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Wednesday 7th February 2018
Cross Community Audience Hears Practitioners Share Their Medical Expertise On Crohn’s And Colitis
A medical information evening at Kinloss Gardens – Dispelling The Myths About Crohn’s and Colitis – attracted a diverse audience from across the Jewish community. Four leading medical practitioners shared their experiences of treating the inflammatory bowel diseases Crohn’s and Colitis, conditions known to be particularly prevalent in the Jewish Ashkenazi community.
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The event, presented by Crohn’s and Colitis charity Jewish Digest in association with Camp Simcha, was moderated by Consultant Gastroenterologist Dr Steven Mann, Clinical Lead for Inflammatory Bowel Diseases at Barnet Hospital, Royal Free London NHS Foundation Trust.
Dr Clive Onnie, Consultant Physician and Gastroenterologist at the Whittington Hospital and an expert in the genetic origins of Crohn’s and Colitis, embarked on “a slow trot through the latest treatment options.” Since IBD tends to be a lifelong condition, new entries on the treatment horizon are scrutinised with great interest not only by the medical profession but also by patients and their families.
“New medicines focus on the immune system in order to suppress inflammation,” Dr Onnie said, adding that the goal is to heal the lining of the bowel and restore it to normality. “Early treatment is key to prevent the inflammation worsening. Using two immune suppressants in tandem has proved to be the best option for controlling this condition.”
Mild to moderate drug treatments well tested over time – Mesalazine, Mercaptopurine and Azothiaprine – were augmented in 1998 with the introduction of Infliximab, the first of a range of biologic drugs for the treatment of IBD along with other autoimmune diseases. Other biologic drugs followed such as Humira, Vedolizumab and in the last few months, Ustekinumab. These immunosuppressant medications, administered either by infusion or subcutaneously, have exerted a dramatic effect in producing healing in moderate to severe disease.
Dr Onnie emphasised that the best outcomes are created by a multidisciplinary approach that includes a consultant, a GI (gastrointestinal tract) specialist nurse and a dietitian. “You should seize the opportunity to get on top of things as soon as you can. When should a person see a consultant? When things just don’t feel right.”
Senior Dietitian Naomi Joseph considered the frequently asked question, is there a specific diet for IBD? The purpose of dietary treatment is to reduce symptoms while maintaining a balanced intake of healthy foods. A liquid nutritional formula given over six to eight weeks can sometimes be administered instead of steroids to damp down inflammation .
The Low Fodmap diet , a process of elimination of known carbohydrates that are difficult to digest, has been found to be useful in some cases. Other foods are gradually reintroduced after 6-8 weeks. Its use in inflammatory bowel disease remains unproven.
The Special Carbohydrate Diet (SCD) which surfaced in America some time ago allows only protein, fruits and vegetables, with few grain or dairy products. Its twelve month duration makes it difficult to maintain. Studies on this diet come mostly from the US and its effectiveness is still not proven.
Lofflex is a type of exclusion diet that limits wheat, lactose, fat and fibre and takes around four months to complete. Since it is not a balanced diet, it requires the addition of a multivitamin supplement.
Evidence for the value of probiotics, a current hot topic, in Crohn’s or Colitis to maintain or induce remission is at a low level. “It’s important to find a diet tailored to individual needs. The attempt to control symptoms by eliminating a dietary trigger should only be carried out under the supervision of a dietitian.”
Dr Sarah McCartney, Consultant Gastroenterologist at University College Hospital, specialises in specific challenges for young people with IBD. 25% of people with IBD first present in adolescence and adolescents make up a large cohort of the IBD population. Young people with Crohn’s disease don’t always show classic symptoms. They could present with joint pain, fever, loss of weight, lack of growth or even with psychiatric issues. IBD in young people tends to be more severe and extensive with a higher risk of complications.
Caring for children and adolescents in the right way teaches them to maintain their medication and to contact their nurse specialist as soon as they feel they need support.
Transitioning from adolescent to adult care poses particular problems. Dr McCartney quoted some reaction of young people who made the change from one system to the other. “I felt anxious and scared about leaving a doctor I could trust.” “I had relied on my parents to make appointments, contact doctors, organise medication . . .” “I wanted someone to talk to me, not to my parents.” “Since adolescents are not keen for parents to make all the decisions, we see them both with and without their parents,” Dr McCartney said.
