Powering Through Internal Conflict

Digestive diseases such as Crohn’s disease and ulcerative colitis often appear when patients are teens or young adults. Laurie Keefer, PhD, shares how she helps her patients build resilience and come to terms with their gastrointestinal challenges.


[00:00:00] Stephen Calabria: From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Stephen Calabria. Today on the show we have Dr. Laurie Keefer, the Director of Psychobehavioral Research within Mount Sinai's Division of Gastroenterology. She specializes in care of patients with chonic digestive diseases, inlcuding inflammatory bowel diseases like Crohn's Disease and ulcerative colitis.

[00:00:25] In treating gastro patients, Dr. Keefer and her team have developed a model for building resilience across the lifespan of their patients, a disproportionate number of whom are children and young adults. We're pleased to welcome Dr. Keefer to the show.

[00:00:41] Dr. Laurie Keefer, welcome to Road to Resilience.

[00:00:44] Dr. Laurie Keefer: Thanks for having me. I'm excited to be here.

[00:00:46] Stephen Calabria: Could you introduce yourself to our listeners?

[00:00:49] Dr. Laurie Keefer: Sure. I'm a professor of medicine, and psychiatry here at Mount Sinai.

[00:00:54] I work in the Department of Gastroenterology, particularly in the Mount Sinai IBD Center, where I am, responsible for the subspecialty medical home for patients living with Crohn's and colitis.

[00:01:08] Stephen Calabria: Now what is the GI tract and is there much of a connection between it and other parts of the body or is it just relatively isolated?

[00:01:17] Dr. Laurie Keefer: Absolutely. So the GI tract, gastrointestinal tract extends from the mouth all the way through the anus and it is probably one of the organ systems that interacts the most with our environment. The GI tract has its own nervous system called the enteric nervous system that connects to the central nervous system and the brain, which is why you've probably heard about the brain-gut connection and how important that is for health and well being.

[00:01:46] Stephen Calabria: So, when someone says, I can just feel it in my gut, That's not just a phrase. That's an actual thing.

[00:01:52] Dr. Laurie Keefer: That's an actual thing. In fact, the gut is often called the second brain.

[00:01:57] Stephen Calabria: Okay. You've talked about Crohn's and IBS. What is the difference between Crohn's disease and irritable bowel syndrome?

[00:02:05] Dr. Laurie Keefer: So, Crohn's disease, as well as ulcerative colitis, are both what we call inflammatory bowel diseases. These are immune mediated inflammatory conditions of the GI tract. Crohn's actually was discovered here at Mount Sinai in 1932 by a professor, Burrill Crohn. Irritable Bowel Syndrome has a lot of the same symptoms, but it is a perhaps equally chronic but less immune-mediated and less inflammatory GI condition.

[00:02:35] So, you might have abdominal pain, diarrhea, similar to Crohn's and ulcerative colitis, but the cause is, is, is much, much different. Irritable bowel syndrome is, is very common. One in 10 people will live with that in their lifetime, whereas inflammatory bowel diseases are much less common.

[00:02:53] Stephen Calabria: So in terms of Crohn's and ulcerative colitis, what does your typical patient look like and what kinds of symptoms do they typically experience?

[00:03:03] Dr. Laurie Keefer: So, with Crohn's Disease, symptoms can really present anywhere in that GI tract that I was mentioning. So many patients will have, of course, abdominal pain. They may have diarrhea. They may have nausea, fullness, fatigue. Patients with ulcerative colitis tend to have, because the disease is located primarily in the colon, they tend to have more of that urgent, bloody diarrhea as well. Both ulcerative colitis and Crohn's are associated with what we call extraintestinal manifestations too, which could include things like fatigue, joint pain, skin difficulties, eye issues, really kind of widespread immune concerns.

[00:03:49] Stephen Calabria: You've written extensively about the role that resilience plays in the lives of your patients, particularly those with Crohn's and ulcerative colitis. Talk a little bit about that. Where does resilience really enter into it and what original research have you done with regard to resilience?

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