The patient-physician relationship is a fundamental pillar of healthcare, and shared decision-making is essential to ensure that patients are actively involved in their own care. It is even more important when dealing with long-term or chronic diseases or conditions.

This is why we have compiled a list of the most common problems in doctor-patient communication and made some recommendations on how to communicate effectively when making decisions with patients.

Common problems in patient communication

• Language and cultural barriers: Differences in mother language can make it difficult for the doctor and patient to understand each other and to explain pathology and options in terms that are too technical or complex.
• Complexity of medical information: Medical information can be complex and difficult to understand for patients who do not have a medical background. The use of medical jargon can contribute to patient confusion and frustration.
• Lack of time or privacy: Medical consultations are often short and tightly scheduled, which may limit the time available for detailed and complete communication, tailored to the individual and with sufficient time to check for full understanding of the message. Lack of privacy may also make it difficult for patients to feel comfortable sharing personal information or asking sensitive questions.
• Strong emotions: Fear, anxiety, shame or sadness, and even acceptance or non-acceptance of the new situation can affect a patient’s ability to communicate clearly and effectively.
• Power inequalities: The doctor-patient relationship may be marked by a perceived unequal power dynamic, which may make it difficult for the patient to feel comfortable asking questions or expressing disagreement.
• Biases and stereotypes and nonverbal language: Unconscious biases or stereotypes can influence the way we interact and communicate, not only verbally but also subconsciously.
• Lack of continuity of care: Lack of continuity of care, with different doctors seeing the patient, can make it difficult to establish a trusting relationship and effective communication, sometimes forcing the patient to repeat information and increasing the risk of misunderstandings or omissions.

Recommendations for effective communication in decision-making

• Clear and direct communication: It is essential to establish clear communication adapted to the interlocutor. Understandable language should be used and tools or information should be provided to help the patient understand their situation and the options available to them (infographics, brochures or educational materials).
• Make the patient feel involved in the decision-making process: the strategy for managing the disease should be the doctor’s decision, as he/she is the person who is prepared to seek the most beneficial options for the patient, based on scientific criteria. In any case, it is advisable to seek the active participation of the patient in the decision-making process, taking into account their lifestyle, needs and preferences, as this encourages their involvement and ensures greater adherence to treatment.
• Provide balanced information: Tailoring information to explain to patients what treatment options are available to them, including benefits, risks and available alternatives, allows patients to fully understand their situation and their health. Their concerns should also be answered fully, simply, honestly and objectively, even if the questions they ask are uncomfortable or difficult
• Active listening, showing interest and making sure that what is being explained is understood will make it easier to raise all the questions necessary to make the most appropriate decisions. Ensuring that the patient understands what is being explained by asking open-ended questions or other options is also highly recommended.
• Respect patients’ individual circumstances and beliefs: sometimes, even when we know that the medical recommendation could be different, we need to respect the circumstances, beliefs or other situations that may lead a patient not to want to follow the proposed clinical strategy. Patients are specific individuals with specific circumstances, which may change over time.
• Support the patient emotionally: Giving emotional support and showing empathy helps patients to cope with difficult decisions and/or situations. The relationship should be friendly, accessible and respectful, showing the patient that the healthcare team understands how their condition affects all spheres of their life. It also builds a more trusting relationship with the team of healthcare professionals working with the patient.
• Continuity of communication: especially in long-term or chronic pathologies, continuous communication throughout the treatment process is essential. Hence the importance of planning and agreeing on follow-up visits. It is advisable to facilitate an environment where patients feel comfortable sharing their concerns and updating information as needed.

By following these recommendations, healthcare professionals can strengthen the partnership with their patients, promoting informed decision-making that respects the individuality and needs of each person.

There are multiple benefits to be gained from following all of these recommendations for good patient-doctor communication:

• There is greater adherence to treatment: If the patient has a good understanding of his or her diagnosis, treatment plan and expectations, he or she is more likely to follow medical instructions.
• There is a reduction in errors and complications, whether due to misunderstanding, omission or disagreement.
• It reduces the number of unnecessary tests and procedures by ensuring that the physician has all the relevant and up-to-date information needed and that the patient understands the risks and benefits of each option.
• Improves the quality of care provided and therefore better clinical outcomes are achieved.
• Increases patient satisfaction: Patients who feel listened to, understood and respected have greater satisfaction with their medical care and are more likely to follow the indications received.
• Patient trust in the medical team is strengthened and vice versa.

