Center for Inflammatory Bowel Disease Treatment and Research

Traveling Abroad with IBD
 

Having Inflammatory Bowel Disease should not keep you or your child from enjoying travel or studying abroad. As with other medical conditions, patients with IBD should see their healthcare team as early as possible before traveling and discuss any risks that may be involved, as well as plan for immunizations, medication, and other medical devices that may be needed before or during the period of travel.

Locating a Doctor

• Ask your health care provider for the names of physicians in the cities you plan to visit. For a list of foundations in cities around the world, see the International Organizations link on www.ccfa.org .
• For a donation, the International Association for Medical Assistance to Travelers (417 Center Street, Lewiston, NY 14092; 716-754-4883) provides lists of English-speaking doctors in many countries.
• The American Embassy's Consulate Section has a list of local doctors broken down by specialization.

Medications and Medical Care

• Bring enough medication for the entire trip, plus some extra in case your return is delayed. This also applies to over-the-counter medications and, if applicable, appliance supplies.
• Speak with your health care provider about whether you may need anti-diarrhea medication for any part of your trip.
• All medications should be kept in their original containers, with original labels (including the Drug Identification Number). Bring along a copy of your prescriptions for the medications as well, in case you are asked to prove the medications were prescribed to you.
• Always store all of your medication in your carry-on bags, in case your luggage is lost.
• Ask your health care provider for a letter outlining your medical condition, in case you need medical attention while in another city or country. You might also consider asking for a written management plan to follow should mild, moderate and/or severe symptoms arise.
• Always bring your health care provider’s name, phone number and e-mail address with you, and try to get the name and phone number of a doctor in the area you’ll be visiting. Your health care provider or a travel medicine specialist may be able to recommend an appropriate contact.
• Ask your doctor or NP for a prescription with your medication’s generic name (and foreign brand name if possible) when traveling abroad. You probably won’t need to use it but may feel more secure knowing you have it.
• If you are studying abroad for a semester and currently receiving Remicade (infliximab), be aware that it may not be easily available in the country in which you are studying. We have had students studying in England who were told that they could easily get infliximab, but the process of getting it approved by the national health service led to untimely delays, and flares of their inflammatory bowel disease.

Logistics

• Check ahead with your hotel to find out about the accommodations and whether appropriate bathroom facilities are available. The bathroom facilities may be shared or may not be on the same floor as your room.
• When traveling by air, pre-book your flight to secure an aisle seat close to the bathroom. You can also usually pre-arrange in-flight meals if you have dietary restrictions. Call the airline or your travel agent to ask about wheat-free, non-lactose or other special meals.
• When traveling by bus, confirm the bus has a bathroom on board. “Toilet stops” may be scheduled along the way, but they may not be convenient for you.
• If you are traveling a long distance by car, plan your route along well-traveled roads which are more likely to have roadside restaurants, gas stations and other ‘pit-stop’ facilities.
• You may also want to bring a few rolls of toilet paper along in case any of the facilities you use throughout your trip are out of paper.

Travel Insurance

Contact your health insurance company for information on the coverage they provide to travelers and determine whether you need to purchase additional medical insurance or insurance for air evacuation in case of an emergency.

• Ensure that you have a comprehensive travel insurance policy before you travel abroad, and that pre-existing medical conditions are not excluded.
• Do not travel against the doctor's advice as this may make the policy void. A letter from your health care provider may be helpful.
• Be familiar with the procedure for obtaining medical treatment or making an insurance claim. Free emergency medical treatment can be obtained in many European countries.

General Recommendations

• Increase the fluid and salt intake in hot climates to avoid dehydration.
• Check if the local water is safe to drink, if not use bottled water for drinking and brushing your teeth. Carbonated bottled water may be the best option since carbonation increases the acid in the water and kills bacteria.
• Choose fully cooked food whenever possible and avoid cold foods. Salads and fruits should be washed in bottled water if self-catering.
• Avoid ice cubes (frozen local water!) and ice cream.
• Peel all fresh fruit yourself.
• Ensure that you have a supply of anti-diarrhea tablets such as Immodium, should diarrhea occur.
• If your IBD is being treated by diet, ensure that you have a supply of elemental diet (i.e., Boost) with you.

Prophylaxis and Travel Abroad

In general, we do not recommend travel to developing or tropical countries. If such travel is in your plans, you must discuss this with your primary gastroenterologist. In order to stay healthy it may be necessary for you to take precautions against conditions which have a particular prevalence in certain countries, i.e. you may require vaccinations before you travel or need to take anti-malaria tablets. If you are traveling outside of Europe or to an area with a high risk of disease from food, water or insects, you should contact the Travel Clinic at Children’s Hospital 617-355-5945 or at Beth Israel Deaconess Medical Center 617-632-7740 at least one month prior to your departure.

Special precautions need to be considered if you are taking medications which lower the immune response of the body, e.g. corticosteroids (prednisone), 5-ASA preparations (mesalazine, olsalazine), 6-MP (azathioprine or imuran), Remicade (infliximab) or Humira (Adalimumab). A patient would be considered immunosuppressed if steroids have been taken at a dose of 40mg per day for more than one week or lower doses of steroids or other immuno-suppressants have been given for long periods of time.

Patients who are immuno-suppressed should not receive live vaccines until at least three months after treatment has stopped, or three months after levels have been reached which are not associated with immuno-suppression. If “killed” vaccines are administered to patients who are immuno-suppressed the antibody response may not be sufficient to provide protection against the infection. Therefore, travel to certain countries may not be advised if you are taking immuno-suppressive agents and vaccinations are required. Be aware that live vaccines are required before traveling to some places in the world (eg yellow fever vaccines). If you are traveling to an area that requires such a vaccine, you may wish to reconsider your trip).

Many patients with inflammatory bowel disease are also upset by taking anti-malarial tablets. Unfortunately, these must continue as there would be a risk of contracting malaria if stopped.

Helpful Links

The International Association for Medical Assistance to Travelers at
www.iamat.org

**Information in this handout was provided in part by the Crohn’s & Colitis Foundation of America’s Web site and the Crohn’s & Colitis Foundation of Canada.