There is no cure, IBD is a life long disease!
Doctors are working on it, but with medicines and nutrition it is possible to keep the disease under control. If your disease is active you may get tired easily and not be as active as you would like to be. In remission, you should be able to lead a normal life. and enjoy all the activities your friends enjoy. there are a number of famous people who have IBD. One has even won Olympic medals…

Can inflammatory bowel disease ever be cured?
Although there is no cure at the moment for UC and CD, with medicines and nutrition it is possible to keep the disease under control so that you can lead an active and normal life. UC can be ‘cured’ by removing the entire large intestine.

Treatments

If your disease is active you may get tired easily and not be as active as you would like to be. however, you should be able to lead a normal life and enjoy all the activities that your friends enjoy. There are a number of famous people who have IBD. One has even won olympic medals. there is also a famous pop star who has CD. You may find that some people will treat you  differently when they know you have IBD. It may help if you explain to them what IBD is and that sometimes you get tired easily and that when your disease is in remission and you feel well, you can join in normal activities.
Treatments available

Treatments can be divided into three main areas.
Medicines
Food and drink (nutrition)
Surgery

Medicines used to treat Ulcerative Colitis (UC) and Crohn’s Disease (CD)
Steroids
Steroids are often the first medicines used for the treatment of both UC and CD, especially, if the symptoms are severe. These steroids are not like those taken by body builders but are more like those that are naturally found in the body. Usually we use a form of steroid called Prednisolone. other steroids work by reducing the inflammation of the intestines.

Steroids can be given as tablets, suppositories, liquid enemas or intravenous infusions. at first, a high dose of Prednisone is used for a month and then the dosage is reduced or weaned down gradually over the next few weeks until the treatment is finished. This slow reduction allows your own body to start making its own natural steroids.

Medicines
At times if the symptoms are very bad and the treatment is not able to get the disease under control, the steroids are often given at higher doses through an infusion or drip directly into the vein. this tries to bring the symptoms rapidly under control.

Suppositories and enemas
Occasionally if the disease is in the lower part of the intestine or rectum we can use enemas or suppositories to get the disease under control.in other words, the medicine goes up your bottom (anus.) This can be very effective as the medicine works directly on the site of inflammation. as a result, unwanted side effects are usually not a problem. However not everyone is comfortable with this form of treatment and we would always discuss this treatment with you before starting it.

Unwanted  side effects
Steroids may cause some unwanted side effects such as weight gain, acne and a round appearance to the face. these usually only occur if a high dose of steroids is taken for a long period of time. The doctor usually prescribes the lowest effective dose for the shortest period of time. even though getting these side effects may be a little tough, when you stop the steroids these side effects will disappear, and you will be feeling a lot better. sometimes newer steroids such as Budesonide which have fewer side effects may be used.

One of the most important things about taking steroids is that you should never stop taking them suddenly.you should always seek medical advice if you are unable to tolerate them. Stopping steroids suddenly could be dangerous and make you very ill. even when you have finished your steroid course, It is important to mention to your doctor that you have taken a course of steroids, as you may need some extra steroids if you are undergoing any medical procedures.

Aminosalicylates
These medicines include Mesalazine (Asacolon, Pentasa, Salofalk), Olsalazine (Dipentum) and Sulphasalazine (Salazopyrin). They are all similar medicines and your doctor will prescribe the one that most suits your needs. They work by reducing inflammation of the lining of the intestine. These medicines can control the inflammation in IBD very well, but they are not as strong as steriods. For this reason steroids are usually used for the treatment of severe disease. these medicines can be taken for a long period of time and do not cause the same side effects as the steroids. They are particularly useful in order to reduce the tendency of UC to relapse. They are less powerful as a ‘preventer’ in CD, but may be used to treat relapse.they are less powerful as a ‘preventer’ in CD,but may be used to treat relapse.

Antibiotics
Antibiotics are sometimes used for treating IBD. they work by reducing intestinal bacteria and possibly by directly affecting the intestine’s immune system. two of the most commonly used antibiotics are Metronidazole and Ciprofloxacin.

Metronidazole (flagyl) can be effective in managing perianal CD (disease involving the bottom area). side effects of Metronidazole may include nausea, headache, and loss of appetite. this medicine can also affect the breakdown of alcohol, so patients should avoid alcoholic beverages while on Metronidazole.

Ciprofloxacin(cipro) is another antibiotic that is occasionally used to treat active CD. it improves anal symptoms and heals fistulas (abnormal channals between two loops of intestine,or between another structure, such as the skin).

Immunosuppressants
The body’s immune system is responsible for dealing with injuries or infections. Inflammation is part of the bodys normal defense system, but in IBD the immune sysyem is overactive which leads to inflammation in the GI tract. The use of immunosuppressant agents, such as Azathioprine (imuran) and 6-mercaptopurine (6-mp, Purinethol) have a very important role in the treatment of IBD. these medicines suppress the immune system and reduce inflammation in the GI tract.

