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Medical > Gastro > Inflammatory Bowel Disease IBD – Crohn’s Disease & Ulcerative Colitis


Inflammatory Bowel Disease IBD – Crohn’s Disease & Ulcerative Colitis

  

Inflammatory bowel disease (IBD) is a term mainly used to describe Ulcerative Colitis (UC) and Crohn's Disease (CD)

Reviewed on : 27 Sep 2024

Reviewed by : Gateway Editor

Expires : 27 Sep 2026

INFLAMMATORY BOWEL DISEASE TEAM UHCW

Our service comprises of  Gastroenterology Consultants, Clinical Nurse Specialists and Dieticians.

We also have access to specialist services including, small bowel capsule, radiology and all aspects of endoscopy.

GASTROENTEROLOGY CONSULTANTS

  • Dr Eaden
  • Dr Burch
  • Professor Nwokolo
  • Professor Arasaradnam
  • Dr Loft
  • Dr Darlow
  • Dr Disney
  • Dr Mannath
  • Dr Vinnamala
  • Dr Unitt
  • Dr Gordon
  • Dr Wong

IBD CLINICAL SPECIALIST NURSES

The Nurses are available during office hours Monday – Friday

Contact:

Tel IBD: Advice line externally 02476 966075 or internal 26075.

Email: inflammatoryboweldiseaseadvice@uhcw.nhs.uk

The IBD Advice line is available during office hours Monday to Friday. Please leave a detailed message if we are not in the office including the patient’s details and contact number and we will respond within 48 hours.

For advice outside of these times, please contact either the patient’s consultant secretary, GP, Walk in centre or A&E as appropriate.

REFERRALS

Pre-referral investigations

  • FBC, ESR, CRP
  • In patients under 45 years, check faecal calprotectin

For faecal calprotectin, the laboratory require a stool sample the size of a 2p coin, in a labelled pot. Mark clearly on the form that the sample is for Biochemistry, not Microbiology. Stool samples should also be sent to microbiology to exclude infection.

Advice from UHCW laboratory: “Analysis of faecal calprotectin for the exclusion of active bowel inflammation is only recommended in patients under 45 years old, or for monitoring patients who have a previously diagnosed inflammatory bowel condition.”

Referral threshold – If a new patient with suspected inflammatory bowel disease, refer urgently.

OUTPATIENTS

Patients who are suspected or newly diagnosed with IBD should be seen by a Gastroenterologist. Once established they may see the IBD Nurse for their outpatient appointments. Patients are also offered telephone clinic appointments with the IBD nurses and patients who are on biologic medications are often reviewed by nurses in the virtual biologics clinics.

IRON INFUSIONS

Please refer patients via the Requests/ Referral Tab on CRRS, patient referral, IBD Nurse Specialist, inpatient/outpatient and iron infusion Tab. Please fill in the patient’s details and their weight if possible.

FOR PATIENTS WITH A SUSPECTED FLARE

Arrange:

  • Stool for FCP,
  • Stool cultures for infection
  • Bloods including inflammatory markers
  • Plain AXR and contact the IBD Advice line.

If patients are being discharged from hospital following a flare they should be followed up with an appointment with their original consultant within 6 weeks.

Click on images below for image with working links

 

 

 

FAECAL CALPROTECTIN – PRIMARY CARE GUIDANCE 2024

Calprotectin is a protein released into the gastrointestinal tract when inflamed, such as in inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis)

It is a stable protein, so can be detected in the stool by laboratory assay

Elevated levels of faecal calprotectin (FC) are found in IBD. In functional disorders of the gastrointestinal tract, such as irritable bowel syndrome (IBS), faecal calprotectin levels are normal

Clinically, it is often very difficult to distinguish IBS from IBD based on symptoms, signs, and blood tests. Faecal calprotectin can be used as a biomarker to support assessment (NICE DG11)

Who should faecal calprotectin be requested on?

Patients aged 18-60 years presenting with lower gastrointestinal symptoms where IBS or IBD is suspected but there is diagnostic uncertainty

It should not be used if colorectal cancer (NICE NG12) or acute severe IBD are suspected, or in place of faecal immunochemical testing (FIT; NICE DG56)

Consider in FIT negative patients where colorectal cancer is not suspected

When to request faecal calprotectin

If no ‘red flag’ indicators are present and cancer, or acute severe IBD, is considered unlikely, primary diagnostic tests should be undertaken:

  • FBC, UE, CRP, TFT, bone profile
  • Coeliac screen
  • Stool culture

If primary diagnostics are uninformative and there is diagnostic uncertainty, request faecal calprotectin before referral

How to interpret faecal calprotectin result

Initial faecal calprotectin <100μg/g

  • IBD unlikely
  • Treat as IBS (NICE CG61) and review in 6 weeks
  • Or consider urological and gynaecological diagnosis

At review, if still symptomatic:

Aged <50y and faecal calprotectin <50μg/g – treat with 2nd line IBS therapy before considering routine gastroenterology referral

Aged ≥50y of faecal calprotectin ≥50μg/g – refer to gastroenterology routinely

Initial faecal calprotectin 100-250μg/g

  • Repeat faecal calprotectin within 2-4 weeks

Initial faecal calprotectin >250μg/g

  • If symptoms are significant or worsening, refer to gastroenterology urgently
  • Otherwise, repeat faecal calprotectin within 2-4 weeks

Repeat faecal calprotectin

  • FC >250μg/g:     Urgent referral to gastroenterology
  • FC 100-250μg/g Routine referral to gastroenterology
  • FC <100μg/g      IBD unlikely, plan care as if initial FC was <100μg/g
Method
  • Use a blue stool pot – a 2p sized amount of sample is sufficient (solid stool best if possible)
  • Morning first void stool is best
  • Send to BIOCHEMISTRY (not microbiology) – stable at room temp
  • Give as much clinical info as possible (symptoms and duration)
  • Send a SEPARATE sample to microbiology for M,C+S  if patient has diarrhoea unless infection has already been excluded

 

 

 

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