Ultimately, greater efficiency in the healthcare system is achieved through effective communication, where the patient speaks with confidence and the physician listens attentively, making it possible to reduce the time and resources needed to provide higher quality care and better clinical outcomes.

REFERENCES:.

• Patient Communication: Practical Strategies for Better Interactions; SHANNON J. VOOGT, MD, KELLI PRATT, DO, AND AMBER ROLLET, MDFam Pract Manag. 2022;29(2):12-16 Patient Communication: Practical Strategies for Better Interactions | AAFP
• Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ. 2002 Sep 28;325(7366):697-700. doi: 10.1136/bmj.325.7366.697. PMID: 12351365; PMCID: PMC1124224.

An ostomy is a surgical procedure that creates an outlet for faecal matter directly into an ostomy device. Drainage of faeces to the outside is achieved by connecting the small intestine (ileostomy) or the large intestine (colostomy) through the abdominal wall via this pouch-like ostomy device.

An ostomy can be short-term (temporary) or lifelong (permanent) and can have different aspects and locations, depending on the anatomical area where it has been performed and the disease itself. Some of the reasons why it may be necessary are: diverticulitis, cancer, obstruction, injuries, congenital defects or IBD.

What does an ostomy pouch look like?

The ostomy pouch can be of different sizes, shapes, transparent or opaque depending on the patient’s needs and preferences.

• One-piece pouch: There are one-piece pouches that are very easy to put on and take off, offer maximum flexibility and are not visible under clothing. This type of device should usually be changed 1-2 times a day.
• Two-piece pouch: these are often used when there is a possibility of irritation as they have a base or plate that protects the periostomal skin for a longer period of time (2 or 3 days) allowing the pouch to be handled independently as often as necessary without coming into contact with the stoma.

Ostomy pouches, whether one-piece or two-piece, have filters that trap the smell of gas and faeces in the pouch and also prevent water from getting into the pouch during showering or bathing.

What does having an ostomy pouch involve?

Using an ostomy pouch is the best way to manage bowel movements after certain types of surgery on the colon or small intestine. This will require certain care and maintenance that will be explained in detail by the nursing staff to avoid any complications. It is important to closely follow the instructions provided depending on the type of pouch and ileostomy/colostomy you have had.

If you have had a permanent ostomy, you may also need some time to adjust and incorporate it into your daily life. The placement of a pouch is a change in body image that may cause some rejection, so there is no need to worry if you feel you need time to see the positive side of this resource. At the end of the day, an ostomy is a solution to serious health problems that allow us to improve our well-being. Rely on your nursing team if you need both practical and emotional support. They are professionals with extensive experience in this field and will certainly be able to offer you some recommendations that will help you in this process.

It is also advisable to talk about it openly with our family and social environment and give them the opportunity to accompany and support us in our daily life of living with an ostomy pouch in ordinary situations such as exercising, going to the beach or sharing intimacy with our partner.

Can I do sport if I have an ostomy pouch?

Sport is always recommended for your health and having an ostomy pouch does not make it an exception. The only exception is that it is not recommended to practice contact and/or impact sports that may pose a risk to the stoma. Neither is it recommended to significantly increase the abdominal musculature to the point where it can affect the stoma. For some sports it may be recommended to protect this area. Consult your medical team if you have any questions.

Water sports are not a problem as ostomy pouches are fitted with filters to protect them from water entry. If possible, it is also advisable to protect the ostomy pouch from the sun. ¹

1. –Ostomy: IBD & Me | Crohn’s & Colitis Foundation

Inflammatory Bowel Disease (IBD), whether Crohn’s disease or ulcerative colitis, can have a significant impact on the quality of life of those who suffer it. Thankfully, a broad arsenal of drugs and other therapies are now available to manage the disease prior to surgery.

In those cases where the disease progresses or is not under control with any of the medications currently available, surgical treatment is another alternative.

