Tag: IBD

Have IBD and Insomnia? You’re Not Alone

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March 16, 2023 – More than one-third of people with inflammatory bowel disease report trouble sleeping, with moderate or worse insomnia. And the more severe their insomnia, the worse the disability related to their IBD, a new study finds.

Poor sleep is common with IBD, says lead researcher Alex Barnes, MD, a gastroenterologist and clinical lecturer at Flinders Medical Centre in Bedford Park, Australia.

The link between insomnia and IBD has not been studied enough, Barnes says. But insomnia in people with other chronic health conditions has been linked to a poorer quality of life.

Barnes and colleagues did an online survey of 670 people with IBD in Australia. They found that clinically significant insomnia was significantly tied to active IBD, belly pain, and significant anxiety and depression.

Diagnose and Treat

The study findings suggest people with IBD be screened for trouble with sleep, Barnes says. In the study, people had clinically significant insomnia if they scored a 14 or higher on the Insomnia Severity Index.

Once identified, “treatment for insomnia is readily available – cognitive behavioral therapy for insomnia – through psychologists or even in the form of smartphone applications,” Barnes says. Seeing a sleep specialist is another option and should be considered especially if someone has significant insomnia while their IBD is mild or in remission.

When to See a Sleep Specialist

Asked when insomnia might be serious enough for a person to see a sleep specialist, Jocelyn Cheng, MD, a spokesperson for the American Academy of Sleep Medicine, says the first step would be to confirm the person has insomnia. This means ruling out another cause of the symptoms, which could include sleep apnea, poor sleep hygiene, or restless legs syndrome.

Once insomnia is confirmed, it is important to decide if it significantly impacts a person’s quality of life. This can include attending fewer social- or work-related activities or having a hard time driving, making appointments, or running errands, for example.

If no other reason can be found for the insomnia, or if your quality of life is significantly impacted, a sleep expert is a good idea, says Cheng, who is also senior director of clinical research-neuroscience at Eisai Inc.

The finding in the study that more severe insomnia – more trouble falling asleep, staying asleep and/or waking up too early – is linked to worse IBD symptoms aligns with evidence from other studies, Cheng says.

Insomnia could be a learned behavior from when people with IBD have flares and have trouble sleeping that gets carried over to times when IBD is in remission, Barnes says.

Multiple tools to identify insomnia exist, Barnes says, and it would be worthwhile to come up with one specific to IBD in the future.

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March 16, 2023
‘Gut on a Chip’: New Tech a Big Step Forward for Gut Health

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March 9, 2023 – From TikTok to kombucha tea, gut health is having a moment – after we’ve already been hearing about it for years. Rightly so.

Your gut – and its diverse mix of bacteria known as the microbiome – is no longer just about digestion. Gut “health” is also linked to the health of your heart, brain, immune system, and more.

The problem: Much about what’s going in in there and what bacteria populate it at what levels – and how to interpret it all – remains a mystery. Studying the gut is tricky. Animal research may not be useful, because animals have different digestive enzymes and gut bacteria than humans do. And typical lab tests, like growing cells in a petri dish, don’t capture how complex the gut is, a part of the body where many types of cells grow and interact in a moist, flowing, oxygen-free environment.

An emerging technology, called “gut on a chip,” promises to change all that, opening the door to experiments never before possible and promising to advance medical research, according to a new paper in APL Bioengineering.

Your Gut on a Chip

It’s among the latest advances in “organ on a chip” technology, the concept of putting human cells in a device designed to mimic the activity of human organs. Scientists have developed models to simulate such organs as the lung, kidney, and vagina.

To build a gut on a chip, scientists culture cells from gut tissue and bacteria.

“These cells don’t grow easily,” says study author Amin Valiei, PhD, a post-doctoral scholar at the University of California, Berkeley. “They need a specific environment.”

To create that environment, researchers put the cells inside tiny channels designed to allow the flow of fluids and mimic forces found in the gut. That means the cells can interact with each other as they would inside the human body.

