBD --

http://journalsblog.gastro.org/does-consumption-of-certain-fatty-acids-increase-risk-of-ulcerative-colitis-flares/?platform=hootsuite

Diets with high levels of fatty acids such as myristic acid (found in palm oil, coconut oil, and dairy fats) increased risk of flare in patients with ulcerative colitis (UC), researchers report in …

11/22/2017

Read our latest research from our Center. To date, it is the most comprehensive analysis of real-world costs and use of IBD medications for outpatient care.

(http://onlinelibrary.wiley.com/doi/10.1111/apt.14430/full)

Why does this study matter? Knowing, discussing, and questioning costs of care in IBD is important. It is particularly important as costs of chronic conditions outpace our budgets -- at the national-, health care system-, and individual-levels. It matters because out-of-pocket costs (to families) matter. It matters because potentially helpful drugs are increasingly difficult to access.

Real‐world data quantifying the costs of increasing use of biologics in inflammatory bowel disease (IBD) are unknown.To determine the outpatient IBD drug utilization trends, relative market share, and...

11/07/2017

Congrats to our Stanford Children's Health - Lucile Packard Children's Hospital Stanford IBD Center's Parent Partners, Mary McGowan, Candace Kelley & Mary Jo McCarthy and team, for receiving one of the inaugural Patient & Parent Innovation Fund Award!!!

http://www.improvecarenow.org/two_projects_funded_through_inaugural_improvecarenow_patient_and_parent_innovation_fund

10/10/2017

Come join us on October 28 at this year's Crohn's & Colitis Foundation Bay Area Patient Education Conference. Two of our IBD Center docs will be presenting!

http://online.ccfa.org/site/Calendar?view=Detail&id=143851

When: Saturday, October 28, 2017, 10:00 AM to 3:00 PM
Where: UC Berkeley Clark Kerr Conference Center
2601 Warring Street
Berkeley, CA 94720

Crohn's & Colitis Foundation

07/29/2017

The Pain cycle - applicable in IBD

07/29/2017

Snapshots from:
http://www.nature.com/nrgastro/journal/vaop/ncurrent/full/nrgastro.2017.88.html

1) Inflammation and microbiota (e.g., bacteria & fungus) are intricately connected. But it's difficult to tease out cause or just association.

2) Regardless, it's important to approach IBD therapies from different angles (i.e., adherence to evidence-based therapies modulating inflammation & lifestyle modifications to improve gut microbiota health through diet, stress management, and exercise, etc)

07/25/2017

Here is our paper in Open Access - we wanted our scientific paper to be available to patients, families, to all...

Why we monitor calprotectin levels...

http://journals.lww.com/ibdjournal/Pages/ArticleViewer.aspx?year=2017&issue=06000&article=00007&type=Fulltext

Background: In asymptomatic patients with inflammatory bowel disease (IBD), “monitoring” involves repeated testing aimed at early recognition of disease exacerbation. We aimed to determine the usefulness of repeated f***l calprotectin (FC) measurements to predict IBD relapses by a systematic lite...

07/14/2017

Congratulations to our IBD Center's very own AnnMing Yeh, MD & Anava Wren, PhD for their comprehensive review paper on "Mind-Body Interventions for Pediatric IBD"!

http://www.mdpi.com/2227-9067/4/4/22/htm

Pediatric inflammatory bowel disease is an autoimmune disease that causes chronic inflammation of the gastrointestinal mucosa. There is emerging evidence that the brain–gut connection affects inflammatory bowel disease (IBD) patients more than previously thought. This is evidenced by comorbid mood d...

07/06/2017

Highly recommend this read: http://www.cnn.com/2017/07/05/health/hunter-gatherer-diet-tanzania-the-conversation/index.html

A scientist from King's College London stayed with the Hadza tribe in Tanzania. After 72 hours his body had already begun to change.

06/20/2017

Support the IBD Center through Packard's Summer Scamper! https://my.supportlpch.org/fundraise/team?ftid=110553

Also, check out this Specific Carbohydrate Diet recipe card we'll have to pass out (WITH actual cookies!). Come by our IBD Center Table this Sunday!

