Spotlight on Inflammatory Bowel Disease

Rachel Fowler, RCGP & Crohn’s and Colitis UK Inflammatory Bowel Disease Spotlight Project Patient Representative
Dr Kevin Barrett, RCGP & Crohn’s and Colitis UK Inflammatory Bowel Disease Spotlight Project Clinical Champion

Inflammatory Bowel Disease (IBD) affects 1 in 250 of the population and the prevalence is rising. Most patients are diagnosed between the age of 15 and 40. Patients commonly report a delay from the time of first presentation to their GP to diagnosis; in a third of cases this can be over a year. The longer the delay, the more severe the disease can be and the more likely patients are to need more aggressive therapy.

The causes of IBD are multifactorial. A genetic predisposition together with an abnormal immune reaction triggers inflammation of the bowel wall leading to a combination of diarrhoea, ulceration and bleeding in the majority of cases. These symptoms can overlap with those of other gastrointestinal and gynaecological conditions, therefore initial diagnosis can sometimes be difficult. The use of faecal calprotectin to exclude functional bowel disorders can be useful. IBD can cause fistulae, strictures and extraintestinal symptoms including seronegative arthritis, erythema nodosum, pyoderma gangrenosum, iritis, scleritis and primary sclerosing cholangitis. Malabsorption of nutrients, particularly calcium, B12 and iron can occur. Fatigue is a common symptom even in remission.

Rachel Fowler, the patient representative for the project, was diagnosed with Crohn’s disease in 2013, around a year after her first contact with her GP. Following a period of misdiagnoses, she finally managed to argue her case to be referred to a Gastroenterologist.

IBD is an illness that predominantly affects younger patients either in education, at the start of their careers, or who have young children themselves. The impact of IBD on the patient and their families can be significant. GPs are in a key position to provide advice and signpost to voluntary organisations who can offer further support.

The initial survey that was carried out as part of the Spotlight Project had over 600 participants and highlighted a desire amongst GPs for education, predominantly with diagnosis. management of flare-ups, surveillance for colorectal cancer, and providing dietary advice and psychological support. The Spotlight Project has launched a toolkit and we will be adding to this as the project develops, as well as launching an eLearning module and holding events in each region of the UK this autumn.

Working in partnership with Crohn’s and Colitis UK has given us the exciting opportunity to improve the lives of the 300,000 patients in the UK with IBD, and to improve the confidence of GPs in dealing with this varied, interesting, and important disease.

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