“These models are getting more and more advanced,” says Valiei. “Compared to a couple years ago, we now have models that can accommodate a few types of cells.”

Why This Matters: Drugs, Disease, and Dysbiosis

Researchers can do experiments on the models that would be difficult or impossible in humans.

“These devices could be especially useful in the hypothesis stage to test new drugs and therapeutics,” says Valiei.

Valiei and his colleagues at UC Berkeley’s Molecular Cell Biomechanics Lab are studying how different bacterial species interact in these gut-chip models. In particular, they’re exploring how certain harmful bacteria can take hold in the gut – a phenomenon known as dysbiosis that’s linked to a range of conditions like inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), diabetes, obesity, cancer, and heart problems.

Researchers are also using gut-on-a-chip models to study IBD, colorectal cancer, and even the effects of viruses like COVID-19 on gut function.

To understand how diseases develop, we need to break things down into fundamental steps, and gut-on-a-chip models could help researchers do that, says Christopher Chang, MD, PhD, a gastroenterologist at the Raymond G. Murphy VA Medical Center in Albuquerque, NM, and the University of New Mexico. (Chang was not involved in the study.)

“We can identify literally thousands of species in the gut, and we sort of know, in broad strokes, what microbes are considered beneficial, and what microbes are considered not beneficial,” he says.

But how do individual bugs fit into a community? And what combinations lead to a healthy gut versus an unhealthy one? Answers to these questions remain unclear.

“We have ways to manipulate the microbiome, through different antibiotics, probiotics, and fecal microbiota transplants,” Chang says. “But we need to know: What should we be manipulating?”

Room for Improvement

One part of the gut not yet reflected in gut chip models is the enteric nervous system, aka our “second brain” – neurons embedded in the GI tract, says Chang. This is how the gut and brain communicate, and its dysfunction is linked to bowel disorders such as IBS.

People with IBS can have pain, diarrhea, or constipation even though their gut tissue looks normal on biopsies. Gut-on-a-chip models might be less helpful in revealing insights about these disorders, though they could still help answer fundamental questions.

The gut-brain connection is still being clarified, so as the science evolves, researchers may be able to add new insights to future gut-on-a-chip models.

Gut-on-a-chip models could be useful beyond disease, too, says Valiei. Any medication you swallow goes through your GI tract. If researchers can use gut-on-a-chip models to uncover precisely how we digest and absorb medications, they might be able to refine how we use these drugs.

For now, the push is on to get this tech into widespread use. Because of the need to do more research, refine the tech, and gather enough data to satisfy regulators, it may still be several years until this kind “precision” medicine will be precise enough to truly personalize its use for patients. But according to Valiei, this is indeed an accurate glimpse of what’s to come.

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March 9, 2023
What People Don’t Understand About Crohn’s Disease

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By McKenna Plant, as told to Barbara Brody

I started having Crohn’s disease symptoms when I was 15 and was formally diagnosed about a year later. In a way, I was lucky: Many people wait years before getting the right diagnosis, but I got a jump-start because my father has ulcerative colitis, another form of inflammatory bowel disease (IBD). He rarely talked about it when I was younger — I don’t think I even heard the words “ulcerative colitis” or “inflammatory bowel disease” until I started having symptoms myself, but once I did, he opened up and became my advocate.

In the years since — I’m 29 now — I’ve had a rough ride. One of the hardest things about living with IBD is the unpredictability. One day you could be feeling great and the next you’re curled up in a ball. I’ve found that connecting with others with IBD is immensely helpful. I was initially reluctant to join support groups because I thought that they were only for old people or those who wanted to sit around commiserating about their problems. But after I gave them a try I realized that it’s a relief to be able to open up in a safe space. I’ve also spent a lot of time on Instagram engaging with people who are really vocal about their experience with IBD or just chronic illness in general.

