Travel tips

Your tray table is an upright and locked position, your carry-on is safely stowed, and your eyes are firmly fixed on the headrest in front of you. Yet at that pivotal moment of takeoff when the plane becomes airborne and the solid Earth is left behind, your stomach – ignoring the "please be seated" icon flashing above you – makes a sickening leap into your throat.

If you’ve ever flown before, you know that travel by air can really do a number on your stomach. And for many unfortunate souls, the lurch of takeoff is only a hint of the gastrointestinal (GI) woes to come for the duration of your travel. You, however, can be a savvy traveler. By planning ahead, you may be able to keep your symptoms in check and enjoy the relaxing vacation that you deserve.

Motion sickness. Back on the plane, the streets and buildings below are swallowed up by cloud cover, and your stomach is finally settling down for the ride. But even the strongest of stomachs can take a turn for the worst when in motion. Be it by plane, train, automobile or boat, traveling exerts a certain stress on your body that often results in nausea – especially if you are predisposed to stomach upset. Any condition characterized by nausea, such as dyspepsia, increases your risk of motion sickness, says an AGA member, professor of medicine and psychiatry, Division of Gastroenterology, at Washington University in St. Louis. "A long car, plane or boat ride, where you have movement and a lot of visual changes, can impact the inner ear’s balance and become a stimulant to nausea, and if you have a condition that already makes you nauseated, it’s just going to be compounded by motion. Also, to combat the disorientating visual effect of motion, try out good ole’ Mom’s answer to your childhood complaints of carsickness: focus on a stationary object instead of looking out the window. If the in-flight movie is too much for you to handle, pull down the window shade and react-quaint yourself to the headrest in front of you.

Stress. Also working against you in the skies and throughout your whole vacation is stress. After frantic last-minute packing, a heart-stopping round of "Who has the tickets? Or a two-hour delay spent worrying about connecting flights, stress can tie your insides in knots before you even board the plane. If you’re not careful, stress can cause GI flare-ups and wreak havoc on even the most foolproof itinerary. Though researchers aren’t sure of the exact science behind the power stress wields over our bodies, most people would agree that maintaining low stress levels is in their best interest. This is especially true for people coping with irritable bowel syndrome (IBS) or an inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis.

IBS and IBD sufferers are often all too familiar with the vicious cycle in which stress leads to flare-up, which leads to more stress, which leads to even more discomfort. If you know that anxiety and stress bring on your symptoms, it’s up to you to make your vacation as stress-free as possible. Don’t overbook yourself, get plenty of rest and take time-outs to relax with a book or take a nap back at your hotel. And remember, if something does go wrong, if your luggage somehow ends up in Antarctica, don’t panic. It’s not the end of the world, and you, the savvy traveler,  have packed all your necessities (money, medications, toiletries, a change of clothes, etc.) in your carry-on bag. Even though airlines, travel agencies and hotels may drop the ball, this survival pack will give you the equipment you need to cope with whatever setbacks the "travel gods" may throw in your path.

Medicine. When traveling abroad with a chronic GI condition, take extra care when packing your medicine. You may not recognize the names of the medications, so if you don’t take your own with you, it may be hard for you to understand what to buy. For example, if you went to a pharmacy in Spain looking for the antidiarrheal product we know as Imodium®, you’d probably walk right past its Spanish equivalent, Fortasec®. Regardless of who well you’ve packed your medicine kit, even the best-laid plans can go awry. What if you lose it? And, even worse, how do you go about replacing prescription medications? First of all, make sure to know the generic names of all medications on which you rely. Unlike a brand name, the generic name of a drug is the same no matter what country you’re in. If you knew that the generic name for Imodium was loperamide, for instance, you’d have a much better chance of finding your way to Fortasec. "You can get the generic name from your physician, from the Internet, from your pharmacist or even from the label or prescription information sheets that come with the medication. It is also a good idea to make an actual list of all the medications you’re taking or have needed in the past, and also make a note of your usual milligram dosage.

