S03_E06 - Let's Talk IBD (Inflammatory Bowel Disease)

Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:19

Hey everybody, it's Dr. David Hilden and welcome to episode six of our show. Perhaps we've all heard of inflammatory bowel disease and irritable bowel syndrome and the many diseases that are associated with your intestines. So today we're gonna get a better look at intestinal conditions with my colleague Dr. Jake Matlock. Jake is a GI specialist. That means he's a gastroenterologist and , uh, someone who's been on the show a few times now. So, Jake, welcome back to the show. Thanks,

Speaker 3: 0:47

Dave. It's good

Speaker 2: 0:47

To be here. IBD inflammatory bowel disease. Let's break it down a bit. What is it?

Speaker 3: 0:52

Inflammatory bowel disease is a broad term for a chronic inflammation in the intestinal tract. There are several different kinds and, and it can be classified in different ways depending on how , uh, much inflammation there is. And what part of the intestinal tract is affected.

Speaker 2: 1:08

Is that the same as colitis or enteritis or gastroenteritis? So

Speaker 3: 1:13

The terms that you're using, colitis, enteritis, gastroenteritis are general terms, meaning inflammation of the colon or the intestinal tract or the stomach. So those are broader terms than I-B-D-I-B-D is a specific diagnosis of a chronic inflammatory condition, usually felt to be autoimmune in origin. So related to one's own immune system , uh, going after a segment of your intestinal tract and causing inflammation.

Speaker 2: 1:41

A lot of listeners are probably, they probably know that the itis is our inflammation of whatever you've got in your body. <laugh> , if it's got an itis , it's got an inflammation. So IBD is a specific group of diseases of the two biggies. Crohn's disease, ulcerative colitis. Break 'em down please. Yeah.

Speaker 3: 1:58

So Crohn's disease and ulcerative colitis are, as you said, the two , uh, types of inflammatory bowel disease. The biggest difference between the two is what segments of the intestinal tract are affected in ulcerative colitis. Only the colon or the last six or so feet of the intestinal tract are involved. Typically the inflammation is more superficial , uh, that doesn't mean it's less severe, but it is more superficial , uh, on the intestinal wall. Whereas in Crohn's disease, you can have not only the colon involved, but actually any part of the intestinal tract from all the way from the lips to the other end. And the inflammation in Crohn's disease is also deeper. It goes deeper into the wall of the intestinal tract and that can lead to different , uh, and sometimes more severe complications.

Speaker 2: 2:48

In uh , just a few minutes, we're gonna get more into how you diagnoses and what symptoms people might be having of these two types of inflammatory bowel disease. Before we do that though, irritable bowel syndrome is something that people often in my own practice get a little bit sometimes confused with IBD. So we have IBD and IBS and they're very close. But could you tell us what is the difference between inflammatory bowel and irritable bowel?

Speaker 3: 3:13

Well, I think that's a really important distinction, Dave, 'cause it is confusing and I think we contribute to that confusion because we've, we've got these names that are so close together. IBS and IBD sound almost the same if you say 'em fast enough in irritable bowel syndrome or IBS, the intestinal tract itself is not inflamed if you look at it under a microscope. So if you take biopsies, put it , put those biopsies under a microscope, the intestinal tract looks normal. What is believed to be at least partially responsible for the symptoms associated with irritable bowel syndrome is a problem with the communication or signaling from the nervous system that innervates the intestinal tract and its communication with the brain. So

Speaker 2: 3:58

If you were to look at a patient's intestines with irritable bowel, it would look normal. That

Speaker 3: 4:03

Is correct. That is actually one of the hallmarks of irritable bowel syndrome is that the intestinal tract itself is structurally normal and that there is not inflammation in the lining of the intestinal tract.

Speaker 2: 4:15

So to all of you who might be experiencing irritable bowel or have a friend who is, or a family member or are simply looking for more information about IBS, we've got you covered. We'll do it in a later episode. I'm gonna say that at the top of this episode 'cause I wanna focus on the inflammatory ones. But we'll get , uh, either Dr. Matlock or one of his colleagues back for a future episode about irritable bowel. So stay tuned for that. Let's dive deeper now into inflammatory bowel Crohn's disease. First of all, how common is it?

Speaker 3: 4:45

So the current estimates are that Crohn's disease affects between one and 300 people per hundred thousand in the population. That's kind of a hard number to wrap your head around, but what that means is that there's somewhere between one and one and a half million people with Crohn's disease in the United States. That's a lot. It's a lot. Yeah. It's more common than people realize.

