The IBD Prehabilitation Program, pioneered at Cedars-Sinai, has significantly enhanced surgical outcomes and reduced complications for patients with the digestive disease.

Gil Melmed, MD, director of Inflammatory Bowel Disease Clinical Research, led the development of the multidisciplinary program and is eager to study its effectiveness in healthcare systems serving patient populations where English is not the primary language.

“We don’t know if the positive outcomes from the program are specific to our local environment and patient population or if they also have wider application,” Melmed said. “This generous grant from the Helmsley Charitable Trust enables us to expand the IBD prehabilitation protocols to a completely different environment and to patient populations in an international setting.”

Cedars-Sinai will partner with Sheba Medical Center through its ARC innovation center, along with two additional Israeli hospitals, to establish prehabilitation programs for IBD patients in need of surgery.

The 10-week program involves comprehensive care starting a month before surgery. Patients receive tailored dietary, mental health and physical therapy interventions both before and after their procedures.

“We have found that people participating in the program experienced a significant reduction in complications after surgery, as well as a reduction in 30-day readmissions and repeated surgery. They also required less opioid medication for pain,” said Melmed, who is also the associate director of the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai.

An estimated 3 million people in the U.S. have inflammatory bowel disease, according to the Centers for Disease Control and Prevention. Worldwide, the Crohn’s & Colitis Foundation estimates that about 10 million people are living with IBD. The disorder produces chronic and often destructive inflammation in the digestive tract. The two most common forms of IBD are Crohn’s disease and ulcerative colitis, with Crohn’s disease patients generally requiring abdominal surgery at least once in their lifetime.

“As part of the grant, we will develop patient materials in multiple languages, including English, Spanish, Arabic and Hebrew. If successful, we hope to expand to other countries to share this approach to meaningful improvement in health outcomes for people who require surgery to manage their disease,” Melmed said.

In 2022, the Helmsley Charitable Trust awarded Cedars-Sinai $1.25 million for initial development of the IBD prehabilitation program aimed at optimizing care and improving surgical outcomes and the overall health of patients undergoing major abdominal surgery.

Read more from Cedars-Sinai Stories and Insights: Is It IBS or IBD?

Pimentel points out that the days between Thanksgiving and New Year’s are among the riskiest for food poisoning, especially as large meals, buffets and leftovers become part of the festivities. Each year, about 48 million Americans—roughly 1 in 6—get sick from foodborne illnesses, leading to an estimated 128,000 hospitalizations and 3,000 deaths, according to the Centers for Disease Control and Prevention.

Pimentel and Cedars-Sinai clinical dietitian Albert Abayev, RD, who works with patients undergoing weight loss surgery and general surgery, serve up answers to common holiday food safety questions.

What new insights have emerged in recent years about food poisoning—its causes, risks and prevention?

Pimentel: Foodborne illness continues to result from contamination with bacteria such as E. coli, Salmonella, Shigella or Campylobacter jejuni. Improper handling remains a major source of contamination. Foods left out for hours—common during buffets and large gatherings—create ideal conditions for bacterial growth.

Abayev: Many holiday-related food safety issues stem from outdated traditions or rushed environments. Long stretches of food left out on counters, undercooked poultry or stuffing, crowding the refrigerator, thawing meats on the counter, and multitasking that can lead to cross contamination are among the most frequent problems.

How long does it take to get food poisoning—and is the last meal always to blame?

Pimentel: Symptoms do not always appear immediately. Certain infections may take up to 48 hours to incubate. When determining the likely source, consider foods eaten in the prior two days and whether others who shared them also became ill.

How long does food poisoning usually last—and is it contagious?

Pimentel: Most cases resolve within a few days. E. coli often clears quickly, while Salmonella and Campylobacter may last a week or longer. Foodborne illness is not contagious like a virus, but contamination can occur if a sick person prepares food for others. Those with any symptoms should avoid preparing meals until fully recovered.

What are the biggest food safety mistakes people make in holiday kitchens?