According to GETECCU (Spanish Crohn’s Disease and Ulcerative Colitis Group) approximately 15-20% of patients with UC and 60-70% of patients with CD will require surgical treatment during the course of their disease.

When is surgery considered in Inflammatory Bowel Disease?

• When there is no response to treatment because the symptoms of the disease are not controlled.
• In case the side effects of medical treatments are intolerable for the patient.
• In case of severe complications such as intestinal obstructions, perforations, abscesses or fistulas that do not respond adequately to other forms of treatment.
• When IBD significantly impacts the patient’s quality of life, interfering with daily activities and compromising general health.

Common types of surgery in IBD:

When facing surgery in IBD, the most common strategies in surgical treatment are:

• total proctocolectomy with ileostomy or with ileoanal reservoir,
• total colectomy with ileorectal anastomosis,
• subtotal colectomy with ileostomy and
• rectosigmoid mucosal fistula.

When a total proctocolectomy is performed, the entire rectum and colon are removed. If a total proctocolectomy with ileostomy is decided, an opening or orifice is made to connect the ileum with the exterior (ileostomy) to eliminate the intestinal waste in a bag (ostomy*). In the event that the medical professionals choose to perform a restorative proctocolectomy or ileoanal reservoir, a reservoir or internal pouch is created with part of the small intestine (ileum) that will be attached to the anus and function as a new rectum.

The technique known as total colectomy with ileorectal anastomosis consists of resecting the entire colon and joining (anastomosis) the ileum to the rectum.

On the other hand, in a subtotal colectomy with ileostomy and rectosigmoid mucosal fistula, only the affected areas of the colon are removed and an ileostomy is performed. If the sigma (final part of the colon) is not affected, it is left intact and communicates with the exterior through the anus or through a mucosal fistula made in the abdominal wall to drain secretions.

Possible complications in IBD surgery:

Although surgery can be transformative for many patients, it is not without risks and complications.

Some of the possible complications include:

• Infections: postoperative infections related to the surgery itself.
• Anesthesia: there are risks associated with anesthesia, such as allergic reactions or breathing problems.
• Fistulas: leaks may develop in the intestinal connections or new fistulas may form.
• Obstructions: although surgery may resolve an obstruction, the patient is not exempt from developing a new obstruction after surgery. It is recommended to follow closely the indications of the health professional to prevent it.
• Ostomy*: in case of having an ostomy, it is necessary to adapt to the new situation with the help of health professionals as this is an important change for the patient.

Thus, although surgery is reserved as a necessary measure when other options have proven to be insufficient, it is considered a treatment of choice and highly effective for the treatment of IBD.

Proper care in preparation for surgery and a correct postoperative period will be essential to minimize risks and maximize benefits.

*An ostomy consists in the externalization of the small intestine (ileostomy) or the large intestine (colostomy) through the abdominal wall, suturing it to the skin; in order to create an artificial exit for the fecal contents (stoma). The intestinal contents exiting through the stoma will be collected in a bag attached to the surrounding wall.

The question of whether inflammatory bowel disease (IBD) is hereditary is complex and has been the subject of numerous scientific investigations.

Neither Crohn’s disease or ulcerative colitis are hereditary pathologies, although studies have demonstrated that there is a genetic predisposition for their development.

These studies have identified certain genetic markers that can increase a person’s susceptibility to symptomatically manifest these diseases. However, having a family history does not mean that the disease will develop, since many individuals who suffer from IBD do not have relatives living with these pathologies.

What is the origin of IBD and how does it manifest?

In order to answer this question it is necessary to talk about the interaction of different factors: genetic predisposition, the environment, the immune response and the intestinal microbiota of each person.

The combination of these elements can provoke a disordered inflammatory response that ends up attacking the patient’s own tissue. This medical condition, both in ulcerative colitis and Crohn’s disease, usually manifests with symptoms such as diarrhoea, rectal bleeding, abdominal pain, fatigue and weight loss among others. In this Mayo Clinic⁴ video they explain very well, and in a simple and visual way, what happens in the body:

What are the environmental factors or elements that can trigger IBD?

