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Crohn’s disease

Crohn’s disease is an inflammatory condition, caused by a combination  of genetic, bacterial and immune system factors. The condition can be present in any part of the gastrointestinal tract and brings a range of symptoms. The most common presentation is abdominal pain and diarrhoea: you may notice bleeding from the back passage, along with diarrhoea and sometimes pain, swelling or infection around the anus. Other symptoms can include fever, weight loss, tiredness and general poor health.

Because the disease can cause considerable impact on quality of life, and because it can develop at any age, diagnosing and treating Crohn’s disease promptly is important. Whilst there is no permanent cure, we can achieve a lot.

Diagnosing Crohn’s disease

Crohn’s can appear similar to other inflammatory bowel conditions and misdiagnosis is not unknown. Making an accurate diagnosis is critical; the diagnostic technology and pathology expertise at our London clinics can help you with this.

Whilst blood and faecal analysis may be useful, visual examination of your digestive tract using endoscopy is more definitive. A further option is to use types of digestive tract imaging, such as ultrasound or MRI scans. We’ll also discuss your medical and family history with you, as well as any related symptoms, such as blood loss via your bowels and your general wellbeing. We find that listening to each individual patient is vital. People don’t always respond in exactly the same way to Crohn’s disease. How this is affecting you and your life is just as vital as any medical symptoms and always plays a part in finding you the best solution.

Treating Crohn’s disease

The aim of Crohn’s disease treatment is to halt the inflammatory process, allow healing of the intestine, reduce or eliminate symptoms, and avoid surgery whenever possible.

Corticosteroids, such as budesonide or prednisone can often control the inflammation, but can have undesirable side effects and are best avoided if possible.

A variety of medications can reduce the inflammatory response, including antibiotics, immunosuppressants and, if necessary, biologic medicines including anti-TNF antibodies, or new drugs such as vedolizumab and ustekinumab. Which treatment you end up receiving will depend on a range of factors, including the nature of your individual condition and the location of the inflammation.

Fully personalised treatment

As well as medication, dietary therapy can prove valuable in some cases. This may mean switching to a low-fat, low-fibre diet, although once again, solutions will depend – and be tailored to – your individual circumstances.

The same applies in cases where Crohn’s disease has been a long-term issue and has damaged the digestive tract or nearby tissue. While surgery may be required, I will always discuss all the options and approaches with you to make sure you’re happy with the personalised treatment plan offered.

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Ulcerative colitis

In cases of ulcerative colitis, the colon and rectum become inflamed without a single obvious cause.

It can be triggered by an infection, but often develops as bloody diarrhoea. For reasons that are unclear, it sometimes involves symptoms in other areas; mouth ulcers, eye irritation, swollen joints, and even liver problems. These side effects can be debilitating, as can the direct effects of ulcerative colitis, and, over time, it can lead to damage of your colon. Thankfully, in most cases, the condition is controllable once correctly diagnosed.

Diagnosing ulcerative colitis

Diagnosis starts with a careful examination, including looking at your medical and family history. Blood and stool sample analysis can be helpful, and can be used to check for other kinds of infection as well. A sigmoidoscopy, or colonoscopy allows your specialist to see inside your bowel, take high-resolution images and tissue samples for biopsy. If necessary, we are able to call on other imaging techniques, including ultrasound and MRI.

Treating ulcerative colitis

For mild to moderate disease, an anti-inflammatory drug called mesalazine is effective. It is similar to aspirin and acts directly on the colon lining with very few side effects.

In more severe cases, corticosteroids can be valuable in reducing inflammation, although these can have notable side effects longer term. Immunosuppressants such as azathioprine and  antimetabolites are an alternative for ongoing control. TNF inhibitors, such as infliximab, or adalimumab or the anti-integrin antibody vedolizumab are additional options. They reduce the over-production of a natural protein, and can help to suppress your body’s inflammatory process. Whilst food is rarely the aggravating factor in ulcerative colitis, intolerance of sugar lactose in dairy products can be. We will consider this, alongside every other treatment option, and talk it through with you to achieve the best possible outcome.

Improving your quality of life

Ulcerative colitis can, by nature, involve periods of remission, counterbalanced by acute flare-ups. One of our aims in the treatment we offer is to induce long-term remission and improve your quality of life. Because we don’t know what causes the disease, we usually see patients at intervals for many years.

