In this video, Dr. Kane discusses her presentation at the Advances in Inflammatory Bowel Diseases virtual 2020 meeting on managing mild to moderate inflammatory bowel disease with medication, nutrition, and lifestyle changes.

Sunanda Kane, MD, is a professor of medicine at the Mayo Clinic in Rochester, Minnesota.

TRANSCRIPT

Hi, I'm Dr. Susie Kane, professor of medicine at Mayo Clinic in Rochester, Minnesota. As part of the advances in IBD 2020, which will be virtual this year, I will be giving a short presentation on the approach to the mild-to-moderate IBD patient.

That's a little tricky because most of us don't think of patients having mild disease. It's moderate to severe or even hospitalized patients to complicated patients, but there are patients out there that are mild to moderate.

Just some quick highlights and takeaway points: for ulcerative colitis, the newest guidelines include calprotectin as a noninvasive marker to help define what mild to moderate to severe disease is. We talk about disease activity as the here and now, and that disease severity is prognosis.

There's now a little bit of a mindset that those 2 terms are not interchangeable, so it's worth understanding that that's where the science is headed. We talk about mucosal healing as being the goal, which certainly, it is very important for Crohn's disease. How much for ulcerative colitis is still a little under debate. We are not at the point of histologic healing yet. 5-ASAs are still the cornerstone for treatment for mild to even moderate ulcerative colitis, for both induction and for maintenance. Those are the top takeaway points for ulcerative colitis, pretty simple.

For Crohn's disease, it's a little bit more difficult only because, again, we have to think about Crohn's as being fibrostenotic, inflammatory, or fistulizing. Certainly, a fistulizing patient would not have mild disease, pretty much by definition.

Who is the mild patient? It might be one who has very minimal inflammatory changes of the terminal ileum. What do you do for that patient? It's chronic inflammation under the microscope, but they don't have that many symptoms that you feel pressed to give them a biologic.

For the mild to moderate patient, the budesonide courses of that, for disease that our self-limited courses are certainly appropriate for the right patient, FDA-approved. What about methotrexate and azathioprine? Probably underused in terms of a mild disease, but certainly, that's all we had before biologics and still have a role for some of these patients.

There's certainly, for the patient who has very mild disease, a role for diet. We think that perhaps an anti-inflammatory diet, like the Mediterranean diet, maybe enough to control disease. For a patient who has mild disease, it might be enough to make sure that they quit smoking, that they are avoiding NSAIDs, and that if they have depression, that is getting treated.

Again, that these are all things that just exacerbate some very mild symptoms. For the mild to moderate patient, we can be somewhat more thoughtful from a medical standpoint than from a gastrointestinal one.