06/20/2017

Help us reach our goal for Summer Scamper! https://my.supportlpch.org/fundraise/team?ftid=110553

Gut Gurus - Stanford's IBD Team: Welcome to the Gut Gurus fundraising page! We are fundraising to support Stanford Children's Inflammatory Bowel Disease department, because we want to help our community’s children and families get the life-altering care and information

06/08/2017

Check out our newly posted [VIDEO] of our patient Simon & mom Hava on our IBD Center's website (Patient Stories tab) -- Interview: Specific Carbohydrate Diet

https://med.stanford.edu/gastroenterology/patient_care/ibd_center/stories.html

Scroll to the bottom and read the peer-to-peer interview on the Specific Carbohydrate Diet.

Two months before my son's 12th birthday things were great. He was crushing it; straight A’s, top ten in the state in swimming, incredibly nice, funny, and polite, the perfect big brother to his three younger siblings. Then he got a stomach ache. It got worse. Three days later he was having emergenc...

05/28/2017

Have you heard of the Choosing Wisely Campaign? Here's the link: http://www.choosingwisely.org

IBD researchers came up with top 5 recommendations for physicians caring for IBD patients.

http://journals.lww.com/ibdjournal/Abstract/2017/06000/Modified_Delphi_Process_for_the_Development_of.2.aspx
We agree with all of them:

(1) Don't use steroids (e.g., prednisone) for maintenance therapy in IBD.

(2) Don't use opioids long-term to manage abdominal pain in inflammatory bowel disease (IBD).

(3) Don't unnecessarily prolong the course of intravenous corticosteroids in patients with acute severe ulcerative colitis (UC) in the absence of clinical response.

(4) Don't initiate or escalate long-term medical therapies for the treatment of IBD based only on symptoms.

(5) Don't use abdominal computed tomography (CT) scan to assess IBD in the acute setting unless there is suspicion of a complication (obstruction, perforation, abscess) or a non-IBD etiology for abdominal symptoms.

Choosing Wisely is an initiative of the ABIM Foundation that promotes patient-physician conversations about unnecessary medical tests and procedures.

05/19/2017

Dr. Charlie Lees' amazing blog post on

https://charlielees.com/blog-1/2017/5/18/world-ibd-day-2017-an-optimistic-note-and-a-call-to-arms

A few words of hope to the millions of people around the world living with Crohn’s disease and ulcerative colitis. A rallying cry to the many healthcare professionals looking after people with inflammatory bowel disease. Already IBD affects more than 1 in 200 individuals in the Western worl

04/28/2017

This weekend, our team members are headed to Dallas for the ImproveCareNow Community Conference (http://www.improvecarenow.org).

We are excited to present Stanford Children's IBD Center's innovative work on our mobile infliximab dosing calculator just for children with IBD (http://med.stanford.edu/gastroenterology/infliximab-calc/).

(By the way, children with IBD are not adults, and should not be dosed based on adult clinical trials.)

Last year, we showed that the majority of children with IBD and receiving infliximab are inadequately dosed (https://www.ncbi.nlm.nih.gov/pubmed/26890885)

ImproveCareNow is a community restoring the wellbeing of all kids with Crohn's disease and ulcerative colitis.

04/09/2017

We teamed up European experts to conduct a comprehensive systematic review of the scientific literature on stool calprotectin.

We found that if a patient with IBD is asymptomatic (i.e., feeling fine and doing well):
1) Repeat NORMAL calprotectin levels 1-3 months apart indicate 67-94% chance for continued remission.
2) Repeat HIGH calprotectin levels 1-3 months apart indicate 53-83% chance for a disease flare.

Why are these findings important?
1) Early-warning alert is an opportunity for *prevention* of disease relapse.
2) Bad symptoms are only the tip of the iceberg.
3) Calprotectin monitoring is the most objective, NON-INVASIVE method we have to predict what is going on inside.

http://journals.lww.com/ibdjournal/Abstract/publishahead/Clinical_Utility_of_F***l_Calprotectin_Monitoring.98599.aspx

03/30/2017

Here's info on one of the numerous studies we are participating in!

Let us know if you or your child would like to be considered in one of our trials.

Are you or someone you know suffering from an ulcerative colitis flare?

Stanford Hospital and Clinics is enrolling patients with active ulcerative colitis for a clinical trial assessing the safety and benefit of an investigational oral drug based on a natural botanical extract. The study includes 6 visits and 2 phone calls over a 12-week period, and all patients will receive the study drug.