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Food intolerance

Food intolerance, an unpleasant reaction to certain foods or drinks, can be immediate or delayed. It is normally a digestive system reaction, unlike food allergies, which are immune system related.

Symptoms can include bloating and stomach pain, although you might experience wider issues, such as headaches, bowel irritation, or feeling run down.

Intolerance can be the result of several factors, among them an absence of enzymes needed to digest a particular food, your body’s inability to absorb nutrients or a reaction to certain chemicals in foods. There are other, less common causes, all of which we can look into as part of your specialist consultation.

Diagnosing food intolerance

Diagnosis can involve specialised, exhaled breath testing for lactose intolerance, bacterial overgrowth or fructose malabsorption. I caution against the wide range of publicly available food intolerance tests, as the NICE guidelines do.

Apart from being scientifically unsound, inappropriate or inaccurate results can pose a risk to your health. Even though you have symptoms which could indicate food intolerance, the problem may well be something else entirely.

Symptoms such as bloating, tummy pain or difficulty digesting foods can be signs of a number of gastroenterological conditions. Ruling other causes out is a one of the many reasons why visiting a consultant is your best course of action.

I’ll take the time to listen, discuss your medical history with you, investigate your symptoms and provide you with a definitive diagnosis. Where food intolerance is the problem, we can help – taking the right approach is key.

Treating food intolerance

Whilst medication can help treat symptoms in some cases, it is not an answer in itself. Keeping a food diary can be helpful, undertaking a professionally supervised elimination diet more so. Food intolerance can be caused by a broad range of factors, such as wheat intolerance, or by subtle additives which need to be carefully traced.

Working with you

While excluding other causes is essential, you may also need to adopt lifestyle and dietary changes that go beyond cutting out a particular food. No two people are the same, or lead the same life. That’s why I treat food intolerance treatment on a fully individualised, patient-led basis. 

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IBS (Irritable bowel syndrome)

Irritable bowel syndrome (IBS) is a common condition that affects up to 20% of the population. Symptoms typically vary from person to person, but can include abdominal pain, bloating, wind, changes in bowel habit from constipation to diarrhoea, including a sudden and desperate need to go.

It’s a complex condition which can result from a combination of excessive intestinal motility (movement) and heightened sensitivity. A mix of physical and stress-related aspects can be compounded by the fact that IBS itself is a distressing condition for many.

Eating certain foods can also contribute to symptoms, although the pattern will vary from person to person. A consultation with a specialist consultant can help put your mind at ease. We’ll talk to you about your individual circumstances, before putting a fully personalised treatment in place.

Diagnosing IBS

IBS is a functional disorder within your digestive tract, with no obvious diagnostic abnormalities. Your diagnosis will be based on your individual symptoms and routine investigations.

In our London clinics, we usually request blood and faecal analysis to help eliminate other causes, such as infection. A stool test called faecal calprotectin can confirm whether your symptoms are being caused by an inflammatory bowel disease rather than IBS.

Treating IBS

Antispasmodic medication such as mebeverine or buscopan can relieve abdominal pain, especially if symptoms worsen soon after eating. Anti-diarrheal agents can also be useful, or laxatives, especially non-stimulant laxatives, if you’re experiencing problems with constipation.

There are also newer medications, including linaclotide or prucalopride, which can be very helpful to regulate constipation or abdominal pain with bloating. Many patients also come to us suffering from IBS-related anxiety, which we can help manage with medication.

All of these, of course, should be used under the supervision of an experienced specialist. While they can relieve symptoms, most drugs bring additional, unwanted effects and may not be a long-term solution.

Often, the best treatment for IBS is a change to your diet or lifestyle. Modifying the amount of soluble, or insoluble fibre in your diet is known to help, but while generic approaches, such as a low FODMAP diet, may bring some benefit, there’s no such thing as an IBS friendly diet. Ultimately, a more detailed approach, designed specifically to suit you, and often with lifestyle changes to match will bring most benefit.

Supporting you

Each patient needs an individualised approach. When you come for IBS treatment in London, I’ll discuss your medical and family history with you, examine you and order any necessary tests.

I’ll work with you to understand your condition and how we can best control it. Whether IBS is a new condition to you, or you have a history with it, we’ll offer you every support. If you need more information, or have any related questions, feel free to get in touch at any time.

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