IBD Flashcards
(8 cards)
Describe IBD in terms of:
- description
- aetiology
- prevalence
IBD - inflammatory bowel disease
Crohns and Ulcerative colitis are most common forms of IBD.
- Aetiology
mucosal immune response due to: - genetics
- gut microbiome
- environment
- diet/lifestyle
- Prevalence
1 in 123 people live with IBD
>70 years = 1 in 67 people
What are some complications of IBD?
- 80% ppl with Crohns and 15% people with UC will require surgery at some point to manage symptoms
- high risk of bowel cancer
- nutrient deficiency
- risk of bowel perf/block due to scarring/strictures
- reduced QoL
How is IBD diagnosed?
- Blood and stool test (inc. faecal calprotectin)
- Endoscopy
- X ray/ CT with barium swallow
- Ultrasound to look at bowel wall
- MRI scan
Describe the pharmacological treatment of IBD
Pharmacological treatment is 1st line treatment:
- 5-ASA’s (mesalazine)
- Antibiotics (metronidazole)
- Biologic therapies (TNF alpha inhibitors)
- Corticosteroids (Prednisalone)
- Immunomodulators (azathioprine)
- OTC meds (loperamide, buscopan, laxatives)
Describe surgical treatment of IBD
There are a range of surgical treatments for IBD.
Many involve the formation of a stoma and and ostomy bag.
- Stricturplasty
- Resection (e.g., ileocaecal)
- Right hemicolectomy
- Colectomy with ileostomy
- Colectomy with ileo-rectal anastamosis
- Surgery for fistulas and abscess
Describe the methods of dietary assessment for IBD
A – weight loss, HGS, weight/BMI
B – bloods (iron (bleeding), micronutrient def, vit D & Ca if on steroids)
C – stool type (what’s normal), bloating, cramping, fatigue, pain
D – common triggers, risk of malnutrition
- est requirements ESPEN guidelines 30-35 kcal/kg bW, 1.2-1.5g pro/kg/day
- fibre intake (Remission = normal, flare up = low fibre)
Describe dietary approaches to the management of IBD
IBD flare ups are rarely triggered by food, however, useful to:
- Limit common irritants e.g., acidic, fizzy, alcohol, caffeine, emulsifiers
- Low fibre intake
- Low residue/texture modified diet (soaked oats, readybrek, passata over tinned toms)
- Polymeric sip feeds e.g., vital 1.5
- Enteral/parenteral nutrition in extreme cases
Low residue diet:
Foods that leave minimal amount of residue in the gut and avoidance of foods that irritate an inflamed bowel or obstruct a stricture e.g.,
* Wholegrains
* Pips
* Seeds
* Skins
* Pith
Can be used long term if recurrent flare up or structuring disease/bowel obstruction.
When in remission –> generally healthy eating advice (med diet, high fibre, F&V, lean meat)
Exclusive enteral nutrition (EEN) :
First line treatment in newly diagnosed crohns in adults and paeds
Polymeric feeds generally well tolerated – can use semi-elemental feed if not
Allowed clear fluids e.g, jelly, fruit squash, boiler sweets
Food reintroduction:
After any exclusion diet e.g., fodmap, EEN, liquid diet
Reintroduce gradually
Focus around LOFFLEX (low fat, fibre, exclusion diet) after EEN
Describe approaches to long term monitoring of IBD.
Long term monitoring:
- Iron
- b12 (esp if ileal resection)
Supplements:
Probiotics NOT recommended for treatment of crohns
Some probiotics can help UC when mesalamine is not tolerated
Probiotic supps not recommended
No recommendations for/against FMT (foecal microbiome transplant)
Herbal supps – curcumin and piperin (anti inflammatory) evidence is weak