Speaker 2: 5:04

Tell me about what their lived experiences like what, what are people with Crohn's experiencing?

Speaker 3: 5:10

So there's a broad spectrum of, of symptoms that can , uh, be associated with Crohn's and a very variable natural history for the disease. Meaning it can be very mild , uh, with , uh, occasional abdominal discomfort and diarrhea. It can also be very severe with , uh, the development of abscesses, perforations, fistulas, anemia, and bleeding. It , it can be really a life altering disease if it's , uh, at the severe end of the spectrum.

Speaker 2: 5:40

What's a fistula?

Speaker 3: 5:42

I apologize. Yeah, I should have been more clear about that. No, I know

Speaker 2: 5:44

What it is, but I'm gonna have you explain this one because , um, in all honesty, it is, is one of the complications of Crohn's that you're trying to avoid.

Speaker 3: 5:51

Yeah. Uh , a fistula is the medical term for a connection between two hollow things that shouldn't be connected. So if you have a , a piece of your intestinal tract that somehow , uh, attaches itself to and develops a communication with something else, even another part of your intestinal tract or your urinary bladder or your skin , uh, that would be classified as a fistula

Speaker 2: 6:17

Holes where they shouldn't be. I like that can when two hollow things are connected, that shouldn't

Speaker 3: 6:21

Be. Yeah ,

Speaker 2: 6:22

That's it. And it is one of the complications of Crohn's disease. So people have intestinal problems living with Crohn's. What causes it?

Speaker 3: 6:30

The short answer is that it's, it's probably from a mistake by your immune system. And to put it very simply, your immune system's job as I think most of us understand, is to fight off infections. The first thing that your immune system has to do is distinguish between self and non-self. It's gotta be able to tell the difference between what's you and what's not you, so that it can leave the things that are you alone and go after the things that are not you. In Crohn's disease or ulcerative colitis or indeed any autoimmune disorder, there's a mistake at that first step and the immune system looks at something that is self determines that it is not self and goes after it. And, and that kicks in the inflammatory response of the immune system , uh, and, and we're off to the

Speaker 2: 7:19

Races. And hence that's why it's called inflammatory bowel disease. 'cause your own immune system in this case is attacking your own intestinal tract. That's

Speaker 3: 7:27

Correct.

Speaker 2: 7:27

Specifically, what kind of symptoms do people have?

Speaker 3: 7:30

So with Crohn's, the most common symptoms that people will present with is abdominal pain. And Dave, as you know, abdominal pain can be from a multitude of causes. Yeah.

Speaker 2: 7:39

That list of possibilities is dozens of things long, eh ? Yeah.

Speaker 3: 7:43

And , but, but that is the most common thing that we see , uh, uh, as a , an initial symptoms with , with Crohn's disease is abdominal pain, sometimes diarrhea, depending on what segment of the intestinal tract is affected by Crohn's disease. Um , but it is usually , uh, also painful equally

Speaker 2: 7:59

Present for all ages. Or do we see it in younger, middle age , older adults? Typically

Speaker 3: 8:04

People first present , uh, when they are younger. Uh, so we do see it in pediatric populations. Uh , we'll often see it , uh, presenting in people in their twenties and sometimes their thirties. The middle decades of life are , uh, are relative quiescent period for initial presentations with Crohn's disease. So if you , if you're going to get it, you're likely to get it before you're in your forties or fifties. It does seem that there's a second smaller , uh, uh, bump in presentation in the later decades of life. Um, uh, though that that bump is much smaller. So it , it is a disease that, that presents in young people.

Speaker 2: 8:41

And you said it's belly pain is the most common thing, abdominal pain, but you also said it can be all the way up in your mouth or your esophagus or your, your stomach for that matter. Why belly pain?

Speaker 3: 8:52

Well, I, I should say that the involvement of the upstream part of your intestinal tract, so mouth or or swallowing tube, esophagus or stomach, are very uncommon. So they , they do happen. But, but to have those things be the first symptom of Crohn's disease is , um, I would say vanishingly rare. Uh, so typically it does start farther down in the intestinal tract, in the abdominal cavity.

Speaker 2: 9:17

When should somebody seek attention? I guess that's a little backhand way to say, how is it diagnosed? I

Speaker 3: 9:23

I think it's important to remember that all of us get stomach aches every single one of us. Right?

Speaker 2: 9:27

Like a hundred percent of listeners are going, well, I got a , I got a stomach ache.