Dr Julian Stern, Consultant Psychiatrist in Psychotherapy at the Tavistock Clinic, whose special interest is IBD, pointed out that even under normal circumstances adolescence can be a stormy time. How much more so in the case of young people with IBD who also have to deal with embarrassing symptoms, the stigma of feeling “different “which may cause them to avoid school and social situations and the side effects of medications and sometimes surgery.
“Crohn’s and Colitis are complicated conditions coming at a complicated time.” Because there tends to be a family predisposition to these illnesses, parents may feel a degree of guilt that causes them to overcompensate.” Parental attention tends to focus on the child who is unwell and this can lead to siblings experiencing “survivor guilt”.
Dr Stern added that the resilience that parents and families need can be greatly bolstered by resources offered by the community, schools and welfare organisations. He referred to the buddying system that Jewish Digest is currently introducing, which allows people with Crohn’s and Colitis, including adolescents, to contact others with similar conditions, helping to relieve isolation by talking through issues that concern them. Nurse specialists whose function is to help with psychological issues arising from these medical conditions are also a valuable resource.
WEDNESDAY 22ND FEBRUARY 2017
Experts Offer Perspectives On Medical Condition Prevalent In the Ashkenazi Jewish Community
A symposium on Understanding Crohn’s and Colitis In Children and Adolescents at Kinloss Gardens, Finchley attracted an audience of around 70 people keen to find out more about the management of IBD (Inflammatory Bowel Disease) and the therapies necessary to keep it under control. The fact that this was an evening devoted to Crohn’s and Colitis in children and young people sparked particular interest. Some people travelled from as far away as Manchester and Gateshead for the chance to hear about these chronic conditions from a group of experts, including paediatric gastroenterologists, a colorectal surgeon, a dietitian and two researchers, all celebrated for their work in this particular field.
Dr Stephen Mann, Consultant Gastroenterologist at Barnet Hospital, acted as the panel moderator and fielded questions, which could be posed anonymously, from the audience.
Paediatric Gastroenterologist at the Royal Free Hospital, Dr Mark Furman described the range of investigative tools available to help doctors decide on a diagnosis. Non-invasive diagnostics and the need to avoid radiation wherever possible in children has led to the increasing use of ultrasound and MRI, and in the last ten years, an innovative diagnostic tool, the video capsule endoscopy invented by Israeli scientists which involves a small capsule that contains a transmitter to convey images as it travels down the gastrointestinal tract.
Dr Warren Hyer, Paediatric Gastroenterologist at Chelsea and Westminster Hospital and at St Marks Hospital, Harrow outlined changes in methods of treating IBD in children and adolescents. “Our priority has changed. Today our greatest concern is to keep the disease “quiet” since the more successful we are in this, the less likely it becomes that complications will ensue. Living with a lifelong disease such as IBD and keeping it under control is a long game. To this end, we focus on closer monitoring including better endoscopy. We are more practised in managing medical intervention with immunosuppressants for example because we know more about them and how to tweak them, we put in more surveillance and use them more effectively. So we know how to use old drugs better.”
The newer biologic drugs like Infliximab might be “stonkingly expensive” but these medications enable practitioners to get on top of the disease at an earlier stage. “There is a great deal of energy in the academic world devoted to trying to fix Crohn’s and Colitis. More new treatments are likely to be coming on line over the next few years.”
Then there is the question of diet and environment and how they might impact on IBD. Why are there more sufferers from IBD now than there were 30 years ago? The relationship between diet and Crohn’s and Colitis is a recurrent question. Although these conditions are not caused by diet, they might well be impacted by the introduction of different gut flora. Dr Hyer indicated that, counter intuitively, 21st century standards of hygiene bear some responsibility for the increasing incidence of IBD. The genetic element in these diseases is intensified by our need to marry one another while “a posh environment” adds yet another layer of risk.
This was confirmed by Dr Adam Levine, Honorary Research Associate and Academic Foundation Doctor at University College Hospital who with Research Co-ordinator Dr Elena Schiff has been conducting a long term research project into the DNA of Jewish patients to help understand why they are more susceptible to Crohn’s and Colitis than the general population.
