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what is IBD?


(upbeat music) – Okay, inflammatory bowel disease describes a group of conditions that cause inflammation, redness, and a loss of function within
the bowel and how it works. And there are two main variants of inflammatory bowel disease, Crohn’s Disease, which can
affect any part of the gut from the mouth down to the anus and doesn’t necessarily
have to affect all parts. It can have what we call skip lesions, which is healthy areas,
interspersed with abnormal areas, and ulcerative colitis, which
tends to just affect the colon in continuity from the anus upwards and can affect all of the colon and sometimes can affect a
small amount of the small bowel as well. There’s a third
entity that we currently call inflammatory bowel
disease type unclassified, which I always think is a
bit of a clumsy name for it. We used to think that that existed as a pre-state before
Crohn’s or ulcerative colitis and that those people would
declare themselves with time. Increasingly, we’re starting to recognize that they’re probably their own entity, and, in fact, those labels that we use are probably convenient labels, and there might be other
divisions within those that describe people a
bit more fully than that. The manifestations of these conditions are that that inflammation, as I say, leads to loss of function,
and that can lead to abdominal pain and
inability to absorb nutrients and grow that may impact
on puberty in teenagers. People can have diarrhea,
they can have a lot of blood in their stools, and
they can be very unwell with these conditions. Sometimes, if that
inflammation is significant, or in particular, people, for reasons we don’t fully understand, that inflammation can spill
over into the bloodstream and can affect other organ
systems, so the skin, the joints. Sometimes even things like the liver can be affected by inflammation as well in inflammatory bowel
disease, so a very serious and significant group of conditions. (upbeat music) So any age can be affected with
inflammatory bowel disease, really from birth right
up to elderly people. The population I look after, obviously, as a pediatrician, are children
up to the age of about 16. And between 16 and 18, we make a decision about when they’re handed
over to adult care. We do see young babies affected with variants of
inflammatory bowel disease. We see under fives affected. Now the amount of patients
we see coming through in those younger ages
is much, much smaller than we see within the teenage
years, but they do happen, and they do have a slightly
different disease course and a slightly different variant to what we see in the teenage populations, and they’re a slightly different entity to think about. But the peak of the disease happens in teenage life and into early adulthood, and then it falls off again a
little bit into middle ages. So really, it’s a disease of teenagers and young adults, predominantly. (upbeat music) First of all, it’s often diagnosed based on a poo sample called
a fecal calprotectin. So this is a protein
that’s a breakdown product of your white blood cells,
and so when it’s around, it suggests there’s been inflammation in and around the bowel. Now, it’s a very, very
good test when it’s low because it tells you
there’s not much going on. It’s not as good a test when it’s high because that tells you
something’s happening, but it doesn’t always tell
you what that thing is. But it’s usually an indication that people need additional investigation. So as a first point of
call, if people are worried about inflammatory bowel disease, the first thing we usually suggest is to submit a fecal calprotectin, which can usually be done by a GP surgery. Once that report comes back, that would then initiate
what the next stage is. If that’s elevated or
significantly elevated, rather, than engaging someone like myself as a pediatric gastroenterologist
would be the next stage. And usually, the baseline investigations for inflammatory bowel disease at that point would be endoscopies, so an upper endoscopy going
down through the mouth, down the gullet, into the stomach, and round into first
part of the small bowel, and a lower endoscopy, which
goes in through the bottom and round the colon and into the last part of the small bowel so we can see what we can see with the naked eye. We can take a series of biopsies and see what they tell us about the disease or if there’s a disease there, I suppose is the first question. But that doesn’t give us the full picture because we’re still
missing the small bowel, the bit in between those two, that we can’t reach with an endoscope. And so we tend to look at
that increasingly with an MRI of the small bowel,
which is taking a drink that stretches it and distends it and lying in a tunnel where
a big, noisy machine clangs at you, and it takes pictures of you that the doctors can then slice up in a computer to look at
what your insides look like and see what your small bowel looks like. So those are the mainstays of tests that are involved in
inflammatory bowel disease. There are one or two slightly niche tests that we would also use to support that, but those are the main things that people can think about as investigations
to lead to diagnosis. (upbeat music) There are broadly two types of treatment. There are treatments that get you better, and there are treatments
that keep you better. And one of the fundamental
things that we have to always remember in
inflammatory bowel disease is that, to keep someone better, you have to have made them
better first of all, okay? It’s a simple message, but it’s something that people sometimes forget, okay? In Crohn’s disease, the mainstay
of treatment in children across Europe and Australasia, and parts of Canada
involves a liquid-only diet called exclusive enteral nutrition, which people would take
for six to eight weeks. Probably the longer the course, the more effective the therapy. But it is a challenging course because you have to take liquid-only diet for eight weeks with no other foods, okay? But we do know that in doing that, it switches off inflammation
and helps heal the bowel in up to four out of five people. But if you come off of that
and back onto normal diet, most people will flare
again within a year, okay? So I’ll come on in a second
to maintenance treatments and how we keep people there. Ulcerative colitis, we
don’t think that diet works. We’ve got very limited information about diet in ulcerative colitis. So the mainstays of treatment there is a medicine that’s quite
similar to aspirin for the colon. It’s called usually mesalazine
or steroid treatments, which suppress the immune system, okay? Once we get someone into remission, it’s important that we keep them there, and we try and do that
with the minimum amount of treatment that we can. But often, that involves medications that dampen down the immune system, and there are a variety of those that we can use depending on the age and the stage of disease and
how bad things have been. And once we get someone into remission, it’s important that we keep them there, and we monitor that. So that’s where things like keeping an eye on the fecal calprotectin,
watching what their symptoms are doing, and keeping an
eye on bloods and things is important in trying
to identify the activity of the disease coming
back, but before it starts to impact on someone with symptoms. (upbeat music) So obviously, there’s
support from organisations like CICRA and other charities and family-oriented organisations who are a wonderful resource. They make great documents, websites. They have facilities for people to contact and get put in touch with other people. We would be absolutely lost without them and not least of which family days that people can come along
to meet other families and to hear from professionals like me. But again, we work within a structure called a multidisciplinary team where the doctors who would look after you are supported by IBD nurses in particular who are a huge part of the jigsaw as a first point of contact for families as a support structure for families and for people who make sure that families are well informed, know
what their treatment is, know what’s involved in their treatment, and know how to contact
us if there are problems. (upbeat music)

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