Speaker 3: 9:30

Yeah. And, and that, that's gonna happen to all of us. And, and I think that, that it is worthwhile to get an opinion from your provider if you have stomach pain that's not going away in a matter of, you know, a few days to a week , uh, or if it's different from something that you've experienced previously in your life. Most of us know what it , what our stomach aches feel like. Most of us know what we feel like when we get a , a stomach bug and, and, you know, get diarrhea or nausea or vomiting , uh, with some pain associated with that. Uh, so if it feels different to you or if it's lasting longer than it's lasted in the past, you should probably get that attended to

Speaker 2: 10:10

Family connections.

Speaker 3: 10:11

There is a family association with inflammatory bowel disease. So if you have a first degree relative with Crohn's or ulcerative colitis, it, it , uh, raises your risk by a factor of about two or three. So it's a pretty substantial , uh, increase in risk. Yeah, that's

Speaker 2: 10:26

Significant. Yeah.

Speaker 3: 10:27

Yeah. Uh , but, but you know, it's still a relatively uncommon thing. It's not the case that you've got a 50 or 60% chance. It's still less than 10%.

Speaker 2: 10:36

So Jake is Crohn's , uh, equally prevalent around the world, or do some countries and populations get it more often? It does

Speaker 3: 10:43

Seem that it affects some , um, populations more commonly than others. Uh, there is a theory that has been proposed loosely referred to as the hygiene hypothesis, which is that as countries go through industrialization and public health measures to make their environment , um, more clean and less the set by , uh, infectious problems, that , uh, they are more likely to experience autoimmune disorders of all sorts, including Crohn's disease and ulcerative colitis.

Speaker 2: 11:11

That's fascinating. I remember a guy in med school, he, he was always loathed to wash his hands. Don't worry. Uh, I don't think he's practicing anywhere or anybody, but, but he didn't wanna wash his hands 'cause he said, well, I'm gonna challenge my immune system. Now maybe he took it in a different direction. But that is a thing , um, uh, is to challenge your immune system. Like, like John Sweet said on this podcast, he's an allergist and he was among the allergy people who said, yeah, let your kids eat dirt. So, you know, <laugh>, the hygiene hypothesis is real. So when they go, people go into the doctor, how do you diagnose this ?

Speaker 3: 11:43

So typically what we look for initially when we're trying to diagnose either Crohn's disease or ulcerative colitis is some objective evidence that there's inflammation in the intestinal tract and to try to localize that inflammation if it is present. So usually that will involve either looking in their intestinal tract, typically with a colonoscopy or doing an imaging study , uh, either a CT scan or an MRI , uh, which , uh, are both superior to colonoscopy for looking at the small intestine. So often those, those two things, an imaging test and a colonoscopy are done together , um, to try to get a good view of the entire intestinal tract.

Speaker 2: 12:25

People maybe don't realize that, but your scopes as scar, long as they are, don't get all the way up into the small intestine, do they?

Speaker 3: 12:33

They don't. Or at least not very far into the small intestine. So with a, with a colonoscopy , uh, if we are , um, particularly aggressive about it, we can get, you know, a foot or , or thereabouts into the small intestine coming , uh, as it connects into the colon. And if we look from above , uh, we can get, you know, a foot or so beyond the stomach if, if there's a compelling reason to do so. But because of our limitations in, in the length of the scope and our ability to push into the small intestine, looking at the small intestine itself is, is typically better done with a non-invasive imaging study. Occasionally, if we see something on a non-invasive imaging study, or if our level of suspicion is so high and the non-invasive imaging study is not giving us an answer like an MR mri , like an MRI . Yeah . Um, if that's not giving us an answer, but we're really, really suspicious, occasionally we will do something called a capsule endoscopy, which is a , a commonly referred to as a pill cam. Um,

Speaker 2: 13:29

You swallow the camera?

Speaker 3: 13:30

Yeah. You swallow a pill, it's got a little camera on it and it, it travels through your intestinal tract and takes pictures and sends 'em to a little receiver that you wear on your belt because

Speaker 2: 13:40

Your small intestines a is a wee bit longer than people might realize. How long is it? Yeah,

Speaker 3: 13:45

Your small intestine somewhere between 15 and 20 feet

Speaker 2: 13:48

Long. And that pill camera makes it all the way through.

Speaker 3: 13:50

It does just like your food, same thing that , uh, propels your food through, propels the , the pill through. So we, we need to make sure your small intestine is empty so that we can see the , what , the walls with the camera. Right , right. But , uh, it'll just tumble through and, and it takes about 50,000 pictures on its journey. And then some poor slob named Jake gets to watch those picture .

