Travel Health and Pretravel Preparation in the Patient With Inflammatory Bowel Disease

by Anil Golani on  June 23, 2015 at 4:13 PM Health In Focus   - G J E 4
Travel related morbidity is high in foreign travel for people with IBD. A study published in Frontline Gastroenterology found that not many IBD patients seek information for travel-associated risks. Several healthcare providers also are not confident enough in providing this information.
 Travel Health and Pretravel Preparation in the Patient With Inflammatory Bowel Disease
Travel Health and Pretravel Preparation in the Patient With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) refers to chronic inflammation of all or a part of digestive tract. The most common IBD conditions are ulcerative colitis and Crohn's disease. In Crohn's disease (CD), the inflammation affects entire digestive tract, whereas in ulcerative colitis (UC), only the large intestine is affected. Both the conditions affect quality of life and cause severe diarrhea, abdominal pain, fatigue and weight loss.

In the US, as per current estimates about 1-1.3 million people suffer from IBD. UC is slightly more common in males, while CD is more frequent in females.

A study surveyed 132 IBD patients which included 67 patients with Crohn's disease and 65 patients with ulcerative colitis. It revealed that most patients were affected during travel owing to IBD. However, only around 23% patients actually contacted their physicians for pre-travel advice. Nearly half of the patients who were taking immunomodulator therapy (drugs that affect immunity) were not aware of any need of avoiding live vaccines. To make matters worse, only 40% patients had travel insurance.

The study also obtained responses to questionnaires from health care providers. They found around 27% of health care providers were not confident in providing travel-related information to patients of IBD. Aspects that most healthcare providers were unsure of were related to vaccination, healthcare insurance and healthcare abroad.

The study thus emphasizes the need for greater IBD-specific travel education and awareness for both patients with IBD and healthcare professionals dealing with these patients.

Preparing for Travel with IBD

Traveling with IBD can be daunting task. A change in climate, water, or food can upset bowels. But, with careful planning and seeking professional advice would ease out and make travel possible to most places.

Locating a doctor: Ask your doctor for names of physician in cities you plan to travel to.

Insurance: Insurance should be taken if traveling to countries that do not have healthcare agreements with your country. Check with your insurance carrier if it covers foreign travel, as well as previously diagnosed chronic conditions.

Vaccination: For IBD patients on drugs that can weaken immune system, live vaccination should be avoided. However, an appropriate letter needs to be sought from your doctor regarding avoiding vaccination.

  • Enough prescription drugs should be carried as filling prescription abroad can be complicated.
  • If traveling by air, always carry your medication on the plane.
  • Keep your medicines in their original containers. Carry enough medicines for entire trip.
  • If traveling to malaria-prone area, anti-malaria medication needs to be taken. Anti-malaria medicines can affect IBD, so a specialist has to be consulted before their use.
  • Typed statement from physician that describes your medical history and drugs being taken should be sought to avoid hassles in a foreign country.
  • Copies of prescriptions, including foreign brand names or generic names have to be sought.

Transport: If traveling by air, a long flight can upset bowels as cabin air is very dry. Therefore taking an anti-diarrhoeal beforehand can be considered and alcohol and caffeine need to be avoided, so as to prevent dehydration.

Traveling with Stoma: If ileostomy or colostomy has been done recently, then ample of stoma supplies need to be taken.

Emergency travel kit: Packing an emergency kit or first aid box is useful for any accident during travel.

Keep your doctor's phone number and insurance card in your wallet so that you can access them at all times.

Dehydration: Hot weather can make you dehydrated. Drink plenty of non-alcoholic liquids (at least 8-10 average glasses) to eliminate dehydration.

Exposure to sun: Protection from sun is important if you are on immunosuppressive drugs such as azathioprine, mercaptopurine and methotrexate for IBD treatment. Include high sun screen protector (SPF 25 or above) for protection.

Avoid traveler's diarrhea:

Take the following steps during your trip to avoid traveler's diarrhea.
  • Drink boiled water than normal water.
  • Use bottled mineral water even to brush your teeth.
  • Do not swallow water when swimming in fresh water, swimming pools as they may be polluted.
  • Avoid non-carbonated beverages such as iced tea and fresh juices.

Avoid: ice and ice-cream, raw vegetables and salads, raw or uncooked meat, fish, or shellfish, uncooked dairy foods (unless confirmed for pasteurization and sterility), food from vendor carts, prepared food (potato salad and canapés), and food that is allowed to sit at room temperature.

Peel all fruits and egg shells completely by self.

Source: Medindia

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