Over the years as I built my IBD tribe — which now also includes my fiancé, who has ulcerative colitis — I’ve become empowered to advocate for people with IBD. I started volunteering with the Crohn’s & Colitis Foundation when I was a teenager. When I graduated from college, I joined the staff that manages Camp Oasis, the foundation’s residential summer camp for kids with IBD. I also frequently speak at fundraising events. I truly hope that by sharing my journey I’m encouraging others to share theirs.

Talking about IBD isn’t easy. It’s not a glamorous illness, and discussing your intestines and bathroom habits can be embarrassing. But I believe it’s the best way to get the support you need while educating others. There are so many misconceptions about IBD, and it’s helpful for those who have it as well as those who don’t to learn the facts. Some misconceptions I try to dispel:

“If you don’t look sick, you can’t be that sick.”

This is a big one for anyone with an invisible illness. I look like a young, healthy, active person, but that doesn’t mean my body isn’t attacking me on the inside.

“You’d feel better if you just ate healthier.”

I wish it were that simple! Crohn’s is a chronic autoimmune ailment, and when I’m in a flare I won’t go near a vegetable. My body can’t even digest a piece of lettuce at that point.

“It’s not a big deal; I have IBS.”

IBD sounds a heck of a lot like IBS (irritable bowel syndrome), but they’re totally different. I fully understand that some people with IBS feel lousy, but it’s not the same thing as having an autoimmune condition. It’s not unusual for people with Crohn’s to develop serious complications including abscesses, bowel obstruction, and fistulas, which is when the body forms a tunnel that connects the intestines to nearby organs or tissue.

I have a fairly severe case of Crohn’s, and I’ve already had to have two surgeries: one that entailed removing about 10 inches of my small intestine and another to create a permanent ostomy, which allows stool to exit my body though an opening (stoma) on my stomach and into an external ostomy bag.

“Just take your medicine and you’ll be fine.”

Even the strongest IBD medications on the market (I get two via infusion every 4 weeks) don’t work for everyone. And sometimes a drug that initially works for you stops working. That’s really scary as a patient because you’re worried you’re going to run out of options. It’s also why fundraising is so important; we need new treatments so that everyone with IBD can get the help they need.

“Getting an ostomy will ruin your life.”

I got my ostomy about 4 years ago, and I wish I had done it sooner! Before I had my ostomy I was constantly worried about where the closest bathroom was. I always kept an emergency kit in my car with an extra pair of underwear, pants, and toilet paper. Do you know how embarrassing it is for a 20-something person to have an accident? You feel like you never want to go out in public again and just want to isolate yourself. Now I can go for a run or take a road trip without being paralyzed with fear.

“It’s better to keep Crohn’s to yourself.”

I know how hard it can be to talk about having IBD, but staying silent is stressful. If you’re able to open up to friends, family, and co-workers, you’ll feel so much better because you won’t have to worry about hiding it. Sharing your story and letting others know what you’re going through also has the potential to make life better for everyone with IBD. I once got into a fight with a flight attendant because I was in the middle of a flare and desperate to use the bathroom as the plane was about to take off. If he had understood more about IBD, he would have known that waiting until the plane reached cruising altitude was not an option.

Talking about IBD is also key to influencing legislators who have the power to enact laws that help you get the best care. Right now many insurance companies require that you try a series of cheaper treatments that don’t help before they’ll pay for more expensive options like biologic drugs. This process, known as “step therapy” or “fail first,” puts us at risk by delaying the right treatment, which can be dangerous.

Many states have recently passed step therapy reform acts, and I’m hoping that California — where I live — will soon join them. I’m also optimistic that federal legislation called the Safe Step Act will be passed in the not-too-distant future.

I hope that by talking to lawmakers, which I’ve done during various advocacy events, they’ll gain a better understanding of why these changes are so important. It’s a pretty amazing feeling to realize that simply sharing your story has the power to impact change on a local and federal level and will have lasting benefits for the IBD community.

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October 20, 2022