Speaker 2: 14:10

You get to look at pictures . <laugh> , I was wondering who gets to look at 50,000 pictures of the inside of somebody's intestine? Yeah, it's,

Speaker 3: 14:16

It's, it's not one of the more exciting parts of my job

Speaker 2: 14:20

Before I leave Crohn's Disease. What kind of treatments are available for people?

Speaker 3: 14:24

So the treatments have actually , uh, are one of the success stories in , in , at least in the course of my career in medicine, I had nothing to do with this success. But, but we've seen a , a , an explosion of treatment options in Crohn's disease and ulcerative colitis in the last 15 to 20 years. In the olden days , uh, we would use steroids like prednisone and anti-inflammatory drugs. Um, the most common of those is a drug called mesalamine. And those were, I would say, disappointing in , in terms of how effective they were in treating the disease. And with regard to prednisone. Disappointing , uh, in terms of the side effects that it produced, side effects .

Speaker 2: 15:05

You say the olden days, that was literally when you and I were training. Yes.

Speaker 3: 15:09

I am sorry to break this to you, Dave, but we we are getting old .

Speaker 2: 15:13

We're we're getting older. Jake.

Speaker 3: 15:16

Um, uh, now, now though, in the modern era , uh, we have drugs that directly target specific aspects of the immune system's response and break the cycle of inflammation. Uh , there's actually a whole host of them now that are out there that can specifically target the steps in the immune system response that promulgate the inflammation in , in the intestinal tract.

Speaker 2: 15:39

It's one of those things in medicine that it is a true success story. These biologic medications, which people probably unfortunately are inundated with on the T but they are effective for the right patients with the , with the right diagnosis.

Speaker 3: 15:51

Yeah. In the , in the , in the appropriate setting. They are truly miraculous , uh, medications.

Speaker 2: 15:57

Okay, I think we've earned a break. We've tackled Crohn's disease and when we come back, we're gonna compare it to its other inflammatory bowel disease cousin, ulcerative colitis. Stay with us. We'll be right back.

Speaker 4: 16:11

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Speaker 2: 16:49

And we're back talking to Dr. Jake Matlock about inflammatory bowel disease and we're gonna get to ulcerative colitis. But Jake, before we do, I have to revisit the video capsule business you were talking about earlier, because I have questions. So a lot of people do. Dave <laugh> . So you'll swallow this thing and what happens to it? I mean, a lot of people are probably saying, like, seriously, what happens to the thing?

Speaker 3: 17:11

So just to be clear, the , the pill itself is the size of a large medication pill. It has a camera, a light source, a battery, and a radio transmitter. When you swallow it, it does the same thing that your food does. It travels through your intestinal tract . The difference being that it will take two pictures every second until the battery dies, which is usually eight to 12 hours later. So it will give us a, a movie basically that we can compile of the journey through your intestinal tract. Most of the time , um, the , uh, pictures of your small intestine , uh, cover about two to four hours of that movie. The rest of the movie is not very valuable. The light source is not bright enough and the camera , uh, focus is not good enough to see things far away. Like the walls of the stomach are just, that stomach is too big a room to take good pictures. The colon similarly is, is a large room. And so if you've got just a small light, you're not gonna see the walls very well. But the small intestine has a , as its name implies, has a fairly small caliber, fairly small diameter. And so we can see the walls pretty well with this capsule.

Speaker 2: 18:25

So does it keep taking pictures until you uh, until it ends up in the toilet?

Speaker 3: 18:30

Yeah, it keeps taking pictures until the battery dies, no matter where it is. Uh, it , it , now those pictures will only transmit to the receiver within a , a range of a few feet. So if, if it passes into the toilet and you walk outta the bathroom , uh, we are not gonna get pictures of your plumbing. Well, your house is plumbing. Um , I

Speaker 2: 18:50

Thought the whole point was to get pictures of your plumbing <laugh>.

Speaker 3: 18:53

Uh , but, but yeah, it does keep taking pictures , uh, the entire time.

Speaker 2: 18:57

And then I gotta ask you, what do you do with it? Do you, do you give it back? Do you reach into the toilet? I , this is sounding maybe more than people wanna know, but what do you do with it?