Even the pill size will vary from location to location. You can’t just say, "I take two of them a day," because that will be meaningless to a foreign pharmacist. In an instance where your medication requires a prescription in the country you’re visiting, you’ve got to be extra prepared, "For my patients who have serious GI illnesses with medications that are very important," tell your doctor to prepare a letter for the patient to carry in their luggage or folded in a wallet that gives the names of the medications, including generic names and dosages. I also state in the letter the patient’s diagnosis. Usually this is all that is required to get refills. So, before your vacation, ask your doctor for a letter stating your condition and your pharmaceutical needs. Though this may sound overly cautious, you’ll certainly be glad of your forethought if you lose your medication.

Cuisine concerns. Planning ahead also will pay off when it comes to sampling the local cuisine. This is true for all travelers, but especially for those with pre-existing GI complications. If you suffer from conditions such as gastroesophageal reflux disease, IBD or ulcers, you’ve probably memorized the list of foods you avoid in order to minimize symptoms. However, when eating a foreign meal in a foreign country, you might not know what you’re getting yourself into. Foods will likely be spicier or richer than their equivalents, catching you off guard and possibly spoiling your meal, your night or even your whole vacation. What can you do to protect yourself? Will you have to miss out on the local culinary delights? No. Enjoy the cultural differences, but be prepared for the fact that you may end up eating larger quantities of something like high-fat food than you would normally because you don’t even know what’s in it. You don’t want to end up saying. "Gee, if I had known, I never would have eaten a meal like that; it always gives me a lot of trouble." To avoid diner’s remorse, familiarize yourself with the country’s cuisine, and try your best to order wisely. Also, for some conditions, your physician might suggest that you pre-medicate. To fend off reflux, for instance, take an acid suppressant before your meal. Even an OTC, antacid should do the trick, so there’s no excuse for unprotected eating.

Traveler’s diarrhea. Though pre-medicating might help you enjoy foreign cuisine, there are some instances when you’d be better off refraining altogether when a poorly prepared meal or contaminated beverage might lead to an unpleasant bout of diarrhea. This is especially true when visiting high-risk destinations such as the developing countries in Latin America, Africa, the Middle East and Asia. Traveler’s diarrhea – or "Montezuma’s revenge", as it’s often termed by visitors to Mexico – is most frequently blamed on bad water. "The water in foreign countries contains strains of bacteria that we’re not accustomed to, but the people who live there have built up a resistance to those strains." To avoid coming in contact with waterborne bacteria during your travels, drink only bottled water and request that all other drinks be served to you without ice. While the "no ice" advice may be nothing new to you, you might be surprised to learn that the worst threat of diarrhea comes from food, not water. Current views point to poorly prepared food as the more common – and serious – culprit behind traveler’s diarrhea. It’s not the nature of the food; it’s the nature of the preparation and the hygiene of the people who are serving it. In other words, it you’re going to have a burrito, skip the street vendor, and shell out the extra few bucks for a cleaner, more reliable establishment. If you suffer from a diarrhea-type illness, such as IBD or colitis, you would do well to be extra cautious: Your tolerance to even a mild form of traveler’s diarrhea may be very low, and it could make you very sick. To avoid this unpleasant scenario, talk to your doctor about taking some antibiotics along with you on your trip. You’ll have the option of pre-medicating or taking them at the first sign of symptoms. If you do become sick, be sure to take in plenty of water and food if you’re able to keep anything down. And, as always, seek medical attention if you become light-headed or seriously dehydrated.

Travel with confidence. Like other with serious health concerns, people suffering from chronic GI conditions often feel captive to their symptoms despite their efforts at treatment. If this sounds like you, it’s time to break free. Travel! While it’s true that voyaging abroad may make you more vulnerable to GI episodes, it’s also true that you can take precautions to help you prepare for whatever may come. By doing simple things like stocking up on your meds, obtaining a letter from your physician and pre-medicating before unfamiliar meals, you can give yourself the advantage you’ll need for a long-awaited and, hopefully, symptom-free vacation.