Abayev: Allowing food to sit at room temperature for extended periods is the most common issue. Once food has been out for more than two hours, bacteria grow quickly. Undercooking turkey, stuffing and casseroles is another frequent problem; all dishes should reach 165 degrees Fahrenheit. Cross contamination, refrigerator overcrowding and improper thawing also add to the risk.

How reliable are the 'smell test' or 'eye test' when judging leftovers, and how long do leftovers stay safe?

Abayev: Appearance and smell are not reliable indicators of safety. Many harmful bacteria do not alter a food’s odor or color. Leftovers should be refrigerated within two hours, used within three to four days and reheated to 165 degrees. Also, freezing the food preserves quality for several months.

How should people with digestive conditions—or those using GLP-1 medications for weight loss—approach holiday meals safely?

Pimentel: Individuals with irritable bowel syndrome, inflammatory bowel disease or other chronic gastrointestinal conditions are more susceptible to foodborne illness, and an infection can worsen symptoms or trigger flares. Careful food handling, thorough cooking and choosing low-risk foods are especially important.

Abayev: GLP-1 users on weight management programs may experience slower stomach emptying, making heavy holiday foods more likely to cause discomfort. Smaller portions, slower eating, prioritizing protein and staying upright after meals can help. Because food remains in the stomach longer, contamination may result in stronger symptoms.

What should people do to recover from food poisoning?

Pimentel: Recovery starts with hydration. Small, frequent sips of water, electrolyte drinks or broth help replace losses. Bland foods like toast, rice, bananas or broth-based soups can be added as symptoms improve. Medical care is appropriate if symptoms last more than a couple of days or if there is high fever, blood in the stool or signs of dehydration.

What is one of the biggest food safety concerns this year?

Pimentel: Improved monitoring has reduced contamination in meat but produce now poses growing concern. Field conditions may limit workers’ access to proper hygiene, and many vegetables are eaten raw, eliminating the safety benefit of cooking.

What is the most important takeaway for holiday hosts and guests?

Abayev: Temperature control is the foundation of food safety. Hot foods should stay hot, cold foods should stay cold and leftovers should be refrigerated promptly.

Pimentel: Better safe than sorry; no one wants a side of food poisoning with their holiday meal.

Read more on the Cedars-Sinai Blog: Weight-Loss Drugs—What to Know Now

“In the morning, we will host a clinician track on best practices for treating women with IBD,” Khanna said. “In the afternoon, patients and families are invited to a dedicated session covering pregnancy, fertility, nutrition, mental health and more. There is also time for patients and providers to connect.”

An estimated 3 million people in the U.S. have inflammatory bowel disease, according to the Centers for Disease Control and Prevention. The disorder produces chronic and often destructive inflammation in the digestive tract. The two most common forms of IBD are Crohn’s disease and ulcerative colitis. While some cases can be mild and manageable, many IBD patients are faced with a constellation of health problems including severe diarrhea, malnutrition, dangerous blood clots, and extensive and painful scarring.

IBD occurs in men and women at about the same rate, but the disease can leave women facing unique health challenges. There can be difficult decisions about proceeding with certain drug therapies while trying to conceive or during pregnancy and menopause. 

“For women living with IBD, simply knowing that their needs are recognized and that there is a community and program designed for them can be incredibly empowering,” Khanna said.

The Cedars-Sinai Newsroom interviewed Khanna about how IBD impacts the health and wellbeing of women, including finding a good healthcare provider and effective therapies available to them.

In what ways can IBD impact women and men differently?

While inflammatory bowel disease occurs at about the same rate in both sexes, women often present differently. After age 30, Crohn’s disease is more common in women than in men. We also see sex-specific patterns: Women are more likely to have Crohn’s limited to the colon, less extensive ulcerative colitis, and more frequent extraintestinal conditions, such as eye inflammation and skin disorders. Recognizing these differences is critical for timely diagnosis and effective management.

Are there differences in diagnosis, disease course or treatment protocols for women?

The diagnostic workup for IBD is the same regardless of sex and typically involves colonoscopy, imaging, lab testing. However, the course of the illness can vary. Women may experience flares around hormonal changes, such as those occurring during menstruation or pregnancy.

