Chronic intestinal diseases (Kids), advice for a safe holiday

It is estimated that in Italy there are around 250,000 people with Mici (Chronic Inflammatory Bowel Diseases) and 5 million worldwide. Mici are pathologies with a chronic and recurrent course, which present themselves with periods of exacerbation alternating with phases of remission and of which the cause is not known. Crohn’s disease and ulcerative colitis fall under this definition. Inflammatory bowel diseases make their debut at any age, especially between the ages of 20 and 40, affect men and women without distinction and are constantly growing, due to the aging of the affected population.

For people suffering from Mici, traveling often becomes a problem, for some so great that they deprive themselves of this pleasure.
‘Travel, on the other hand, is not considered contraindicated if planned appropriately and in compliance with one’s conditions, while giving up a priori has a negative effect on the quality of life’, he says Except Leodirector of Amici Italia (Chronic Intestinal Inflammatory Diseases Association) who gave voice to the many questions from aspiring traveler patients, to which Maria Cappello, gastroenterologist, head of the Mici Clinic of the Palermo Polyclinic and national councilor of Aigo answered.

Patient questions

1. Is it safe for me to travel considering my current condition?
It is obvious that recurrences or exacerbations in progress characterized by symptoms such as diarrhea, abdominal pain, evacuation urgency, as well as having recently undergone surgery, are conditions that do not allow planning a short-term trip. At the same time, however, the fear of facing a simple weekend or a short vacation is unjustified if the disease, thanks to the therapy, has been in remission for some time now.

2. Do I need to make any adjustments to my medication or medications before departure?
No, indeed it is essential to continue maintenance therapies that reduce the risk of exacerbations.

3. What should I do if my symptoms flare up during the trip?
Know how to recognize the symptoms, have contact with the reference center to receive advice for mild exacerbations.
Identify the hospitals closest to your travel destination and write down the emergency numbers. If you go abroad and you don’t know the language, use the Google translator or special apps for smartphones.

4. Do you recommend that I bring a copy of my medication plan and prescriptions with me?
Absolutely yes, as access to medicines without a prescription is impossible in many countries and the prescription will require unpleasant waiting in the emergency room. If you take a biological or practice topical therapy and therefore medicines in liquid form, you must obtain a certificate from your doctor stating the prescription and that the therapy is essential for the patient, for transport in hand luggage.

5. Are there any medications or treatments I may need to take while travelling? How should I handle them?
I would recommend bringing a small supply of the drugs you take chronically, in addition to paracetamol in tablets, an antispasmodic, an antidiarrheal, the medicines already prescribed by your doctor and a probiotic.

6. What are the warning signs that you should seek medical assistance while travelling?
The patient with Mici must learn to recognize the symptoms and signs of his illness: abdominal pain that cannot be resolved with paracetamol or an antispasmodic, diarrhea with more than 6 evacuations/day especially if at night and lasting more than 48 hours, fever, repeated vomiting which, associated with severe abdominal pain, can be a sign of intestinal obstruction. For those who are on immunosuppressive therapy and therefore at greater risk of contracting infections, a fever lasting more than 3 days, a persistent cough, urinary burning can mean an even severe opportunistic infection and therefore lead to seek medical assistance.

7. Do you recommend contacting a local doctor at the destination in advance?
Moving away from home, from one’s hospital and specialist who is always available, is a source of discomfort and even fear, which often leads one to avoid travelling. It is necessary for the patient to talk to his reference gastroenterologist who will have the task of reassuring him if the patient is in remission but is ready to report a Mici center in the place of destination in case of sudden relapses (perhaps checking on the Amici Italia website, which is always updated). In most cases it will not be necessary to contact him in advance and the mere knowledge will serve to allay the anxiety.

8. Are there any particular precautions to be taken regarding drinking water or local hygiene?
The greatest risk that a traveler with Mici runs abroad is that of contracting intestinal infections, especially in some countries with inadequate hygiene or water supply. In any case, the general rules of prevention and hygiene apply to avoid ‘traveller’s diarrhea’ or other infections and available on the Farnesina’s ‘Travel Safe’ website, valid for everyone. Specifically, always drink bottled water and also use it to brush your teeth; avoid swallowing water when taking a shower, in the pool and even in the sea; avoid ice in soft drinks or cocktails and also ice cream; avoid raw foods, fresh vegetables or fruit even if washed; drink carbonated drinks, in cans or bottles and hermetically sealed; do not buy food from street vendors; avoid dairy products unless you are sure they are pasteurized; alcohol or spicy foods can stimulate intestinal motility and therefore worsen the symptoms; do not experiment with the consumption of dishes and foods without adequate information on origin and cooking methods.

9. Do you have any specific recommendations for choosing a destination or type of travel that might be more suitable for my condition?
The choice of the holiday destination must be related to the severity of the disease. Visiting a European capital is perhaps a less exciting but safer journey than a safari in Africa. The flight time can determine different needs for a person affected by Mici as well as the choice of means of transport whether it be plane, train, ship or car. Choosing a means of transport that allows easy access to the toilets is a valid precaution and in some countries there are toilet geolocation apps (Toilet Finder or Triptoilet). Not being able to count on quick access to quality health care should be taken into consideration if you choose to travel to sparsely inhabited areas or developing countries.
Taking out health insurance is also recommended in advanced countries such as the USA where medical assistance is paid for.
Getting informed before leaving is essential and this is true for everyone, not just for those with a cat. In some destinations, vaccinations will be required: vaccinations with live attenuated viruses such as yellow fever are contraindicated for patients on immunosuppressive or biological therapy, therefore it is essential to always ask your doctor.

10. And what do the doctors recommend for those who stay in the city?
For those who stay in the city, the main danger is the heat, especially for those with an active disease and diarrheal symptoms:
to avoid dehydration it is always advisable to drink plenty of water and possibly take oral rehydrating solutions rich in mineral salts. Very cold drinks can cause abdominal cramps and diarrhea and should be avoided. Avoid processed foods (packaged hamburgers, cured meats) and eat fresh, locally sourced foods. For those who stay, remember that they can count on their own referral centre.

“The gastroenterologists who take care of patients with Mici- adds the president of Aigo, Marco Soncini– are the preferential interlocutors and the patient must not be reluctant to ask questions concerning a holiday because a pleasant opportunity for recreation and sometimes for cultural growth without adequate information can become a nightmare”. “Don’t forget also – concludes Salvo Leone – that patient associations, both national like Amici and international like Effca, are a reliable source of information”.