Using eHealth strategies in delivering dietary and other therapies in patients with irritable bowel syndrome and inflammatory bowel disease.

Health-care systems around the world are facing increasing costs. Non-adherent, chronically ill patients are one such expense incurred by health-care providers. Web-based home-monitoring of patients-or eHealth-has been shown to increase adherence to medical therapy, facilitate contact between patients and health-care professionals, and reduce time to remission for patients with inflammatory bowel disease (IBD). Web-based treatment is a supportive tool for the health-care provider in an out-patient clinic. eHealth web-programs, such as the Constant Care application, visualize disease activity in a traffic light system and empower patients to screen for disease activity, enabling them to respond appropriately to their symptoms. The eHealth screening procedure for monitoring both pediatric and adult IBD patients is based on a self-obtained symptom score, together with a fecal biomarker for inflammation (fecal calprotectin) that the patients can measure independently using their smart phone, providing both patient and physician with an immediate disease status that they can react to instantaneously. Likewise, web applications for IBD patients, web applications for irritable bowel syndrome (IBS) patients and also IBD patients with co-existing IBS, have proven valuable for monitoring and treating IBS symptoms with a diet low in fermentable oligo-, di-, monosaccharides and polyols (low-FODMAP diet). With careful disease monitoring via the web application and increased patient adherence, eHealth might be capable of improving the natural disease course of IBD and IBS.

Differences in glycaemia, hormonal response and energy expenditure after a meal rich in mono- and disaccharides compared to a meal rich in polysaccharides in physically fit and sedentary subjects.

Postprandial glycaemia, hormonal response and energy expenditure (EE) were measured after two isocaloric carbohydrate-rich meals (69 energy-percent [E%] carbohydrate, 16 E% fat) rich in either mono- and disaccharides (47 E%, half of which sucrose) (MD) or polysaccharides (64 E%; P). Both meals were based on natural food items and were tested in a cross-over design in a group of sedentary (S) and trained (T) healthy, young subjects. Compared with the P meal blood glucose concentrations were significantly decreased and plasma insulin concentration significantly increased after the MD meal. A group difference was observed after the P meal with increased glucose and decreased insulin concentrations for T compared with S. Plasma norepinephrine concentrations were significantly increased after the MD meal compared with the P meal, but for S only. For both groups a significantly increased EE was observed 3 and 5 h after the MD meal compared with the P meal. However, no significant differences between the meals were observed in plasma insulin or catecholamine concentrations 3 and 5 h postprandially, when EE was measured. In conclusion, significant differences were observed in postprandial glucose and hormone responses as well as energy expenditure after two meals based on either mono- and disaccharide-rich or polysaccharide-rich food items. Physical fitness level influenced the glucose and hormonal responses but not the relative increases in postprandial energy expenditure.