IBD is a consequence of the inadequate response of our immune system towards our own body. Although the origin is unknown and we know that there is also a genetic predisposition that could favour the manifestation of these diseases, we also know that there are some environmental factors that condition or trigger these immune disorders in individuals more prone or susceptible to develop an exaggerated immune response to these factors.

According to EFCCA, these environmental conditions may include:

• diet
• certain infections
• exposure to tobacco smoke
• treatment with antibiotics, oral contraceptives or non-steroidal anti-inflammatory drugs)

Also, according to this study², it is believed that the influence of environmental factors explains the increase in incidence in recent decades in industrialised countries, which is not attributable to genetic modifications. This fact is highlighted by the increase in cases among immigrants from developing countries, especially when they migrate to developed countries before the age of 15 years.

In summary, although there is a genetic influence in the predisposition to suffer from IBD, we cannot consider these diseases to be hereditary. Having relatives with IBD may increase the risk, but the presence of environmental factors, immune health and the patient’s intestinal microbiota also play a significant role in the manifestation of the disease.

Thus, as has been published in some articles³, it is important to recognise that the study of the pathogenesis of IBD has advanced tremendously in recent years, coinciding with advances in genetic testing techniques and computer analysis tools. Large amounts of information can be obtained from genetic profiles, microbiome composition, etc. In the future, techniques will be required to analyse these data and even to know the disease mechanisms specific to each individual. It is expected that we will be able to obtain the genetic profile of a patient with IBD, predict their clinical course and even predict the response to certain therapies in order to choose the most appropriate one for each patient.

1. https://educainflamatoria.com/crohn-cat/causas-y-factores-de-influencia-crohn/
2. Enrique Medina: Enfermedad inflamatoria intestinal (I): clasificación, etiología y clínica, An Pediatr Contin. 2013;11(2):59-67
3. Felipe Silva, Tomás Gaticab, Carolina Pavez: Etiología y fisiopatología de la enfermedad inflamatoria intestinal ,REV. MED. CLIN. CONDES – 2019; 30(4) 262-272
4. 14. Santos MPC, Gomes C, Torres J. Familial and ethnic risk in inflammatory bowel disease. Ann Gastroenterol. 2018;31(1):14–23.
5. https://www.youtube.com/@EntrenaEII

Inflammatory bowel disease (IBD) is a term that describes various disorders involving chronic inflammation of the tissues of the digestive tract. Among the different types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis.

Although they present similar symptomatology, they present different courses and affectations. As recommendations to improve the quality of life of people suffering from either of these two diseases, we could highlight the following:

1. Face the disease as a new situation we have to live with and not as an inconvenience. Unfortunately, IBD has no cure so, although at the beginning it may be particularly complicated, it will be necessary to accept it and integrate it into our routine.
2. The disease is not the protagonist of our life. Although in times of flare-up it seems to be, it is important to keep in mind that both ulcerative colitis and Crohn’s disease are chronic but manageable diseases. The beginnings are hard, but once the disease is under control it is easy to forget about it and it is equally important to follow the recommendations indicated by the doctor.
3. Receiving specialized care and access to truthful and contrasted information will be essential since IBD is complex and only specialized and up-to-date health professionals will be able to provide us with the tools we need. Trust the professionals and do not be left with doubts.
4. Balanced diet, exercise and avoiding bad habits. Whether you suffer from IBD or not, these would be good recommendations for anyone, but in the case of these diseases, they are especially important.
5. Adherence to treatment is key to making it work. As patients, it is also our responsibility to follow the indicated treatment regimen so that the approach is effective.
6. Communicate with your doctor. As we mentioned before, IBD is a chronic disease and this means that the doctor-patient relationship will have a long journey and therefore it will be essential that you communicate your doubts, concerns and also the potential adverse effects that may arise from the treatment.

It is important to highlight that due to the chronic nature of the disease and the fact that it will it will stay with us at different stages of life, it is difficult to foresee how it will progress. This situation generates stress, uncertainty and insecurity so it will be essential to understand that you are not alone and that you can ask for help. Especially in times of flare-up, when you feel weakened and limited to carry out your day-to-day activities, living with the disease is really challenging, so taking care of your mental and emotional health at this time is as important as treating the physical symptoms.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders affecting the intestine and/or other organs among which we can highlight, mainly: Crohn’s disease and ulcerative colitis. Both present a similar symptomatology that frequently manifests with abdominal pain, diarrhoea, isolated bleeding, blood in the stool (rectorrhagia), weight loss, among other symptoms.