Immunosuppression medicines are usually used in patients that

1. Have disease that does not respond to treatment with aminosalicylates, antibiotics, or steroids
2. Have had repeated courses of steroids
3. Have disease affecting many areas of the GI tract
4. Have perianal disease that does not respond to antibiotics
5. Have fistulas

For the first few weeks when you are on these medicines, we will need to check your blood count every week to make sure that your immune system is not suppressed   too much. When we are happy that your blood counts are ok, we only need to check your blood on a monthly and eventually a three monthly basis.

It takes a while for these medicines to become effective (up to four months). therefore we often start a course of steroids at the same time so that when you are finishing the steroids, the immunosuppression has become effective.

Occasionally when the above treatments do not work we use newer treatments like anti-TNF alpha (infliximab). this treatment can be very effective with some patients. Infliximab is given via a drip over two hours. we usually give three infusions spaced out over a number of weeks. further infusions may be necessary to keep the disease under control. We usually also keep using an immunosuppressant agent such as imuran or 6-mp when giving these infusions. After the infusion you have to stay in the hospital for a few hours so that the staff can monitor your pulse and blood pressure.

Elemental feeding
Children and young people with IBD often suffer from poor appetite. They can feel sick and sometimes associate eating food with worsening of their symptoms. This then can result in poor nutrition.poor growth and weight loss. nutrition treatments aim to improve nutrition and weight, and also to reduce the inflammation in the intestine in much the same way as medicines can.

One of the commonest nutrition treatments is called elemental feeding. elemental diet requires very little digestion and therefore allows the intestine to heal and helps regain the weight that may have been lost. When the doctor decides to try this Treatment option, The team’s dietician is involved. the dietician assists in finding the correct diet to suit you.

If the doctor dies recommend nutrition treatment, it is usually for about 6-8 weeks during which time you will need to drink a special feed and you will only be allowed to eat little amounts of normal food. At the start it may be difficult but the dietician will give you a list of things that you can have if you are feeling hungry. These include clear drinks (like 7up or water), clear soups and some fruit sweets like fruit polo’s.

Elemental feeds are available in a number of different flavours and usually they are a little sweeter than normal milk. Sometimes children and young people are not able to drink the elemental feed,so then it is given through a Naso-Gastric tube(NG). An NG tube is a very fine tube that goes through the nose into the stomach. Usually the feed is given overnight when you are sleeping and is given through a special pump. This pump regulates the amount of feed that is given over night. Many children with IBD put the NG tubes in place themselves every evening, feed over night and then pull it up on their own in the morning. Even if you choose to leave the tube in place there is no reason why you cannot continue normal activities and attend school. This treatment may sound unpleasant, but most young people find it gets much easier to do as they get used to the treatment.

After the 6 week period, we will advise you on the type of foods to start reintroducing. as the amounts of normal food are increased, the quantity of elemental feeds is reduced. Occasionally we sometimes recommend that you take supplements as well as normal diet to assist growth and development.

Total parental nutrition (TPN)
TPN is used rarely as a treatment regime for IBD. TPN allows for complete rest of the intestine when symptoms are not responding to drug therapy or elemental feeds. TPN is nutrition delivered directly via a drip into the blood stream through a vein. TPN gives the body all the calories and nutrition that it needs to grow and develop. This treatment is usually given in the hospital, but if needed long term TPN can be administered  at home.

There are also alternative diets/nutrition which can be used in conjunction with medication until symptoms have completely gone.
This can achieve long periods of remission in some cases of IBD but unfortunately flare-ups after a couple of years are common.

Diet & Nutrition

Is there a special diet that I need to take when I am diagnosed with IBD?Usually there is no need to go on a special diet, but sometimes certain foods may not agree with you. if some foods cause worsening of symptoms, you should avoid them.

Some children and young people with IBD, even though they feel hungry, lose their appetite when a full mean is put in front of them. In this case it is helpful to eat smaller amounts of food more often. Even though you may be feeling unwell, it is important that you try

Some of the more popular diets tried in conjunction with meds are:
(please consult your doctor and dietitician before trying new diets a lack of the proper nutrients and vitamins can prove harmful!)

Specific Carbohydrate Diet

The Specific Carbohydrate Diet
Gluten and Wheat Free diet
The Stone Age Diet

Surgery
sometimes in severe cases of IBD surgery may need to be considered. this is usually necessary if the disease does not respond to medicines or nutritional therapy. surgery usually improves the quality of life of those that require it, as they typically have been unwell for some time prior to the surgery.

If surgery is to be an option, we will arrange for you to see a doctor who is a specialist in surgery of the intestine who will explain the surgical procedure to you. We can also organise someone of your own age who has gone through a similar experience to come and talk to you.

Although the idea of an operation may be scary, most patients who have had surgery are glad they have had it done. Afterwards they feel so much better, and are able to join their friends in activities that they were unable to do previously.

Surgery for children with IBD is not that common and the decision to have an operation will only be taken if it is necessary and following a lot of discussion with you and your family.

*Let us know your child’s experience with medications or surgery it may help other parent’s and children face some tough decisions or change their course of treatments, info@gutsykids.ie

New Research

Poo Transplants…New study reveals that healthy fecal matter transplanted into bacteria laden colons cures infection…

Read about the study By Brett Spiegel, Staff Writer at EverydayHealth.com

OR Click on the image below to watch a video…