The IBD series for primary care

A number of people with IBD, both ulcerative colitis and Crohns disease, require surgery at some point in their disease journey.  For some it is curative, and for others surgery is performed to manage troubling symptoms caused by stricturing disease and fistulae.  During this episode, I discuss the role of surgery in the management of people with IBD with Melanie Orchard, a final year colorectal registrar with an interest in IBD.  We discuss the indications for surgery, complications and longer-term outcomes from surgery.  Melanies also shares her top tips for GPs when managing patients who have had surgery for IBD. 

I talk to Dr Anthony Wiskin of Bristol Childrens Hospital about the hugely important topic of IBD in children.  
25% of IBD is diagnosed under the age of 18, and when diagnosed in this age group, the disease is generally more aggressive than when diagnosed later in life.  Dr Wiskin gives a superb overview of the disease, some pointers for diagnosis and the role of faecal calprotectin in children.  We talk about the huge impact of the disease on families as well as the sufferer, and look at the process of transitioning the child from paediatric to adult gastroenterology services.  

I speak to GP Dr Kevin Barrett, lead clinical champion for IBD for Crohns and Colitis UK and the RCGP and chair of the PCSG ( primary care society for gastroenterology) about flare management in primary care.  We discuss the recently released flare pathway for primary care, which offers clear advice to GPs and those managing IBD in primary care about when it is appropriate to initiate treatment, and what treatment to consider.  

The flare pathways can be found on the IBD toolkit online at: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/inflammatory-bowel-disease-toolkit.aspx

Patients with IBD are very interested in the relationship between their diet and their disease. Up to 85% of patients with the condition suffer from malnutrition for a variety of reasons, and in this episode I discuss reasons for malnutrition and how to assess for this with Sam Poore, a specialist dietician at Bristol Royal Infirmary.  We talk about topics including ileostomy advice, the role of probiotics in IBD, and dietary modification in IBD, including the role of the low FODMAPS diet in patients with IBD in remission.  

Does IBD affect fertility?  Do people with IBD have more adverse outcomes in pregnancy?   Are biologics (eg. Infliximab and Adalimumab) safe to use in pregnancy? How do you treat a flare in pregnancy?  If you work in primary care and you want to know the answer to these questions and lots more, this is the podcast for you.

In this episode, I discuss contraception, pregnancy and breastfeeding in people with IBD with Dr Aarthi Mohan.  Dr Mohan is an extremely experienced Obstetrician at St Michaels hospital in Bristol who runs a quaternary level service for pregnant women with concurrent medical conditions.  She shares a wealth of experience with me about all aspects of fertility and pregnancy in patients with IBD.

According to a study by Tavernier et al., infertility rates in people with IBD is mainly due to voluntary childlessness rather than infertility contributed to by the disease itself (Tavernier et al.Systematic review:fertility in non-surgically treated inflammatory bowel disease, Alimentary pharmacology and therapeutics, Oct. 2013).  This voluntary childlessness is significantly higher than those not affected by IBD (14-18% vs. 6%) and this is mainly due to incorrect beliefs about how their disease may affect their fertility and outcomes in pregnancy. Therefore having a good knowledge of these issues is important for both primary care and secondary care clinicians looking after patients with IBD so that these patients can have accurate advice when planning their family.

We cover:
Contraception
The effects of IBD on fertility
What to do with various medications in pregnancy
How should we approach flare management in these patients. 
IBD and venous thromboembolism risk in pregnancy
Folic acid use
Mode of delivery in those with IBD
The pregnancy pathway for those with IBD
IBD and breastfeeding
Post-natal depression in patients with IBD.

You can visit the RCGP IBD toolkit at: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/inflammatory-bowel-disease-toolkit.aspx

For a link to an excellent patients' guide to IBD and pregnancy, follow this link to the Crohns and Colitis UK website:  https://www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/publications/pregnancy-ibd

NB. This episode was recorded in a busy maternity hospital, so there are some background noises as a result of this!

This podcast is designed for any primary care clinicians who care for patients with IBD.  GP Dr Charlie Andrews speaks to Aileen Fraser, IBD specialist nurse at University Hospitals Bristol about her role, the sorts of questions she receives from GPs, how she can help support patients and clinicians in the community, and lots more besides!  This episode is packed with useful information for clinicians, and is a must for anyone who would like to better understand the role of the IBD nurse specialist. 

1 in 3 patients with Crohns and Colitis do not have contact with an IBD specialist nurse, however this role is expanding across the UK.  In areas where patients do have contact with a specialist nurse, they are highly valued (94% of patients who had contact with an IBD specialist nurse said that this link with the hospital was important in a 2016 survey). 

By working collaboratively with secondary care colleagues, primary care clinicians can have a significant impact on the quality of care provided to these patients, and the IBD specialist nurse can act as an invaluable link between primary and secondary care.

You can visit the RCGP IBD toolkit at: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/inflammatory-bowel-disease-toolkit.aspx

To find details for your local IBD nurse specialist, have a look at the interactive map at: https://www.crohnsandcolitis.org.uk/support/find-an-ibd-nurse-specialist