IBD

Question 1

What is IBD?

Answer 1

Inflammatory bowel disease

IBD is a Chronic Autoimmune Inflammatory condition of the Gastrointestinal tract (GIT), which includes;

Crohn’s disease

Ulcerative colitis

Inflammatory bowel disease unclassified (IBD-U).

Question 2

What is the difference between Ulcerative Colitis and Crohn’s Disease?

Answer 2

Site of Disease:

UC: Colon Only CD: Anywhere

Pattern of Inflammation:

UC: Continuous, beginning at anus. CD: Discontinuous

Type of inflammation:

UC: Mucosal, no granulomas. CD: Transmural,Granulomas

Extracolonic disease:

UC: No. CD: Abscesses, fistulae

Question 3

What are the causes of IBS?

Answer 3

Genetic

Function of the immune system

Environment (Smoking, ?Diet)

Question 4

What are the symptoms of IBS?

Answer 4

abdominal cramps and pain

frequent, watery diarrhoea (may be bloody)

severe urgency

constipation

fever during active stages of disease

loss of appetite and weight loss

tiredness and fatigue

Anaemia (due to blood loss)

Question 5

What are the different complication associated with IBS?

Answer 5

Bowel Stricture: Narrowing of the bowel because of the inflammation or scarring that can cause bowel blockage.

Abscess: A collection of pus or abscesses because the inflammation extends through the bowel wall.

Fistulas: Fistulas (where the disease tracks outside of the bowel via an abscess and extends through the bowel wall, forming a cavity)

Toxic megacolon: Where there is severe ulceration of the bowel wall, which causes the large bowel to rapidly distend.

Perforation: A hole or break in the bowel walls

Question 6

What are examples of Extraintestinal complications from IBS?

Answer 6

Joint pain

Skin conditions

Eye inflammation

Thinning of the bones

immune-mediated disease

Increased risk of skin cancers of melanoma

Question 7

What is Chron’s Disease treatment paradigm?

Answer 7

Steriods

Immunomodulators

Biologics

Surgery

Question 8

What are the energy requirements?

Answer 8

If weight stable:
EER- 100-125kJ/kg/d
EPR - 1.2-1.5g/kg/d (with ACTIVE inflammation)

If Malnourished:
EER 125-145kJ/kg/d (for repletion)
EPR – 1.2-1.5g/kg/d

Question 9

What are the dietary intervention for patients with IBS?

Answer 9

HPHE diet

Low fibre - diet may be required with structuring or obstructive disease

Identify & address any malabsorption (e.g. B12, bile salt malabsorption, fat soluble vitamins or Iron) & manage micronutrient deficits as needed

Small frequent meals

Keep hydrated

Consider ONS if required

Tackle any FAD diet or food avoidance – advocate strongly

Liquid diet/EEN - Should be considered if patient is steroid dependent or have structuring or fistulating disease.