Bill Snyder, Carol Poston, and Meredith Carr
Two recent innovations — point-of-care intestinal ultrasound and functional medicine — are improving the lives of patients at the Vanderbilt Inflammatory Bowel Disease (IBD) Clinic at Vanderbilt Health One Hundred Oaks.
Characterized by chronic inflammation of the gastrointestinal tract, IBD is a group of disorders that includes Crohn’s disease and ulcerative colitis. While the exact cause of IBD is not known, heredity and certain genetic mutations are thought to play a role, and lifestyle factors, such as smoking, can aggravate symptoms.
Upper endoscopy and colonoscopy are used to diagnose IBD, and treatment focuses on reducing inflammation. Endoscopy, along with CT and MRI, also is used to monitor the response of patients to anti-inflammatory and other therapies.
Recently Baldeep Pabla, MD, MSCI, assistant professor of Medicine, David Schwartz, MD, director of the Vanderbilt IBD Clinic, and their colleagues in the Division of Gastroenterology, Hepatology and Nutrition evaluated point-of-care intestinal ultrasound as a less-invasive and more efficient alternative to regular endoscopy screening.
Point-of-care ultrasonography is performed by a physician at the bedside and can quickly and accurately diagnose a wide range of medical conditions. The treating physician obtains and interprets these images synchronously, allowing for real time decision-making that can advance the patient’s treatment plan without delay.
In an abstract published last year in the journal Gastroenterology, Pabla, Schwartz and their colleagues reported that point-of-care intestinal ultrasound “is an accurate and fast tool for assessing disease activity at the point of care in adult patients with IBD.”
All exams of the 102 patients in the study took less than 10 minutes and did not interrupt the clinic’s patient flow. “We acquire the images, interpret them and make treatment decisions all within one visit; that’s a really unique way to measure and monitor inflammation,” Pabla said.
“Since patients with IBD have ebbs and flows in their inflammation, a patient-friendly, accurate means of detecting and monitoring this is the name of the game, and ultrasound is a viable way to accomplish that,” he added.
Functional medicine is another innovation that can improve the quality of life for patients with IBD. This holistic, patient-centered approach to the management of chronic diseases considers a host of potential genetic, environmental and lifestyle factors that may trigger or aggravate symptoms.
“The nature of digestive issues works well as an entry point for the functional medicine approach,” said Dawn Beaulieu, MD, professor of Medicine, who introduced functional medicine to the Vanderbilt IBD Clinic in 2019.
“Even when patients’ colonoscopies showed that they were better on medications, many were reporting they still had diarrhea or abdominal pain, or that fatigue or joint pain were still affecting their quality of life,” she said. “I needed to find a way to do more to help patients feel better.”
Certified through the Institute of Functional Medicine, Beaulieu created a program that identifies triggers such as diet, stress and allergens, and which helps patients develop symptom-relieving strategies in all realms of their lives, including exercise, sleep and social relationships.
“Our goal is to help the patient create a plan to take control of their life,” she said.
Schwartz holds the McClain Family Directorship in Gastroenterology. A professor of Medicine, he also directs the Endoscopy Lab at Vanderbilt Health One Hundred Oaks.
Beaulieu also is a co-author of the point-of-care intestinal ultrasound abstract, along with Seema Kumar, MD, Elizabeth Scoville, MD, MSCI, Robin Dalal, MD, Sara Horst, MD, MPH, and James Slaughter, DrPH.
Others from VUMC who participated in the functional medicine studies were Thomas Strobel, MD, Amy Motley, Spencer Upadhyaya, RD, Emily Spring, PA, and Sarah Campbell, LCSW.
