Inflammatory bowel disease

THE INCIDENCE of inflammatory bowel disease (IBD) is in- creasing worldwide. The underlying causes of IBD, which encom- passes Crohn's disease and ulcerative coLitis, are unknown but are thought to be a com- bination of genetics, environmental factors, abnormal immune re- sponses and disruption to the microbiota in the gut. IBD can be a devas- tating disease, affect- ing quality of Life and increasing risks for bowel cancer. Effec- tive management has been an elusive goal, but with better under- standing of the inflam- matory and immune pathways involved in IBD, more successful therapies are entering clinical practice. To deliver quality care and help people with IBD manage this dis- ease, nurses must be familiar with the cur- rent understanding of its causes.

Specialist support

People with ulcerative colitis of Crohn's disease often develop the conditions in their teens or early twenties. Specialist nurses help people cope and get on with their lives. Access is improving, but one in five young patients still miss out on specialist nursing care.

Impact of a patient-support program on mesalamine adherence in patients with ulcerative colitis--a prospective study

BACKGROUND

Patient adherence to medications, particularly mesalamine, is reported to be low in patients with ulcerative colitis. We sought to determine whether a nurse-delivered patient-support program could improve medication adherence in these patients.

METHODS

Patients prescribed mesalamine for ulcerative colitis prospectively received either a 23 week, nurse-delivered, patient support program (PSP) by phone, or standard care (SC). Medication adherence and quality of life were measured before and at 3 and 6 months after the program started.

RESULTS

Eighty-one patients completed the study; 60 who received standard care, and 21 who received the PSP. Patients were in remission (mean SCAI score 3) at enrollment. Mean % of prescribed mesalamine refilled was 71% and 74% in the SC and PSP groups at 3 months (p=0.7), and 73% and 84% at 6 months (p=0.4). The proportion of adherent patients at 3 months (39% vs 44%, p=0.7) and 6 months (50% vs 67%, p=0.3) were similar between the SC and PSP groups. There was no association between use of the PSP and adherence at 3 (OR 1.2, 95% CI 0.4 to 3.8) or 6 months (OR 2, 95% CI 0.6 to 7). The change from baseline in SIBDQ scores were similar between SC and PSP groups at 3 months (+0.3 vs +0.2, p=0.8), and 6 months (+0.6 vs +0.2, p=0.2).

CONCLUSIONS

This nurse-delivered patient-support program did not significantly improve medication adherence or quality-of-life beyond standard care at short and medium-term time-points. Simply discussing and measuring adherence improved mesalamine adherence in both groups in this study.

“Take Your Medicine”

Ulcerative colitis is a lifelong disease causing inflammation and ulceration of the colon. Symptoms of ulcerative colitis include abdominal pain, bloody diarrhea, bloating, and fecal urgency. The current standard therapy for mild to moderate ulcerative colitis is the use of 5-aminosalicylates, with patients requiring continuous treatment to maintain remission. A substantial proportion of patients, however, are nonadherent to prescribed 5-aminosalicylate treatment regimens, resulting in a greater chance of disease relapse with severe associated symptoms. There are many reasons why a patient with ulcerative colitis may be nonadherent including the patient's perception of the condition or a lack of understanding about the disease or treatment. Multiple daily dosing or rectal administration of 5-aminosalicylate medications also can adversely affect adherence rates. Because gastrointestinal nurses often are the primary points of contact for patients with ulcerative colitis, they are in a unique position to take simple steps that will improve adherence rates and thus increase the efficacy of prescribed therapy. This article highlights important aspects of education and patient care for patients with ulcerative colitis.

Inflammatory bowel disease--nursing care during the surgery treatment period

Inflammatory bowel disease is highly associated with an option of potential surgical treatment. Variety of surgical methods require detailed and appropriate patient preparation for the operation. In our study we tried to present some problems in dealing with patients with inflammatory bowel disease in aspect of perioperative period. We discussed methods of solving these problems and expected effects of nursing procedures.

Creating the evidence base: the journey from practice to research

The ability to deliver accurate, evidence-based information when helping patients make decisions about their care is fundamental to the role of the clinical nurse specialist. For patients with ulcerative colitis who are considering surgery to form an ileo-anal pouch, it is essential to give them information about the psychosocial, as well as the physical, effects of such surgery. As many of these patients are of working age, understanding the likely consequences for paid employment is a priority. However, very little evidence is available on this subject. The authors therefore decided to develop a research study aimed at filling this gap. A proposal to conduct a phenomenological study into the subsequent employment experiences of patients who have undergone ileo-anal pouch formation has been developed. This article seeks to explore how the research idea and its methodology stemmed from practice and highlights the importance of seeing research and practice as complementary components of good nursing care.

Ulcerative colitis-Diagnosis and surgical treatment

Ulcerative colitis is a serious illness affecting the colon. Extracolonic manifestations include sclerosing cholangitis, arthritis, eye diseases, ankylosing spondylitis, and sacroiliitis. Ulcerative colitis may increase a patient's risk of cancer, depending on the duration and extent of the disease. Surgery is the only definitive way to remove the disease in its entirety. It may be possible for patients who do not wish to have a permanent stoma to undergo a restorative proctocolectomy with ileal pouch-anal anastomosis. Normal bowel physiology, pathophysiology of ulcerative colitis, medical and surgical treatments, and postoperative complications are discussed.

