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Ten Questions To Ask Your Doctor About Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a condition in which the intestinal tract is inflamed over a long period of time and may have ulcers in its lining. Let find out more about the problem from the experts.

Could Any Condition Other Than IBD Be Causing My Diarrhoea And Cramps?

It is well known that as many as a third of our IBD patients have irritable bowel syndrome symptoms at the same time. These can include occasional loose stools, abdominal bloatedness, and "gas and wind". Occasionally, infective gastroenteritis can result in some of the symptoms that mimic an IBD flare-up. Rarely, some drugs may cause loose stools or abdominal discomfort. When in doubt, please consult your doctor.

Do I Have Ulcerative Colitis Or Crohn's Disease?

Both ulcerative colitis (a chronic disease that causes long-term inflammation of the colon lining) and Crohn's disease (chronic inflammation of the intestinal wall) can have symptoms like chronic diarrhoea, sometimes bloody, abdominal pains, weight loss and lethargy. While both conditions may also include joint pains, mouth ulcers, rashes and red eyes, these are more commonly seen in Crohn's disease than in ulcerative colitis.

There is usually more weight loss, anaemia and lethargy associated with Crohn's disease. Definitive diagnosis of either diseases is usually obtained through endoscopy and histology from biopsies taken from the intestines.

What Parts Of My Digestive System Are Affected?

In ulcerative colitis, only the colon is usually affected. In Crohn's disease, the entire gastrointestinal tract can be involved-the mouth, oesophagus, stomach, small intestine, colon and anus. Local data suggests more than 50 per cent of Crohn's disease patients have disease in the ileum - the last part of the small intestine - and colon.

What Medications Do You Recommend?

The usual first-line therapy is a 5-amino salicylate compound. For moderate to severe flare-ups, short courses of steroids are used. Patients who require maintenance therapy after repeated flare-ups, are given second-line drugs which are immune-modulators. New drugs in the form of monoclonal antibodies are increasingly being used to treat Crohn's disease and may soon be approved for ulcerative colitis, but these drugs are expensive and are associated with side effects.

How Soon Can I Expect Relief?

In disease flare-ups requiring the use of steroids or monoclonal antibody treatment, one should expect relief within a week. Other agents like the 5-amino salicylate drugs may take a little longer. 

What Side Effects Should I Watch Out For? What Should I Do If I Notice Them?

Most medications carry some side effects. While 5-amino salicylates are usually safe, rare side effects may occur. Steroids can cause a variety of side effects that include weight gain, emotional liability, sleep disturbances and water retention. Less common complications may include avascular necrosis - a disorder that causes bones to become brittle and break easily - of the hip joint.

Prolonged courses of teroids may predispose one to nfections, diabetes, hypertension and ataracts. If the side effects are serious, :onsult your doctor early for a reduced lose of medication, or other alternatives.

What Should 1 Do If My Symptoms Return? Which Symptoms Should I Consider An Emergency?

Patients who have a return of symptoms while on maintenance medication can increase their medication doses. Sometimes, the disease relapses when patients do not take their medication for a period of time. Usually the mild attacks can be aborted by taking the usual medication again or by increasing the dosage.

If symptoms such as diarrhoea (often bloody), abdominal pains, fevers and lethargy do not go away in a few days, the gastroenterologist should be consulted with a view to in-patient management. An "emergency" is when there is severe bloody diarrhoea, which may be associated with abdominal pains and fever.

Should 1 Change My diet Or Take Nutritional Supplements?

There is usually no need for a radical diet change except in a few Crohn's disease patients with narrowed small intestines. In these patients, a low-fibre diet is advised so as not to precipitate a small bowel obstruction. Generally, one should take a balanced diet with components from all major food groups to ensure good supply of vitamins and minerals.

Personalised dietary counselling may be useful. While nutritional supplements are specifically advocated in patients with small bowel Crohn's disease due to problems related to malabsorption, they can be a good adjunct to any diet.

Do I Need To Make Any Other Lifestyle Changes?

It is always my hope that my patients live life to the fullest. My responsibility to them is to try to keep the disease in remission while they take to life, as completely as possible, just like any ordinary individual.

When Should We Have A Follow-up Appointment?

Patients with IBD should see their doctors regularly. Depending on the state of the disease and how well the patients are, the doctors will decide on the timing of the follow-up.


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