Speaker 3: 19:06

We always try to be very clear with people. We do not want the pill back <laugh>. Um , so , uh, most people actually don't even see it pass. Uh, there , there is a stool in the colon most of the time and, and the pill gets mixed in with the stool and they don't even see it. So it's

Speaker 2: 19:20

Like the Mars rover. They send the thing off there, sends pictures until it dies and we never see it again. This is hard hitting stuff that people want to know. Jake, I appreciate it, <laugh> .

Speaker 3: 19:29

It's a little known aspect of my job. Yeah,

Speaker 2: 19:32

Good grief. Okay, let's move on to ulcerative colitis. It's similar to Crohn's, but a little different. Explain it if you would please.

Speaker 3: 19:38

So ulcerative colitis affects only the colon. So only the large intestine, or last five or six feet of your intestinal tract are affected in ulcerative colitis. It tends to be a more superficial inflammation. Um , but again, I don't want to imply that that more superficial inflammation means it's less severe. The symptoms that are typically seen with ulcerative colitis are bleeding, diarrhea, urgency to have a bowel movement, sometimes pain, although pain is less of a common concern in ulcerative colitis than in Crohn's disease, it , it , it does happen, but it , it's typically the diarrhea and bleeding that, that bring people in.

Speaker 2: 20:18

Why is it even considered a second type of inflammatory bowel disease? Just simply because of the location? Is that pretty much it or is it caused by something different?

Speaker 3: 20:26

It's the location, the depth of invasion also is important. Yeah . Uh , you know, as we were talking about before with Crohn's disease, you worry about the formation of abscesses and fistulas, meaning, meaning inflammation that spreads all the way through the walls to start creating problems outside the walls or in things that are adjacent to the intestinal tract because the inflammation and ulcerative colitis is less deep in the walls. You don't see those problems with ulcerative

Speaker 2: 20:54

Colitis. And we talked about some treatments including medication treatments for, for Crohn's disease , uh, and many of them are similar for ulcerative colitis, but could you talk briefly about surgery? Is that needed?

Speaker 3: 21:05

Uh, that is the thing that we're trying very hard to avoid in both conditions. And , um, the, the types of surgeries involved , uh, if, if a person does need surgery are different. So in Crohn's disease, for example , uh, surgeries are reserved for the management of specific complications of the disease. So if you get an abscess , uh, antibiotics may not successfully treat that abscess. And so you mean may need an intervention or a procedure to drain it. Similarly, if you have an abnormal connection between two things that shouldn't be connected, occasionally medications will cause those connections to close or those fistulas to close, but if not, it sometimes is necessary to have surgery for that. In ulcerative colitis , uh, really the only indication that we have for surgery is inflammation that we simply can't control with medication. And in ulcerative colitis, for better or for worse, the only surgical solution is to remove the entire colon, which is a very large operation.

Speaker 2: 22:08

That's a big deal. Yeah, that's a big deal. What about the risk of other complications such as cancer? So that's an

Speaker 3: 22:15

Excellent question. Have any chronic inflammation of the colon can over a long period of time increase a person's risk of cancer? So if a person has ulcerative colitis or if they have Crohn's that specifically involves their colon, after about eight years of that , uh, inflammation, we start to see an increase in the risk of colon cancer in those people. And so typically, if a person has had ulcerative colitis or Crohn's disease involving their colon and they've had that disease for at least eight years, we do recommend that they have screening for colon cancer on a much more frequent basis, usually every one to two years.

Speaker 2: 22:56

Alright , we've covered Crohn's disease and ulcerative colitis, the basics. Let's get into a few different questions about these. If you could, could somebody have both ulcerative colitis and Crohn's?

Speaker 3: 23:05

So technically, no. Uh, if someone has inflammation in their colon when we first meet them and first detect that inflammation, we may be uncertain about whether that is ulcerative colitis or Crohn's disease that just happens to be limited to the colon. And, and in those circumstances, what we'll often say is that they have what's called undifferentiated colitis. Undifferentiated makes it sound like the disease hasn't made a decision, what it actually is that we haven't made a decision or we haven't figured it out yet. Fortunately, in undifferentiated colitis, the treatments are largely the same. Uh , the treatment options are largely the same. And by following someone over time and seeing what happens with the disease process, we can often make a determination of whether it is in fact Crohn's disease or ulcerative colitis.

Speaker 2: 23:55

Let's talk about what the future might hold. Uh , let's start with transplant. Is there ever a , a situation where organs get transplanted?

Speaker 3: 24:02

So I , I think when you're talking about the intestinal tract and you use the word transplant, you have to be careful to distinguish between organ transplant as you, as you mm-hmm , <affirmative> as you specified and stool transplant or fecal transplant.

