Welcome to PHU's Inflammatory Bowel Disease Team service.
Our aim is to provide high quality care to our patients and families with Crohn’s disease and Ulcerative Colitis. Ensuring that they are supported and advised, utilising best practice standards and evidence base approach.
If you are concerned you may have inflammatory Bowel Disease but not yet diagnosed please contact your GP
What is IBD?
Inflammatory Bowel Disease is inflammation of digestive system. There are two main types. Ulcerative Colitis and Crohn’s disease. These are lifelong diseases that individuals with theses can have alternate periods of flare to being well managed (remission) . Treatment includes, medication, diet or surgical intervention.
Two Types of IBD
Ulcerative Colitis- Inflammation of the colon (large intestine).
Crohn’s disease- inflammation of part of the digestive system, from the mouth to the bottom (anus).
These can be managed with medication, diet or surgical intervention to enable remission and reduce flares.
Signs and Symptoms
Not everyone experience the same signs and symptoms of IBD which also known as a Flare. However, here are a few out look out for:
- Increase bowel movements up to 6 per day
- Visible blood/mucus/slime in stool
- Abdominal pain
- Increased temperature
- Constipation ( associated with Crohn's disease)
- Loss of appetite, weight loss and severe tiredness
- Joint pain
At present there is no know cure for IBD But it can manage using different treatments, diet and/or surgical intervention.
Step 1
Blood test: Speak to your GP to organize a blood test, this will include Full Blood Count, Liver Function Tests, Urea and Electrolytes, C-Reactive Protein, Vitamin D. Blood tests check for inflammation, infections and if you are getting enough nutrients and vitamins.
Stool test: Speak to your GP to organize a test for Enteric pathogens including
C.difficile and Faecal calprotectin. This will check for infections and inflammation
| Medication | Form and dose |
|---|---|
| Salofalk | Granules/Tablets - Maintenance dosing 1.5g, once a day. Treatment dosing is 3g once a day. |
| Octasa | Tablets - Maintenance is 2.4g once a day or divided doses. Treatment is 4.8g/day in divided doses |
| Mezavant XL | Tablets - Maintenance is 2.4g once a day. Treatment is 4.8g once a day. |
| Pentasa | Granules/Tablets - Maintenance is 2g once a day. Treatment is 4g once a day. |
If the IBD Team have started you on treatment– here are your response times.
Patients responses differ but generally improve well to various medications:
- Steroids: Within 2 weeks
- Mesalazine /5asa: Within 2 weeks
- Azathioprine/Mercaptopurine: Within 12 weeks
- Methotrexate: within 12 weeks
- Adalimumab/infliximab: within 6-8 weeks
- Tofacitinib/Upadaticinib: within 2-8 weeks
- Filgotinib: within 10 weeks
- Ustekinumab: within 8 weeks
Please Note: Failure to attend for blood monitoring as directed may mean that your therapy is Withheld or Withdrawn
It’s perfectly safe for you to increase your mesalazine therapy to ‘Treatment’, when you have symptoms (as indicated above) but if you do, we ask that you increase therapy for 6 weeks.
Rectal Therapy (Mesalazine Suppositories, Enemas or Foam) It is safe to institute this therapy, normally nightly for 4 weeks, to help control symptoms during flare up. Symptoms should improve after two weeks, but if they don’t, get in touch with your IBD Team. Please Note: Some patients use Rectal Mesalazine as a maintenance regime to control their IBD. The frequency of this will by directed by the IBD Team.
Steroids
It is not advisable to initiate steroid therapy without discussing this with your IBD Team. It is important to remember that these medicines are not recommended as a long term treatment. If you are prescribed these please let you IBD Team know. If you are started on steroids and have no symptom improvement after 7 Days, please contact the IBD team to discuss further treatment/appropriate management. The current medical treatments for both Crohn’s disease and Ulcerative colitis are used to avoid repeated courses of steroids as they potentially have the most significant side effects in the longer term.
Immune system ‘Adjustment’ medicines (Azathioprine, 6- Mercaptopurine & Methotrexate)
These are immunosuppressant medicines and you should not increase or decrease these therapies without discussing it with the IBD team. There is a requirement for blood monitoring at a minimum of every 12 weeks.
Biological Medication
Tofacitinib, Golimumab, Filgotinib, Upadacitinib, Adalimumab, Ustekinumab, Infliximab & Vedolizumab - If you develop or are being treated for an infection, then you should withhold your Biological medication until the infection has resolved. Please contact the IBD Team to discuss this further.
Side effects
If you think you have, or may have had, a side-effect to a medicine, also called an 'adverse drug reaction' (ADR) or 'adverse event' please report it to your GP/111 if severe, then your IBD Team as soon as possible. This includes any possible side effects not listed in the package leaflet. Reports can also be made via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or on the Yellow Card app and to the pharmaceutical company. Reporting suspected adverse reactions is important as it allows continued monitoring of the benefit/risk balance of the medicine.
Diet
There is no single diet that helps with the management of Crohn’s disease or Ulcerative Colitis. Keeping a food diary can be helpful in identifying what works for you. Spicy and high fibre foods (including vegetables, nuts and wholegrains) can make people feel worse, when they are in a flare up. Dietary advice can also depend on symptoms and physical factor. For example, if you have a stricture (narrowing) in your gut, you may require a low fibre and/or soft diet to make foods easier to digest. Sometimes in Crohn’s disease, a liquidised diet called enteral or parenteral nutrition can be used to support and treat a flare up. It is important to eat a healthy balanced diet when symptoms are well managed. Please speak to your GP or a Dietitian before making any big changes to your diet.
Crohn's & Colitis UK (crohnsandcolitis.org.uk)
Guts UK - (gutscharity.org.uk)
IBD Passport - Travel Advice for Individuals with IBD - ibdpassport.com
For non-urgent IBD enquiries and advice please contact:
IBD advice line: 02392286000 ext 5943– Leave, your name, date of birth, hospital number or NHS # and a brief message
IBD email line: inflammatory.
You MUST be a current patient under the Gastroenterology service with a diagnosis of Ulcerative Colitis or Crohn’s to access this. Messages will be answered within 4-5 working day (weekends/bank holidays not included).
The detail of your message will prioritize a reply.
Inflammatory Bowel Disease (IBD) Self management advice for prevention and flare management.
(there will be linked to the page)
If you are concerned you may have inflammatory Bowel Disease but not yet diagnosed please contact your GP
For appointments please contact outpatient Booking Team.
For any procedures-please contact the Endoscopy department.
If you have been taking immunosuppressants/ biologic are are going on holiday, please contact the team at least 2-3 weeks in advance for a letter. Please also visit the website: Passport - Travel Advice for Individuals with IBD