Treatment approaches are generally the same for men and women, but side effects can differ. For example, women are more likely to develop drug-induced lupus with certain biologic therapies. Providers must stay alert to sex-based responses to various treatments for IBD. For women of childbearing age, therapy selection must consider whether a medication is safe in pregnancy. Most of them are, but not all.

Does IBD impact a woman’s reproductive life, including menstruation, fertility and pregnancy?

Absolutely. Many women report worsening symptoms during menstruation due to hormone fluctuations. Fertility can be reduced in women with active inflammation or prior pelvic surgery, although more research is needed on that front. Pregnancy outcomes are best when disease is in remission for at least three to six months before conception. Interestingly, we have found that some women with IBD may actually experience improvement in symptoms during pregnancy.

Most IBD medications can be safely continued during pregnancy, particularly when the disease is under control. Methotrexate, an immunosuppressant medication, should be avoided. There are other classes of medications, such as JAK inhibitors, whose safety and use should be discussed with your provider. At Cedars-Sinai, our IBD Pregnancy and Fertility Clinic brings gastroenterology and obstetrics together so women receive coordinated care.

Do women find it challenging to get an accurate IBD diagnosis? What advice would you offer?

Many women do face delays. They may see multiple providers before reaching a gastroenterologist who recognizes their symptoms as inflammatory bowel disease. My advice is to advocate for yourself. If you are not being heard, seek a second opinion, ideally at a dedicated IBD center. A colonoscopy and appropriate testing are essential to confirm the condition.

How do IBD patients benefit from a multidisciplinary approach to care?

One young woman in her 20s came to me after years of aggressive Crohn’s disease. She had seen specialists across the country, endured multiple treatments, and was facing another surgery. She broke down in tears, telling me she felt abandoned by her doctors. I reassured her and then brought her case to our weekly IBD meeting where top experts could collaborate on her care. That sense of not being given up on, and of building a trusted partnership with a care team, can be life-changing for patients living with a chronic illness.

The Women and IBD conference will take place at Cedars-Sinai on Saturday, Sept. 13. Attendance is free but registration is required. Those interested in attending can email groupibdwomensprogram@cshs.org to register and receive more information.

Read more on the Cedars-Sinai Blog: A Good Grip on Crohn’s Disease

The results of the representative study are published in the journal Gastroenterology.

“This new study is among the largest population-based evaluations of IBS epidemiology. The results reveal that the condition is more prevalent than previously thought and varies by race and ethnicity,” said the study’s corresponding author, Brennan Spiegel, MD, MSHS, director of Health Services Research and the Dorothy and George Gourrich Chair in Digital Health Ethics at Cedars-Sinai.

In May and June of 2020, investigators conducted online surveys of adults age 18 and older. A large cross section of people living in the U.S. were asked to complete the Rome IV IBS questionnaire and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) survey to assess the presence and severity of their gastrointestinal symptoms.

“We wanted to update our understanding of how common IBS is in the U.S. and to get a sense of the associated burden of the illness. Because diagnosis is symptom-based, we used the Rome IV validated IBS questionnaire to survey respondents about their abdominal pain and changes in bowel habits. We also used the PROMIS survey to see what other symptoms they were experiencing,” said gastroenterologist and co-first author of the study Christopher Almario, MD, MSHPM, who is also an assistant professor of Medicine at Cedars-Sinai.

In addition to the significant size of the study cohort, investigators point out there have been few large-scale studies looking at racial and ethnic differences in IBS.

“Our findings showed that non-Hispanic Black people, Hispanics and non-Hispanic Asian people all were less likely to have IBS when compared to non-Hispanic white people,” said Almario.

“But some of the non-white participants who did have IBS experienced more severe symptoms. For example, Hispanics and non-Hispanic Black people with a form of IBS where diarrhea is common had more severe belly pain than their non-Hispanic white counterparts,” said Almario.

Since the prevalence of IBS appears to be on the rise, Almario suggests physicians may be seeing more patients with associated symptoms in their clinics.