Due to this symptomatology and the chronic nature of the disease, with moments of flare-up and remission, these pathologies have an effect at an emotional level. Especially in times of flare-up, the symptoms have a direct impact on patients’ general well-being, as they see their physical condition affected and, therefore, their autonomy to carry out certain daily activities at a family, social and professional level. However, even patients with controlled symptoms report a clear impact in one or more of these areas.

Emotional support and IBD

According to one study ², most patients believe that IBD has a negative psychological impact and that their disease worsens when they feel anxious (82%) or depressed (67%). More than half of patients feel sad or depressed (58%) or have anxiety (51%) at some point during the course of their disease. Most doctors (80%) agree that psychological aspects have an influence, so it is essential to maintain good emotional health to improve the course of the disease.

The social impact of IBD

IBD also imposes an additional burden on the social, professional and family life of those who suffer from it. They report impacts at the level of relationships with family or friends or in leisure and recreational activities. It also has an impact at a professional level, conditioning their work, the acceptance of promotions or even, in some rare cases, the loss of their job.

In younger patients, academic difficulties are reported, as well as problems finding a job.

The impact of IBD on sexuality³

As with any disease we suffer from, if we are not physically or emotionally well, our sexuality3 (broadly understood) may be affected.

It is true that, IBD, since it usually appears in adolescence and/or in young adults, can have a greater impact on the development of our sexuality. At this age, body image, self-esteem and personal relationships are of great importance, and IBD could affect full sexual development by causing decreased libido, body image concerns, anxiety or stress, especially in cases where there is a stoma or ileostomy.

Patients consider that suffering from IBD has caused a decrease in libido (almost 50%), prevents them from continuing intimate relations (45%), is associated with the break-up of a relationship (36%) or worsening of sexual activity (> 35%) and has made them choose abstinence, especially during the active phase of IBD (67%) but also during remission (19%). Patients also recognise that UC affects their ability to have children (17.2%) and their ability to care for them (41%).

As explained in one of the support platforms you are informed of when you are diagnosed with IBD, Educainflamatoria ¹, it is important that upon diagnosis of the disease, we become aware of what our new condition means and that we rely on the team of professionals around us to manage the possible frustration, fear or uncertainty that may arise in any of these areas.

We must understand that when we do not ask questions, the problem does not exist for others and, therefore, it will not be addressed and solutions will not be provided.

It is essential to be able to confidently discuss these issues with the medical team supporting you, even though it is sometimes difficult to openly share aspects of your intimate life with health professionals, or you may not be clear about whether these issues should be discussed with them or with another professional, or whether they are not considered a priority in your health. 

Nursing, within the multidisciplinary team that will work hand in hand with the patient, has a very important role in this area. One of their tasks is to provide emotional support and health education and to accompany the patient in this process.

If you feel that living with your disease is causing you stress, anxiety or sadness, speak to a professional you trust so that they can help you, both clinically and emotionally, to manage the impact that the symptoms are having on your life. They will also advise you or refer you to professional experts in employment issues.

With help, planning and care, it is possible to have a full life with less negative physical, psychological, social and sexual impact from your IBD.

1. Marín-Jiménez, I., Gobbo Montoya, M., Panadero, A. et al (On behalf of GETECCU Study Group and ACCU): Management of the Psychological Impact of Inflammatory Bowel Disease: Perspective of Doctors and Patients—The ENMENTE Project, Inflammatory Bowel Diseases, Inflamm Bowel Dis, 2017, 23(9),1492-1498, Doi:10.1097/MIB.0000000000001205. https://academic.oup.com/ibdjournal/article/23/9/1492/4560710?login=false
2. https://educainflamatoria.com/bienestar-y-apoyo-emocional/como-afecta-la-enfermedad-inflamatoria-intestinal-a-mi-bienestar-emocional-2/
3. https://educainflamatoria.com/vida-sexual/
4. Calvet X, Argüelles-Arias F, López-Sanromán A, Cea-Calvo L, Juliá B, Romero de Santos C, Carpio D. Patients’ perceptions of the impact of ulcerative colitis on social and professional life: results from the UC-LIFE survey of outpatient clinics in Spain. Patient Preference and Adherence. 2018:12 1815–1823.

