Inflammatory Bowel Disease (IBD) Service

Inflammatory bowel disease (IBD) is generally used to describe two conditions: ulcerative colitis (UC) and Crohn’s disease.

Both ulcerative colitis and Crohn’s disease are long-term, autoimmune conditions that involve inflammation of gastrointestinal tract. Sometimes, IBD isn’t distinguishable between UC and Crohn’s and may be described as IBD-unspecified, or IBDu. Other diagnoses include microscopic or lymphocytic colitis.

Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect any part of the digestive system, from the mouth to the anus. The symptoms of both conditions are often similar, including:

  • pain, swelling or cramping in the tummy
  • recurring diarrhoea
  • blood and mucous in the stool
  • weight loss
  • fatigue
  • other symptoms such as joint pains

Not everyone has all of these symptoms, and some people may experience additional symptoms, including vomiting, anaemia and high temperature or fever. During a flare, symptoms may be more severe and additional treatment and advice may be required. Other times, the condition may be stable and in remission.

Most patients will be diagnosed with IBD with a flexible camera inserted into the bowel, via flexible sigmoidoscopy or colonoscopy. This would be carried out in one of our Endoscopy Departments. Other investigations like MRI scans of the small bowel may be required depending on the type of IBD you are diagnosed with.

Your Care Team

If you are diagnosed with IBD, you will be under the care of the gastroenterology team. You will either be booked in to see a gastroenterologist or a specialist nurse in clinic. The specialist nurse team work alongside medical and surgical colleagues at consultant level and meet regularly to discuss cases.

Junior doctors may conduct clinic appointments and can readily obtain advice from the consultant if necessary. This is an essential part of their training to ensure we have suitably qualified and experienced doctors for the future.

IBD Specialist Nurses

Our IBD specialist nurses offer patients information, education and support about all aspects of Crohn’s disease and ulcerative colitis, including any treatments they may receive. Their aim is to help patients live well with IBD and manage their condition as successfully as possible. There are currently four (soon to be five) IBD nurse specialists at our trust, across both Conquest Hospital and Eastbourne DGH. They provide a variety of different services designed to keep people well while ensuring they receive timely and effective care and treatment.

Our specialist nurses run both telephone and face-to-face clinics. This may be to discuss a newly diagnosed or existing case of inflammatory bowel disease, medication, tests undergone or required for monitoring and treatment planning purposes. Some patients with stable disease or mild disease will be on our Patient Initiated Follow Up (PIFU) whereby appointments can be requested by the patient when they feel they need one.

The service sees special drugs called biologicals, such as Infliximab, given to patients by an infusion through a drip in the arm, and Adalimumab which is given via an injection usually administered at home. Our nurses will screen patients to see if they meet the criteria for these drugs. They will then apply to the local care board (ICB) for special funding, to pay for the treatment, before coordinating the infusions in our infusion unit at Eastbourne DGH. There is also a homecare delivery team, who can help patients receive some treatments at home. Two of our nurses specialise in biologics, who assist and support patients receiving biologic therapies.

The specialist nurse team, along with the gastroenterologists, will regularly review all patients who are having biologics, either at the time of the infusion, via the telephone, or in clinics, to ensure they are making a positive difference to their condition.

If you think you may have IBD but are not diagnosed, you will need to be investigated by your GP first. The IBD service is for patients with a confirmed diagnosis of IBD. For patients already under our care, you may either have face-to-face or telephone clinics, depending on your preference, clinician availability and clinical need. You may see or speak to different nurses each time, but we are a small team and all work together to provide patient care.

Patients who have a diagnosis and are receiving care from us can use our advice line service, which is open between 9am to 11.30am (Mob: 07967 591636). Calls will be triaged in order of clinical priority and responded to within 72 hours. On rare occasions, we may have a reduced service – a voicemail message will be left alerting you to this. Please ensure you listen to this message. We are currently running this as a live advice line; if we do not answer your call between these hours and there is no message about changes to service availability, it means we are on the phone to a patient already and you will need to call back. Our IBD coordinator may speak to you about the details of the problem you are calling about and be able to help you if your query is administrative. IBD nurse specialists will then review and respond to queries.

Please note: the advice line is not suitable for medical emergencies or queries that require immediate clinician input. Your GP, 111 or the Emergency Department should be your primary methods of accessing these types of query, or non IBD related enquiries.

My Health and Care Record (MHCR)

The IBD team uses ‘My Health and Care Record’ (MHCR) to share information with patients.

MHCR is provided via a system known as Patients Know Best and is a secure online system where personal information relating to the care we provide can be viewed on any internet enabled device eg a desktop computer, tablet or mobile phone.

The IBD service is using the system to:

  • share information with you about your care
  • ask you to complete questionnaires about your health prior to appointments
  • signpost you to relevant resources and support
  • message the team directly and securely when you need to.

More information about MHCR, including details of how you can register and answers to some frequently asked questions, is available here.

If you do not have access to the internet or do not wish to register for MHCR, you will continue to receive information from the IBD service as you always have done.

Colorectal Surgery

Colorectal Surgeons specialise in surgery of the bowel. Patients with IBD sometimes require surgical treatments if, for example, medical treatments have failed to control symptoms. We try to ensure that our IBD clinics run at the same time as the colorectal clinics. You may be able to be seen by both teams at the same visit.

Only a small number of IBD patients need a stoma, where the bowel is diverted out of the abdominal wall and into bag. Where this does become necessary, stoma care nurses can give information and support before and after surgery whilst also providing education about appliances and how to care for a stoma.

Research

From time to time you may be offered the opportunity to participate in clinical research, including trials of new treatments for IBD. Currently available treatments do not always work as well as we would like, and we are constantly striving to offer better treatments and to improve our understanding of IBD. Participation in research is entirely voluntary and your normal care remains unaffected whether you take part or not. Please ask if you want to be involved in our research or if you would like more information about specific trials.

Referrals

Patients can be referred to our service via their GP.

Contact information

IBD advice line – 07972 243347 – 9am to 11.30 Monday to Friday (excluding bank holidays)

Our IBD advice line is open to IBD patients who are under the care of East Sussex Healthcare NHS Trust, GPs or other health professionals who have questions or concerns about any aspect of IBD, including treatment, medication, lifestyle changes and managing flare ups or relapses.

Please bear in mind that the Nurse may wish to review all of your current medication, even those drugs not taken for IBD, so it would be useful to have this information to hand. If your call is of an urgent of life-threatening nature then it is essential that you also seek alternative advice. Every patient will be given the advice line number following their diagnosis.