Eligibility:
1. Age 13-75
2. Mild, moderate, or severe ulcerative colitis
3. Active disease
4. Previously tried 5-ASA and did not get better or unwilling to try 5-ASA

For background on this clinical trial, check out this article published in Inside Stanford Medicine:
https://med.stanford.edu/news/all-news/2015/11/musician-turned-scientist-develops-drug-for-inflammatory-bowel-disease.html

Finding an alternative remedy for her ulcerative colitis set a Stanford musicology student on a new and unexpected career path as a scientist and entrepreneurial drug developer.

03/29/2017

People like KT Park, MD, MS put the "CARE" in "health care." This was one mom's email to Dr. Park. Do you have a doctor who went above and beyond? Be sure to thank them in honor of tomorrow.

03/18/2017

At our IBD Center, we recommend screening vitamin D levels annually - Spring time is a good time to check! Here's why... Read http://journalsblog.gastro.org/can-vitamin-d-affect-risk-of-ulcerative-colitis-relapse/

Serum levels of vitamin D of 35 ng/mL or less in patients with ulcerative colitis (UC) in clinical remission are associated with disease relapse, researchers report in the February issue of Clinica…

03/08/2017

Listen to Dr. Park's interview at the recent Crohn's & Colitis Foundation annual meeting on pediatric growth and how to respond clinically.

https://reachmd.com/programs/crohns-colitis-foundation-perspectives/optimizing-growth-pediatric-inflammatory-bowel-disease/8487/

Recorded on location at the Crohn’s & Colitis Foundation's Annual Meeting in Orlando, host Dr. Sophie Balzora, Crohn's and Colitis Foundation Reach-IBD member and faculty advisor of the Greater New York Chapter Fellows' Education Committee, discusses general strategies for clinicians and familie...

03/04/2017

Why being "in-shape" is important. Less belly fat and more lean muscle may be important factors for longer-term remission and recurrence of Crohn's flare.

(Many ways we could interpret this study, but the take-away is being fit can only help.)

http://onlinelibrary.wiley.com/doi/10.1111/apt.14018/abstract

Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease.To determine whether body composition is associated with outcome in a prospective...

02/24/2017

We hear many patients and families affected by IBD raise concerns about the "side-effects" of starting infliximab (Remicade) or other biologic therapy. (We admit the word "biologic" sounds scary -- but they are actually antibodies that bind/inactivate inflammation-causing antibodies your body makes in an IBD flare.)

More and more data show that INCOMPLETELY controlling disease inflammation is WORSE for your health than being on appropriate therapy.

It's better to be well-treated and have your IBD in deep remission than endure ongoing flare or persistent disease activity.

Here's yet another reassuring large-scale study showing that infliximab (Remicade) and other biologics are NOT linked to cancer or malignancy.

http://www.gastrojournal.org/article/S0016-5085(17)30148-8/abstract

Immunosuppressive therapy for inflammatory bowel disease (IBD) in pediatric patients is thought to increase risk of malignancy and lymphoproliferative disorders, including hemophagocytic lymphohistiocytosis (HLH). We compared unadjusted incidence rates and of malignancy and HLH in pediatric patients...

02/13/2017

Patients with Crohn's disease have a specific gut bacterial "signature" - distinct from ulcerative colitis and very different from other GI conditions like irritable bowel syndrome.

http://gut.bmj.com/content/early/2017/01/31/gutjnl-2016-313235

Objective A decade of microbiome studies has linked IBD to an alteration in the gut microbial community of genetically predisposed subjects. However, existing profiles of gut microbiome dysbiosis in adult IBD patients are inconsistent among published studies, and did not allow the identification of…

02/09/2017

Just one of the several innovative things we are doing at our IBD Center: 1-Hour Infliximab Infusions without Pre-medications.

Read our abstract highlighting how we started this quality-improvement project:

https://www.ncbi.nlm.nih.gov/pubmed/28141678

J Pediatr Gastroenterol Nutr. 2017 Jan 28. doi: 10.1097/MPG.0000000000001535. [Epub ahead of print]

02/08/2017

Check out our Yoga! IBD Study -- Enrolling now! prAna
See flyer.