Responses of people with inflammatory bowel disease to foods consumed

The purpose of this study was to assess the reactions of people with IBD to foods consumed. A database was created to capture the season of data collection, the disease, the food, and the subject's reaction to each food. A 122-item food list was used. Sixty patients with IBD (n = 33 persons with Crohn's disease, n = 27 persons with ulcerative colitis) completed the questionnaire about foods and their reactions to the foods in the fall and spring representing summer and winter consumption. Foods that made the subjects feel better and worse were identified. Although the original purpose of the study was to assess people with IBD as a group, it became apparent that reactions to foods were different according to whether a subject had Crohn's disease or ulcerative colitis. Failure to distinguish between the two diseases and use only the pooled data made the data meaningless. The importance of this finding and themes related to foods that had a positive or negative effect on the subjects is discussed in this article.

Ulcerative colitis: from medical management to ileal pouch anal anastomosis: a patient's perspective

Ulcerative colitis (UC) is a chronic disease that may require extensive medical and, at times, surgical intervention. Patients with UC are encouraged to form a multidisciplinary healthcare team to provide the support needed to cope with this chronic, debilitating illness. In this article, the authors provide the personal perspective of a patient coping with UC, the role of the gastroenterology nurse, and the viewpoints of key members of the healthcare team. Tracing the course of the disease from onset to medical management and then surgery, the authors relate the process by which the patient interacted with the healthcare team to reach the decision for seeking a surgical solution to the disease and how the patient coped with the rare but extended complications of surgery. The patient's decision illustrates the importance of her perspective and the varying roles played by the healthcare team. Medical management of UC and the technical aspects of ileal pouch anal anastomosis surgery are discussed.

Living with ulcerative colitis: experiences of adolescents and young adults

The problems associated with ulcerative colitis and its treatment have effects on adolescents and young adults dissimilar from as well as more profound than those on older individuals. Adolescents are confronted with problems such as biological, psychological and social changes as well as role changes related to peers and family. This inductive study aimed to describe the adolescents' experiences of living with ulcerative colitis. A total of 28 subjects were asked about their experiences both at the present time and at the time their first symptoms appeared. Verbatim transcribed thematized interviews were analysed according to a method influenced by the constant comparative method for grounded theory. Eight categories were grounded in the data, forming a model which describes the process from onset of disease to present time. The main variable identified was: reduced living space, a strategy to manage the new situation. Dependent on the reactions received from significant others, the outcome for the adolescents hovered between feelings of self-confidence and lack of self-confidence. If the adolescents experienced support, the living space was expanded again. The results might be of great value when caring for and assisting young persons with a chronic disease in general, and in particular when taking care of adolescents with a recently diagnosed inflammatory bowel disease.

Therapeutic advances in ulcerative colitis

Ulcerative colitis is an inflammatory condition that requires individualized and innovative therapy for each patient depending on the symptoms, location, severity, and chronicity of the disease. It is most often a chronic illness that requires modification in treatment as the stage of the disease changes. Systemic and rectal aminosalicylates (sulfasalazine, mesalamine, olsalazine and corticosteroids) remain the most useful therapeutic agents. Rectally administered mesalamine and the forms of oral mesalamine appear to have significant advantage over sulfasalazine dosage forms. Future clinical usage and scientific study will determine the place of these newer agents among other medical therapies and the surgical management of ulcerative colitis.

Inflammatory bowel disease: primary health care management of ulcerative colitis and Crohn's disease

Inflammatory bowel disease encompasses both ulcerative colitis and Crohn's disease, two conditions so alike clinically that they are frequently indistinguishable from one another. Inflammatory bowel disease occurs at a rate of approximately five per 100,000 people. It tends to cluster in families and is seen four to five times more often in Jewish Caucasians than in other Caucasians. The etiology is unknown. Increasing attention is being paid to autoimmune factors, genetic factors and food allergies, and the notion that inflammatory bowel disease has its roots in a psychological disorder continues to pale for want of empirically sound evidence. Disease pattern is one of remission and exacerbation. The aim of therapy is to maintain an optimal lifestyle in remission through an individually tailored protocol of medications. Sulfasalazine remains the medication of choice; corticosteroids have short-term utility in exacerbation; and immunosuppressants, though controversial, are thought to have some steroid-sparing benefits during acute flare-ups. Indications for surgery vary, depending on whether or not a clear differential diagnosis has been made between ulcerative colitis and Crohn's disease. There is no cure for inflammatory bowel disease except for total colectomy in clearly diagnosed ulcerative colitis. Current research endeavors seek a cause or causes for inflammatory bowel disease, but the literature does not solidly support any one possibility above other rival etiologies.

Rowasa suspension enema (mesalamine, USP)

Rowasa (mesalamine) rectal suspension enema, a new product by Reid-Rowell, represents a major breakthrough in the treatment of distal ulcerative colitis. It provides patients with an alternative therapy to the current oral and enema preparations. This treatment reduces the incidence of unwanted side effects and toxicity associated with oral therapy.

Inflammatory bowel disease: effects on lifestyle

While there has been speculation in the literature about what life with inflammatory bowel disease (IBD) is like, patients have not, prior to this study, been asked about their perceptions. This paper reports the results of a study which measured the impact of having IBD on eight lifestyle variables. Eighty IBD patients completed the Inflammatory Bowel Disease Stress Index. Results showed that although the impact of IBD on relationships, school and employment, recreational activities, sexuality, psychosomatic symptomatology, body image and worry was minimal, the patients' satisfaction with life was impaired as a result of having IBD. Rationale for this discrepancy and the significance of the findings for nurses are presented.

Care of the patient critically ill with inflammatory bowel disease

The nurse is instrumental in providing and coordinating the complex care of the patient critically ill with inflammatory bowel disease. Knowledge of the disease process and its complications provides the nurse a foundation for understanding the clinical course of the disease and for planning patient care. Management of alterations in nutritional status, wound healing, and fluid and electrolyte balance ensure an optimal recovery trajectory.