“In addition to abdominal pain and changes in bowel habits, patients with IBS may experience bloating, excess gas and heartburn. It is important for healthcare providers to take a thorough patient history in order to identify and manage these treatable symptoms,” said Almario.

According to the study authors, the COVID-19 pandemic may have played a role in the increased prevalence of IBS, and they are performing additional data analysis to examine the potential connection.

“It is possible that both direct infection with the virus that causes COVID-19 and the psychological stress associated with living through a pandemic contributed to the rise in IBS prevalence through a number of mechanisms worthy of further investigation,” said Spiegel.

DOI: https://doi.org/10.1053/j.gastro.2023.08.010

Funding: Support for this study was provided by Ironwood Pharmaceuticals in the form of an institutional research grant to Cedars-Sinai.

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Read more on the Cedars-Sinai Blog: When to See a Doctor for Constipation

IBD is an autoimmune disorder primarily causing ulcerative colitis or Crohn’s disease. The immune system attacks healthy tissue in the gastrointestinal track, and can lead to severe diarrhea, malnutrition, dangerous blood clots, pancreatitis, and extensive and painful scarring.

“Almost all treatments for IBD target inflammation that occurs in this disease,” said Kathrin Michelsen, PhD, research assistant professor of Medicine and Biomedical Sciences in the F. Widjaja Foundation Inflammatory Bowel Disease Institute in the Department of Medicine at Cedars-Sinai, and senior author of the study. “We want to learn how to repair what we refer to as a ‘leaky gut,’ the damaged intestinal lining that also occurs in people with IBD.”

Scientists hypothesize that people with leaky guts are vulnerable to getting harmful substances, such as some types of bacteria, in their bloodstream.

This study by Michelsen and colleagues follows up on previous studies that investigated the function of a gene called tumor necrosis factor superfamily member 15, or TNFSF15. This is one of the first genes found to be associated with IBD.

TNFSF15 produces a protein called TL1A that is involved in intestinal inflammation. The investigators sought to know more about how the interactions between this protein and the intestinal lining might cause IBD symptoms. They focused on the TL1A receptor, a protein called death receptor 3, or DR3. Receptors are proteins that bind to molecules and aid in the communication between cells. DR3 binds to the surface of TL1A, for example.

To perform their study, the investigators observed laboratory mice carrying the TNFSF15 gene and mice not carrying it. They examined cells taken from the intestines of the mice and cultured them in a petri dish to see whether the cells expressed the gene. They also studied whether the collection of cells lining the intestines, known as the epithelial barrier, were damaged and how the cells could heal and grow again. 

Epithelial barrier cells are connected by proteins that keep the lining of the intestines tight. This prevents bacteria from getting into the lamina propria, the connective tissues that also line the intestines and that form part of the immune system. People with IBD typically have inflammation in the lamina propria, which is supposed to serve as a protective physical barrier in the body.  

The investigators discovered that mice that did not produce DR3 had less tightly bound epithelial cells. Their intestines were permeable enough to allow in bacteria that caused inflammation in the lamina propria.

The investigators also discovered that although laboratory mice that had inflammation in their intestines showed increased levels of TL1A, their epithelial cells did not show increased DR3 expression.

“These findings suggest that therapeutic approaches targeting TL1A rather than DR3 could reduce inflammation while preserving the repair mechanisms that DR3 is essential for in epithelial cells,” said Yosuke Shimodaira, PhD, first author of the study and a former investigator at Cedars-Sinai.

DR3, for example, contributes to the regeneration of the epithelial barrier, which is necessary for healing cell damage in the intestines caused by IBD.

“There are currently clinical trials that are studying drugs that target TL1A,” Michelsen said. “It's really important to elucidate all the potential mechanisms that could impact potential therapeutic efficiency and efficacy in those clinical trials.”

The investigators are continuing to study the effects of other genes associated with IBD.

Funding: The study was funded by the National Institutes of Health (award number DK056328) and the F. Widjaja Foundation.

Read more on the Cedars-Sinai Blog: Living a Life That Isn't Defined By IBD