Inflammatory bowel disease (IBD) is chronic in nature. This means that the disease evolves over time in different ways and it is necessary to support the patient on an ongoing basis, since living with it often has a high impact on the quality of life of the patients and their families, affecting them not only physically, but in all areas of their lives: their social lives, families, relationships, work, school and emotional state. This circumstance requires specialised health professionals: medical teams, psychological care and nursing professionals.

Some more frequent symptoms, such as pain, fatigue, tiredness, body image disorders, or inflammation, can affect mood and generate high levels of stress, anxiety and an increased risk of depression. All of this can lead to abandonment of treatments, an increase in outbreaks and, as a result, poor control of the disease, making an interdisciplinary and multidisciplinary approach essential.

The appearance of symptoms, sometimes non-specific, throughout the course of the disease requires fluid communication between the different care centres and easy access to both the medical and nursing teams so that the patient can receive care adapted to their physical, emotional and professional needs.

For this reason, it is common to find a specialised team, trained and up-to-date on inflammatory bowel disease, in referral centres. In addition, in order to meet these needs, the N-ECCO (Nurses-European Crohn’s & Colitis Organisation) was created at european level to standardise criteria and share experiences that enrich the work carried out by these professionals when accompanying patients with IBD, so that this work is as optimal as possible and adapted to their individual and specific needs.

How does a nurse help a patient with IBD?

The bond that is created between the medical team and patients suffering from a chronic disease is very close. They all work hand in hand so that the patient understands and accepts their disease as soon as possible after diagnosis in order to integrate it into their daily life, taking into account each person’s specific needs.

This is why the nursing team performs vital work in order to design a specific care plan for each patient. These include the following:

• Establishing the beginning of a trusting relationship with the patient.
• Providing the patient with quality information so they can understand the disease and its care, resolve any doubts they may have about it and introduce healthy habits into their life that improve their autonomy and control of the disease.
• They provide information on how to access the IBD Unit, explaining how visits to the IBD Unit are organised, when it is necessary to go there, what are the warning signs and symptoms of the disease and how to act in each case.
• Helping and supporting the patient in the acceptance of the disease: understanding the impact it will have on their life in the future, the potential limitations they may face and the changes they will need to introduce in their life at each stage of their disease.
• Detecting the need for emotional support during this period or at certain times throughout the disease so that their quality of life is affected as little as possible.
• Checking the patient’s immunisation status before starting any immunosuppressive treatment and scheduling, updating and administering the necessary vaccinations and recording their effectiveness.
• Involving and educating the patient on the importance of adherence to treatment as the best strategy for successful disease management and flare-up prevention.
• Administering some pharmacological medications or hospital therapies and carrying out and necessary session planning, test requests or coordination with other medical teams, as well as educating and informing the patient regarding pre- and post-treatment precautions, if necessary.
• As it is an immunological disease, it is possible that some extraintestinal manifestations may appear that require treatment or other types of follow-up by the nursing staff, as well as multidisciplinary management.

Situations that may require contact with a nurse

There are a wide variety of situations that may require consultation with nursing staff. We will highlight some of them below:

• Suspicion of worsening of the disease or presence of symptoms associated with the onset of an flare-up.
• Doubts regarding prescribed medical treatments (dosage, regimen, form of administration, side effects, interactions, etc.).
• Requesting scheduled follow-ups of the disease.
• Requesting information on pending diagnostic tests and the necessary preparations for such tests.
• Gathering information on topics related to the disease (symptoms, extraintestinal manifestations, diet, healthy lifestyle habits, exercise, consumption of toxins, sexual relations, pregnancy, breastfeeding, medications, vaccines, contraceptives, travel, etc.).
• Verifying the information about the disease obtained from different sources (internet, family, friends, etc.).
• Communicating the presence of changes and discomfort in the perianal area.
• Checking the appearance of extraintestinal manifestations of IBD (dermatological, ophthalmological, rheumatological and nephrological).
• Reporting a pregnancy or clarifying related doubts.

