Prevention Makes Perfect! A Dietary Approach for Reducing GI Disease
The CDC estimates that in 2012, 117 million Americans had one or more chronic health conditions, most of which involve problems with the gastrointestinal tract. An astounding 86% of health care spending was allocated toward treating chronic disease that year!
Gastrointestinal disorders afflict 60 million to 70 million Americans; reducing cases should be a top priority for health care professionals. Gastrointestinal symptoms range from annoyances to life-threatening diseases. Gas, bloating, vomiting, diarrhea and constipation may not kill a patient, but they affect quality of life. In extreme cases, a patient may plan daily activities based on locations of restrooms. Some miss days of work from these uncomfortable complications or multiple doctor visits. Meanwhile, Crohn’s disease, celiac disease, intestinal cancer and pancreatitis can cause incremental tissue damage that can kill a patient, if not treated in time.
Figure 1. Age-specific prevalence of Crohn’s disease per 100,000 persons in a commercially insured U.S. population, 2008-2009.
Crohn’s disease is a particular concern, affecting roughly 200 per 100,000 adults, with the incidence rising worldwide (Figure 1). The average hospitalization for a patient with Crohn’s disease in this country lasts 5.5 days and costs $10,639. What’s more, the disease is associated with a 30-day readmission rate as high as 19%, at a cost of more than $12,000 per return trip to the hospital (see article on page 21).
Given these grim numbers, gastroenterologists are right to be seeking strategies to reduce hospitalizations and readmissions for Crohn’s disease flares. And they have had some success. In a new study presented at the 2016 annual meeting of the American College of Gastroenterology, for example, Sigmon and colleagues developed a clinical note template to reduce readmission rates that led to a 21% reduction in such hospitalizations (abstract 384; Figure 2).
Figure 2. Readmissions for patients with Crohn’s disease dropped after intervention.
The template is promising, but diet appears to be an overlooked preventive measure. Food consumed influences the risk for developing Crohn’s disease, and speaking with a registered dietitian (RD) can help. Solving the monetary puzzle of treating Crohn’s disease may be as simple as speaking with an RD, because the average cost of a consultation is less than $200 a session. Furthermore, this cost may be covered by insurance.
Registered dietitians pass a national exam to earn their RD credential, and have a minimum of a bachelor’s degree in food and nutrition. They translate nutrition research into practical suggestions, develop custom menus to accommodate patient food preferences, and debunk nutrition myths promulgated by the media and online.
Gastroenterologists should combine forces with RDs to tackle the chronic disease epidemic plaguing American hospitals and outpatient centers. Malnourished GI patients, including those with Crohn’s disease, present an additional layer of complexity for physicians. By consulting an RD, a GI can focus on treating the patient without worrying about nutrition status. After conducting a full nutrition assessment, the nutrition professional will optimize a patient’s nutrition status by prescribing a treatment that may include selecting an optimal tube feeding formula, restricting specific foods or keeping the patient NPO (nothing by mouth) while using total parenteral nutrition in extreme cases.
Nutrition consultation conducted during an outpatient visit usually includes a full diet history, nutrient analysis, diet education regarding the patient’s diagnosis, and developing specific goals that the patient and dietitian create. Goals are revised and evaluated during the patient’s follow-up visit at a clinic.
Hippocrates famously said: “Let food be thy medicine and medicine be thy food.” But dietary treatment is underused for the prevention of chronic GI disease, and should be included in the physician’s toolbox of patient care. Consider employing an RD in practice to provide expert diet education for your patients.