IBD

Question 1

When do you order an FCP and how do you interpret results?

Answer 1

To exclude IBS. Check local pathway but in general <100 can be managed in primary care, >250 needs urgent referral, intermediate result 100-250 should be repeated (if on NSAIDs stop these for 4 weeks) and if still raised refer for routine referral 4 weeks

Question 2

Medical complications for GP to consider?

Answer 2

• bone health re steroids and malabsorption
• other steroid risks e.g. cataracts, hyperglycaemia, glaucoma
• nutritional deficiencies - iron, vit B12, folic acid, calcium/vitamin D
• mental health
• biologics: skin cancers lifetime risk
• other autoimmune conditions (inflammatory arthritis most common)
• colorectal cancer

Question 3

How do you manage a flare?

Answer 3

• Check not acutely unwell. Refer to ED if fever, tachycardia, hypotension, anaemia
• Confirm flare with serum inflammatory markers and FCP but don’t need to wait for results before starting treatment
• Consider sending stool for m/c/s and o/c/p and C. diff PCR
• In CD ideally arrange US to exclude abscess
• in mild UC discuss self care such as diet, stress, stopping NSAIDs
• Liaise with IBD nurse specialist
• In general for UC: oral mesalazine is most effective (can be used together with topical preparations and works synergistically; topical can be used alone if isolated rectal or L sided disease) - increase to 4.8g/daily
• Steroids in UC not responding to mesalazine or in CD - 40mg/day tapering by 5mg/week for total 8 weeks - 252 x 5mg tablets in total - coprescribe vit D and calcium and consider bisphosphanate if >65
• Consider oral budesonide for mild to moderate ileo or ileo-caecal CD
• Consider whether this is a presentation of CRC