Dietitian Abi Freedman spoke about the anxiety experienced by parents of children with these illnesses about the effect of diet on their condition. Clearly a diet rich in fruit and vegetables is preferable to one full of fats and sugar but this holds true for the whole population. While adapting your diet does not prevent IBD, a healthy, balanced diet can be of benefit.
Mr Daren Francis, Consultant Colorectal Surgeon at Barnet Hospital, said that in the case of colitis, surgery can help. In the case of Crohn’s, surgery is often only performed when medical treatments have been unable to control the disease. Surgeons carry out the minimum amount of surgery necessary to improve the patient’s quality of life.
Neville Goldschneider, Chief Executive of Camp Simcha which organised the function together with Crohn’s and Colitis charity Jewish Digest, said Camp Simcha has the tools to offer children with serious medical conditions a range of services that can make a positive difference to their quality of life.
Jewish Digest presents: Meet the Foodie Experts – Healthy Food Event
Tuesday 24th May 2016
As part of the Kinloss Education, Culture & You Programme , Crohn’s and Colitis charity Jewish Digest together with Kinloss hosted the first ever Healthy Food Event on Tuesday to the delight of around two hundred enthusiastic spectators. A group of acclaimed foodie experts addressed the issues many of us encounter in the constant search for quick and easy kosher recipe ideas that support the health and well being of ourselves and our families, presenting a tempting display of tasters, snacks and food bites.
Deborah Eckstein who together with Jonathan Jay founded Jewish Digest, said: “We are fortunate to be part of a beautiful heritage and a wonderful Jewish community but it does come with the downside that Ashkenazi Jews are approximately four times more likely to develop Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis) than non Jews in the same country. There is no cure yet and for many people living with IBD can be a huge struggle and impact on their lives in unforeseeable ways. Jewish Digest was set up as an online community to provide information, support and advice to deal with the everyday challenges it brings. Although there is as yet no definitive study that demonstrates that diet has any effect in patients with IBD, for many people food does play an important part in helping to control their symptoms.”
Author and cook Lisa Roukin discussed ways in which making healthy food can become part of our lifestyle. Integrative nutritionist and holistic health coach Devori Nussbaum described how our craving for sugar impacts unfavourably on our well being, contributing to chronic inflammatory conditions and even affecting the brain to the point where our powers of concentration are disturbed by a sugar overload.
Kosher nutritionist Eve Noe shared some delicious recipes beneficial to health and Dr Michelle Storfer was kept busy answering queries involving health and nutrition. Rebecca of Rebecca’s Kitchen made easy, healthful snacks from just a handful of ingredients for people to taste and try at home. A nutritionist from Highfield Vitamins responded to questions about the use and value of the company’s kosher vitamins and food supplements, including probiotics. Or Golan, former Ottolenghi chef shared some easy, healthy dishes and energising juices.
Look forward to seeing you there!
Eminent colorectal surgeon Mr Richard Cohen captivated his audience at Kinloss Community Centre last week as he offered a series of lifestyle tips on diet, lifestyle and disease prevention. “Smoking – the worst thing you can do – outweighs everything else although obesity, inactivity and alcohol follow close behind,” Mr Cohen warned during his overview of simple ways to look after our health as Jewish tradition and observance advises us to do.
Are we programmed to inherit certain conditions or are there other factors that trigger disease? Mr Cohen considered the role played by familial conditions likely to exert an influence on future health. These include the Inflammatory Bowel Diseases Crohn’s and Ulcerative Colitis which are four times more prevalent in the Ashkenazi Jewish community.
The Kinloss function was also the occasion of the official launch of the Crohn’s and Colitis charity Jewish Digest, a website designed to help and support people living with these chronic debilitating diseases that can exert a serious impact on lifestyle. Jonathan Jay, who together with Deborah Eckstein and Dr Adam Levine set up the charity, spoke of the incredible medical advances in the treatment of Inflammatory Bowel Diseases (IBD), outlined the range of services offered by Jewish Digest, including up to date information, gut friendly recipes and articles by gastroenterologists and allied professionals. A twice weekly helpline staffed by a specialist IBD nurse was made possible by an award from the Big Lottery Fund.