Speaker 2: 24:15

Good distinction. So there's no organ transplants I take there,

Speaker 3: 24:18

There is not an organ transplant option for , uh, inflammatory bowel disease. Uh, there has been some edge therapy , uh, using stool transplant for , um, inflammatory bowel disease. So I , I wanna be careful to make it clear that this is something that is not in general use. It is, it is typically done as part of a research protocol, and only in cases where more traditional therapies have failed. A stool transplant is kind of what it sounds like. You take the actual stool or an isolate of stool from a healthy person and somehow get it into the intestinal tract of somebody with, with whatever condition you're trying to treat and how you get it there varies. Uh, you know , we used to do it by doing a colonoscopy and just spraying, spraying it , spraying it in. And now there are , are concentrates on the market that it , that come in a pill form, again, only available for through research protocols that can be used and just swallowed , uh, as, as much of an IIC factor as that is it , it is just a

Speaker 2: 25:22

Pill. Why would that work? I mean , uh, I know it's, it's relatively cutting edge and , and , and there's biologic medications that are highly effective for Crohn's disease and ulcerative colitis. Why would it even work at all if it's an autoimmune problem? It's an immune problem and an inflammatory problem, whereas a stool transplant is giving you the microbiome of somebody else.

Speaker 3: 25:43

Well, the theory, at least as I understand it, and again, this is fairly on the edge of our understanding, but as I understand it, the , the theory is that if you have some component of your microbiome, the creatures that live inside of all of us that look similar enough to you to self, to allow your immune system to mistake you for those things, then your immune system may make the mistake. And , and in trying to go after what it, whatever it is that's a part of your microbiome, it may go after you instead. And by getting rid of that, whatever that mysterious thing is, by replacing it with someone else's microbiome, you , you may get benefit. If it sounds like I'm hand waving , it's because I am. Because you are. Yeah . Uh , because we, we don't really understand how that works .

Speaker 2: 26:32

What about diet or other non-pharmacologic treatments?

Speaker 3: 26:36

So that's something that, that people will often ask about, and people are often given a lot of advice about diet by their providers, and if they have inflammatory bowel disease, what I would say is that, that the goal with treatment of inflammatory bowel disease is to get the inflammation under your under control so that you don't have to worry about your diet. As far as we know, they're not aspects of your diet that specifically drive the inflammation in inflammatory bowel disease. Now, I would emphasize as far as we know, because you know, there's obviously a lot of research and inquiry going on and trying to figure out whether that's true or not, but in general, if your inflammatory bowel disease is well controlled , you should be able to eat whatever you want. It is the case that when it's not well controlled, there will be foods that produce more symptoms than others. Now , it's not that those foods are making the disease worse, it's that the disease makes you more able to detect symptoms that those foods are gonna cause.

Speaker 2: 27:31

We've been talking with Dr. Jake Matlock, he's a gastroenterologist at Hennepin Healthcare, and we've been talking about inflammatory bowel disease. Before I let you go, Jake, what three tips would you like people to know about Crohn's disease and ulcerative colitis?

Speaker 3: 27:45

The first thing I would say is if you have stomach symptoms that you can't explain or are worried about, I would talk to your primary care provider before you talk to Google. Uh, if you get on Google, you're gonna find a lot of really frightening stories, and most of them aren't gonna be relevant to you. The second thing I would say is that if you are diagnosed with Crohn's or ulcerative colitis, don't panic. Uh, again, if you get on the internet and you start looking for stories about Crohn's and ulcerative colitis, you're gonna see the worst end of the spectrum. And there is a broad spectrum of, of natural history for both conditions, and most people do quite well. The third thing I would say is that if you have either Crohn's or ulcerative colitis, stay engaged with healthcare and, and continue to see both your primary care provider and probably your specialty provider, because our treatments are improving every year, they , they've gotten dramatically better in my career and I anticipate that they will continue to do so in the future.

Speaker 2: 28:44

Great tips from Jake about inflammatory bowel disease. Thanks for being on the show, Jake. It's

Speaker 3: 28:48

Always fun. Dave, we've

Speaker 2: 28:49

Been talking with Dr. Jake Matlock , gastroenterologist at Hennepin Healthcare. I hope you've picked up some tips from this show. It's been a great episode, and I hope you'll join us for our next show. And in the meantime, be healthy and be well.

Speaker 1: 29:01

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well .