FEATURE
Inflammatory Bowel Disease
I
nflammatory bowel disease is an umbrella term for Ulcerative Collitis and Crohn’s disease, two frequently encountered conditions in community pharmacy. These conditions can develop at any age but most commonly present in teens and those in their early twenties. They are lifelong conditions, affecting men and women in equal proportions. Although it is difficult to tally the total cost of IBD to the NHS, one recent cost analysis (2008) suggested a cost of approximately £631-£732 per person per year. This adds up to an annual cost to the NHS of up to £470 million6
. Smoking
Pharmacists are in an ideal position to help patients receive the best possible care for their condition, assisting with early disease recognition, optimising disease management and aiding those affected to continue their usual daily activities unimpaired.
CROHN’S DISEASE
Scotland has one of the highest rates of Crohn’s disease in the world2. The incidence of Crohn’s disease is about 83 per million people per year in the UK. It is a chronic, relapsing-remitting condition affecting any area of the gastrointestinal tract from the mouth to the anus. Areas affected are often referred to as “skip lesions”, as they tend to be distinct areas with areas of normal tissue between. The entire thickness of the gut wall is affected1
.
Not a lot is known about the exact cause of Crohn’s disease; many
46 - SCOTTISH PHARMACIST Appendectomy
A systematic meta-analysis found smoking to be related to the presence of Crohn’s disease, with an odds ratio of 1.761. Pharmacists can provide the smoking cessation service to eligible patients and promote quitting smoking.
Family History
25%-40% of children with Crohn’s have a family history of the condition. Siblings of a person with Crohn’s disease are between 17 and 35 times more likely to develop Crohn’s than the rest of the population.
Post- appendectomy, the risk of Crohn’s developing increases, but then reduces again to that of the general population after about five years
NSAIDs
There is weak evidence to suggest a link between the use of NSAIDs and increased risk of relapse or exacerbation of Crohn’s
Oral Contraceptives
Although there is an increase in IBD with contraceptive use, healthcare professionals should note that the absolute risk is very small and so should not influence the decision to use oral contraceptives
sources suggest it is due to an interaction of both environmental and immunological factors1
. Table 1 lists
some of the established risk factors for Crohn’s disease.
Dr Charlie Lees is a Consultant Gastroenterologist and Senior Lecturer at the Centre for Genomic & Experimental Medicine, University of Edinburgh. In a recent statement, he said:
Risk Factor for Crohn’s Disease
“Over the last ten years we have made significant progress in understanding the genetic underpinnings of Crohn’s disease. However this only accounts for about a third of why somebody gets the disease. We need to look at healthy people and follow them over time to truly understand which factors cause the condition and which are consequences of the inflammation in the gut that occurs as part of the disease…”2
Table 1: The risk factors associated with Crohn’s disease1 Description
Diagnosing Crohn’s disease can be difficult. Disease presentation varies widely and is influenced by patient age, disease onset, symptoms, areas affected and disease severity. Pharmacists can be alert for the following signs and symptoms occurring in patients, particularly if they are recurring:
• Diarrhoea or frequent loose stools • Abdominal pain and tenderness
• Signs of malnutrition or malabsorption
• Anal or peri-anal skin tag/fistula/ abscess
• Anorexia • Fatigue • Malaise • Fever • Mouth Ulcers
As part of disease management, healthcare professionals are encouraged to ensure that there is specialist follow- up in place for patients. While pharmacological treatment is started in secondary care, it can be continued in primary care under a shared-care protocol between gastroenterologist and GP; primary care and secondary care should be co-ordinated1
. Adherence
to drug treatments is low, with an astonishing 40% of Crohn’s patients not taking medicines correctly1
. Pharmacists can promote compliance
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