Inflammatory Bowel Disease

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

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Please Note: Failure to attend for blood monitoring as directed may mean that your therapy is Withheld or Withdrawn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