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Dr. Kara De Felice: IBD Detection Monitoring and Diet | Low FODMAP Diet by FODMAP Life

You may have heard of Crohn’s disease or ulcerative colitis, two types of inflammatory bowel diseases (IBDs), but do you know how devastating it can be for those who suffer from these incurable diseases? Could you imagine how difficult it can be around this time of the year when those with a chronic illness need to navigate busy holiday schedules, get-togethers and travel?

Here are five things that people with Crohn’s disease want you to know:

  1. Crohn’s disease is a chronic, progressive and destructive disease that can cause damage of the GI tract in the majority of patients.[1]
  2. Symptoms of Crohn’s can include frequent or urgent diarrhea, abdominal pain and fatigue, and can range in severity and longevity.
  3. As many as 1 million people globally may be affected by this devastating disease for which there is no cure.[2]
  4. Most Crohn’s disease patients are diagnosed before the age of 35,[3] which can mean a lifetime of invasive procedures, drug therapy, and surgery. In fact, 70% of Crohn’s disease patients require surgical intervention,[4] which can have significant financial and physical impacts on their lives.
  5. Once diagnosed, many patients undergo periodic, expensive and invasive endoscopic monitoring to evaluate their disease progression. In fact, pharmacologic treatment alone can cost as much as $100,000 a year.[5]

IBD DETECTIONLeading IBD specialist Dr. Kara De Felice, Assistant Professor of Clinical Medicine, Section of Gastroenterology at Louisiana State University School of Medicine, discusses with me the symptoms of IBD and innovative detection and monitoring options that are now available to help Crohn’s disease patients manage their health, and she also shares some of her tips about diet.

Colleen Francioli: What is your preferred method to try and detect and diagnosis Crohn’s Disease?

Dr. Kara De Felice: So Crohn’s Disease, as you know is a chronic condition and it can really affect the GI tract in many different locations. So, patients can have inflammation involving their esophagus, their stomach, their small bowel and their colon. And I think it depends on how the patient presents and what symptoms they present with where you’ll be looking. If you’re looking in the upper GI tract, you can do an upper endoscopy, and if you want to look in the colon, you can do a regular colonoscopy. The small bowel is where it gets a little bit tricky because that’s the area where scopes don’t go on a regular basis. So your options for looking at small bowel is doing some imaging studies, but if you’re trying to prevent using radiation and getting a closer look at the mucosa of the small bowel, what I do is I order a pill cam. And the way that that works is that the patient will take a pill that has a camera attached to it and they will swallow it. They will go about their regular day and wear a recorder with them and at the end of their day they’ll bring back the recorder. Once we plug the recorder back into the computer, we have eight hours of imaging that really gives us beautiful images about their small bowel. And that really allows us to understand where the patient’s disease is and if it involves their small bowel.

CF: Can you tell us more about innovative detection and monitoring options?

DrDF: Yes, so monitoring is really key in these patients because they have inflammation that will never go away unless treated appropriately. We need to make sure we monitor these patients. Crohn’s disease patients also have lots of symptoms that does not always correlate with the amount of inflammation in their gut. So, ways to monitor is kind of similarly to the way we diagnosis patients. So we can do endoscopy, we can do imaging and again a great technique to monitor the patient especially if they have small bowel Crohn’s Disease is the pill cam. And our goal with monitoring it is to really see what has happened with the inflammation over time. And our goal is for all of the inflammation to be gone when we treat these patients effectively.

CF: Are there any monitoring or detection methods that are dangerous or could cause infection?

DrDF: Yes, so colonoscopy as well as upper endoscopy comes with it’s own risks. One very small risk is infection, but that’s usually not what we find. Infection is really not seen with imaging studies and is minimal to zero with pill cam.

CF: Aside from smoking, which I know can make Crohn’s worse, what else do you advise your patients not to do or to limit?

DrDF: Absolutely, so yes, you’re absolutely correct. Smoking is terrible for Crohn’s Disease. I also like for my patients to avoid NSAIDS. NSAIDS can cause ulcers in their bowel and there is some belief that it can cause the Crohn’s disease to flair. Another medication that needs to be avoided is narcotics. So we now know that narcotics increase patient motility and mortality so we avoid those. And then prednisone use, umm even though we use it sometimes to kinda get a patient into remission for short courses, long term prednisone is really bad for patients. And so those would be my four things I try to avoid in all of these patients.

CF: Let’s talk a little about diet. Can you tell me more about the low-FODMAP diet? When people are not experiencing a flair?

DrDF: So the low-FODMAP diet is really designed, mostly for patients who have some upper GI symptoms, so bloating, increase in gas and distention. And we see a lot of patients having symptoms like that when they have irritable bowel syndrome which is different from having Crohn’s Disease. So, I find that my Crohn’s disease patients on a low-FODMAP diet don’t necessarily always do better. It does cut out certain foods that bacteria love to make, which cause an increase in gas. But for mostly for my Crohn’s Disease patients I try to not limit the foods that they eat. Depending on how healthy they are, what their BMI’s are, I know that many of my Crohn’s Disease patients struggle with the absorption of their food and so for me, what’s most important with them, is that they eat healthy and balanced. Cut out processed food, fried food and really try to eat what really feels good to them and what sits well with their GI tract.

CF: Are there any other diets that you would suggest?

DrDF: I kind of use this term a little bit loosely but I talk a lot about clean diet. And really what that is, is just cutting out everything in a box and in a wrapper and in a brown bag. So that all means is processed foods and things like that. And really try to promote that Crohn’s Disease patients eat healthy and things that come out of the ground so your fruits and vegetables etc.

CF: Thank you so much. This has been super informative. Is there anything else you would like to add?

DrDF: No, I would just like to give patients a web site that can be helpful for them. So the website is called, pillcamcrohns.com and this website will tell patients about the Crohn’s Disease and symptoms. It’ll also review what pill cam studies are all about and different ways to monitor patients and it will give them a way of also looking up in their local area by putting in their local zip code of any physicians in their area that have expertise in Crohn’s Disease management.

Meet Dr. De Felice and learn more about IBD:

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cropped-bec_6825.jpgBe good to yourself and your gut!

Colleen Francioli

Certified Nutritionist Consultant
Founder FODMAP Life & BonCalme


[1] Cosnes et a. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8(4):244-250.

[2] Molodecky N, Soon, I et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012. 142(1):46-54.

[3] The Facts about Inflammatory Bowel Disease – Updated incidence and prevalence of Crohn’s Disease and Ulcerative Colitis in Olmstead County, MN

[4] Lewis, Robert, et al. Efficacy and Complications of Surgery for Crohn’s Disease. Gastroenterol Hepatol. 2010; 6(9):587-596.

[5] Liu Y, Wu EQ, Bensimon AG, et al. Cost per responder associated with biologic therapies for Crohn’s disease, psoriasis, and rheumatoid arthritis. Adv Ther. 2012;29(7):620-634.

[6] Baert, F, Moortgat, L, et. Al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterol. 2010; 138(2):463.468.

[7] Aleez M, Lemann M, et al. Long term outcome of patients with active Crohn’s disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol. 2001;97(4):947-953.