IBD

Question 1

What is IBD

Answer 1

It is an autoimmune disease that causes prolonged inflammation to the GI tract. It follows a relapsing and remitting disease course.

Question 2

What are the 2 type of IBD

Answer 2

• Crohn’s disease
• Ulcerative colitis

Question 3

Cause of IBD

Answer 3

The exact cause is not known but it is thought to be multifactorial involving a combination of genetic and environmental factors
- Genetic predispostion increases risk
- Fast food consumption (fat and refined sugar) and a western diet may increase risk
- smoking
- gut dysbiosis

Question 4

What is protective against IBD

Answer 4

Vitamin D
Exercise
sleep
pets
breastfeeding.

Question 5

Explain Crohn’s disease

Answer 5

Crohn’s disease can affect any part of the GI tract from the mouth to the anus and usually involves patches of inflammation

Question 6

What are symptoms of crohn’s

Answer 6

diarrhoea, blood or mucus in stool, abdominal pain, weight loss, loss of appetite, fatigue.

Question 7

What is ulcerative colitis

Answer 7

Involves any part of the last intestine and areas of inflammation are continuous.

Question 8

What are the symptoms of UC

Answer 8

Diarrhoea
blood in stool
urgency
tenesmus
abdominal pain

Question 9

What are complications of IBD

Answer 9

• Higher risk of bowel cancer
• May need surgery at some stage in their life
• malabsorption
• Extra GI symptoms
• Bowel perforation or blockage.

Question 10

what biochem should be done for a person with IBD

Answer 10

• albumin - low albumin can occur due to protein losing enteropathy, disease activity and nutritional status
• nutritional bloods due to risk of malabsorption (ferritin, vitamin D and B12
• electrlytes and urea
• coeliac serology
• CRP
• ESR
• FBC

Question 11

Pharmacological management of IBD

Answer 11

• aminosaliclates - reduces intestinal inflammation and help maintain remission
• antibiotics - fight infection, abscesses and pouchitis
• biologic therapies - blocks proteins, that cause inflammation, reduce signs and symptoms and help maintain remission
• corticosteroids - suppress the immune system, control flares and and help reduce inflammation
• over the counter medication: diarrhea (loperamide), anti-spasmodic (buscapan), paracetamol, laxatives.

Question 12

Dietary assessment

Answer 12

A: weight, BMI, weight loss, handgrip strength
B: FBC, U&Es, albumin, coliac serology, nutritional bloods, ESR, CRP,
C: history - meds, surgery, stool type, other symptoms
D: diet intake tends to chance - remission vs flare up, risk of malnutrition, common triggers.

Question 13

Diarrhoea and IBD

Answer 13

Severe, prolonged or bloody diarrhoea can cause poor absorption of nutrients such as K, NA, magnesium, zinc and iron. THis can cause anaemia, dehydration, weight loss and nutritional depletion

Question 14

What are the causes of diarrhoea

Answer 14

medication use such as aminosalicylates
surgery such as small bowel surgery
dietary triggers such as fiber, caffeine, alcohol, spicy foods, artificial sweeteners
iron supplements
Malabsorption of fats.

Question 15

What is the aim of nutritional interventions

Answer 15

• To achieve good nutritional status during active disease and remission
• To help alleviate clincal symptoms
• To induce remission in CD by using enteral nutrition

Question 16

What is the first line dietary advice for IBD

Answer 16

• limit common irritants that can make flare ups worse such as fatty foods, spicy foods, caffeine and alcohol
• if suffering with diarrhea, may be advised to follow a low fibred diet and drink plenty of water to avoid becoming dehydrated
• if you have strictures or inflammation that narrows the digestive tract may be advised to follow a low residue diet

Question 17

What are ways of lowering fibre intake

Answer 17

• choose low fiber cereals such as rice cripsies and cornflakes
• chose white bread, pasta and rice
• eat peeled fruits or tinned fruit
• avoid salads and raw veg, choose cooked peeled veg instead
• avoid dried fruit and nuts.

Soluble fibre might be better tolerated during a flare up if constipated and can be found in oats, fruit, root veg and beans and pulses.

Question 18

Explain the low residue diet

Answer 18

Designed to focus on foods that will leave a minimal amount of undigested material in the gut that may irritate an inflamed gut or obstruct a narrowed gut. Need to avoid skin, nuts, seeds, pips and pits. Can change the texture of fiber foods such as masking or blending.

Question 18

What causes malnutrition in IBD

Answer 18

• anorexia in active disease
• protein losing enteropathy
• malabsorption, especailyl if suffering with diarhhoea
• increase energy expenditure
• drug nutrient interactions

Question 19

Exclusive enteral nutrition and crohn’s

Answer 19

It is the first line treatment in newly diagnosed Crohn’s in paeds and adolescents
Can support growth and development while avoiding drug-related side effects

Question 20

what does EEN consist of

Answer 20

Specially prescribed nutritional drinks that meet ally our nutritional needs. This diet is designed to be taken without any food is is your sole source of nutrition
avoidance of food lasts for 6-8 weeks.

Question 21

what are the benefits of EEN

Answer 21

• provide rest to your gut from potential food irritants
• reduce inflammation
• help the gut to heal
• improve nutritional status
• reduce symptoms
• induce remission.

Question 22

tips on making the diet easier to follow

Answer 22

• serve the food chilled or cold
• try a variety of flavors to avoid flavor fatigue
• sip the drinks slowly
• space the drinks evenly throughout the day.

Question 23

What is the choice of feed for EEN

Answer 23

Polymeric feeds have good compliance, are more palatable and have a variety of flavors
If feeds are not tolerated to there are signs of malabsorption, could trial peptide based ONS

Question 24

food reintroductions after EEN

Answer 24

Foods need to be reintroduced to tolerance after EEN - start slowly with one meal a day May like to focus on LOFFLEX and then move towards including a variety of food.