Traveling with inflammatory bowel disease can be a challenge. An obvious issue: the need to know where the nearest toilet is at all times. But for some travelers with bowel ailments, flare-ups can prove a far more serious problem.

In a study presented at the 2019 annual meeting of the European Crohn’s and Colitis Organisation, Kay Greveson, RGN, MSc, the lead IBD nurse specialist at the Royal Free Hospital Centre for Gastroenterology and Hepatology, in London, and her colleagues found that 5% of nearly 2,500 patients surveyed in four countries said they had been admitted to the hospital while traveling abroad (abstract P332).

The risk for an emergency admission and other travel difficulties related to IBD led Ms. Greveson and her team to develop IBD Passport (www.ibdpassport.com), a “one-stop, evidence-based IBD and travel information website for clinicians and patients. Even though travel barriers are common, less than half of patients with IBD seek out advice before traveling,” she told Gastroenterology & Endoscopy News.

With more than 90,000 patients and 300 IBD centers registered through IBD Passport, Ms. Greveson hopes to give peace of mind to anxious travelers and increase the number of patients receiving appropriate medical treatment wherever they may go.

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The website—which, so far, has been translated to Hebrew and Chinese and is in the process of translation to German, Spanish and French—includes lists of IBD centers and practitioners in countries that have joined the site, as well as country-specific travel advice: Always pack sunscreen to protect from ultraviolet rays; some medications for IBD, such as azathioprine or mercaptopurine, can make skin more sensitive to the sun.

The website also includes other useful information, such as a link to the “Can’t Wait” card, Australia’s version of the American “Restroom Request Card,” which can be flashed at an establishment to quickly explain that a patient with IBD requires urgent use of a toilet.

IBD Passport is a “well-organized website that contains evidence-based recommendations,” but some topics are best discussed with a primary care provider or gastroenterologist, cautioned Jami Kinnucan, MD, an assistant professor of gastroenterology at the University of Michigan, in Ann Arbor.

“For example, some international travel destinations recommend or require live vaccinations, such as for yellow fever, but that might be contraindicated in IBD patients taking high doses of immunosuppressants, because of the increased risk of infection due to the vaccination,” Dr. Kinnucan said.

The Top 5 ‘Don’ts’ of IBD

Evidence-based best practices abound, but physicians, being human, sometimes stray from the recommended path. As the results of a recent survey of gastroenterologists in Italy show, clinicians there are concerned that their colleagues may be failing to optimally manage their patients with inflammatory bowel disease.

Marco Lenti, MD, from the Department of Internal Medicine at the University of Pavia, and his colleagues surveyed members of the Italian Group for the Study of IBD (IG-IBD) to find out which commonly used practices they believed gastroenterologists should question. The 101 respondents included GIs in academic and community practices, as well as a handful of surgeons and nurses who treat people with IBD.

Every respondent submitted five statements beginning with “Do not,” with each statement touching on a separate management strategy, procedure or treatment. The statements were reviewed and prioritized by a team of senior and junior members of the IG-IBD. Their top 10 recommendations were sent back to all respondents for another look and prioritization, who whittled down the list to five items.

What did they think was most important? Here are the top five “Don’ts,” as presented at the United European Gastroenterology Week 2019 (poster 367):

1.'Do not use corticosteroids for maintenance therapy, or without a clear indication.

2.'Do not forget venous thromboembolism prophylaxis in hospitalized patients with active disease.

3.'Do not treat perianal Crohn’s disease with biologics without prior surgical evaluation.

4.'Do not discontinue IBD-related medications during pregnancy unless specifically indicated.

5.'Do not delay surgery.

—David Wild

In these cases, she said, journey-bound patients should work with a provider to determine the best course of action, whether it be discontinuing high-dose immunosuppressive therapy for three months before vaccination, avoiding travel to that destination, or deciding that the risk for infection due to vaccination is tolerable.

Other IBD-specific travel considerations that a health care provider is best suited to help with include providing documentation for medications that require refrigeration while traveling or creating contingency plans in case of an acute disease flare, she said.

In addition to IBD Passport, Dr. Kinnucan said the Crohn’s and Colitis Foundation’s “Traveling With IBD” webpage is a good resource (crohnscolitisfoundation.org/ what-is-ibd/ traveling-with-ibd).

To add your center to the IBD Passport network, visit www.ibdpassport.com/ user/ register/ professional.

—David Wild