Role of the nursing team in patients undergoing surgery

When surgery is part of the treatment of IBD, the nurse has a very important role to play in resolving any possible doubts or problems that may arise regarding the management, handling and acceptance of the ostomy, if necessary. A nurse specialised in ostomy care, advice and/or counselling is called a stomal therapist.

The placement of an ostomy pouch can be a challenging experience for some patients, not only on a practical level but also on an emotional level. This procedure is performed through surgery, so for it to work successfully, close communication with the patient should be established both before and after surgery, informing the patient about the preoperative period and also seeking a space where they can express their concerns and doubts, not only physical, but also emotional, both for the acceptance of the ostomy, and so that, in the future, the effectiveness of this measure is not compromised, providing clear guidance on the care and maintenance of the ostomy.

In short, nurses are an essential part of the team of healthcare professionals who will accompany people suffering from IBD throughout the course of their disease. In addition, they will often be the direct and most common point of contact with the patient for the entire medical team, playing a key role in establishing and promoting good communication with the rest of the medical team.

• https://www.ecco-ibd.eu/about-ecco/ecco-operational-board/n-ecco.html

In Inflammatory Bowel Disease¹ there is an inflammation of the intestine that causes neutrophils to infiltrate to the inflamed area to act. In this inflamed environment, and to defend the body from the entry of bacteria from inside the intestine due to the disruption of the intestinal barrier and its increased permeability, neutrophils “commit suicide” in a process known as Netosis, forming NETs, structures with a network structure, whose function is to destroy the largest number of “intruding” bacteria as quickly as possible, so that they release all the intracellular contents to the outside. A very high percentage of neutrophil cytoplasm consists of calprotectin, which is a protein highly resistant to bacterial degradation and stable at room temperature for days. This calprotectin passes into the lumen of the intestine (since the intestinal barrier has lost its integrity) and is eliminated from the body through the feces, hence its name fecal calprotectin (FC). Thus, by measuring the levels of calprotectin in the stool, it is possible to determine, by its concentration, whether the patient is in an active flare or not, and even the severity of the disease.
The measurement of fecal calprotectin is very common in the diagnosis of IBD, to determine and evaluate the state of the disease. In addition, it is a biomarker that allows to analyze in a non-invasive way, the changes of a patient at the intestinal level over a long period of time.

How is a fecal calprotectin test performed and when is the best time to perform it?

Since the measurement of this protein is performed through the stool, it will be necessary to take a stool sample from the patient and analyze it. GETECCU’s recommendations for sample collection² are as follows:
It is recommended to collect a small amount of stool (approximately 3-5g) and deposit it in a collection container that is usually dispensed at the requesting center. This container does not require any specific treatment. The sample can be taken from any part of the stool, as it has been shown that CF is distributed homogeneously³ and at any time during the course of the disease.
As a precaution and to obtain a reliable result, a marked decrease in FC levels has been observed during preparation for colonoscopy⁴. Therefore, in case the patient is scheduled for one, caution should be taken to collect the sample before starting the colonic cleansing or several days after the test.

What does it mean when fecal calprotectin is elevated?

When CF is elevated in inflammatory bowel disease, it means that there is inflammation in the bowel. As a rule, high levels indicate bacterial infections, parasitic infections, colorectal cancer, or certain diseases that cause inflammation of the bowel, such as ulcerative colitis⁵ (UC) and Crohn’s disease⁶ (CD).

In both UC and CD this could mean that the disease is active and may be causing symptoms such as abdominal pain, diarrhea or bleeding as the immune system is fighting to decrease such inflammation in the gut.

Now that you understand what fecal calprotectin is, the most important thing is to trust your doctor, follow the prescribed treatment and communicate your symptoms so that he/she can plan the best strategy for managing your disease and perform the necessary tests at any given  time.

1. Ulcerative colitis and Crohn similarities – Adacyte
2. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la utilidad de la determinación de calprotectina fecal en la enfermedad inflamatoria intestinal | Gastroenterología y Hepatología (elsevier.es)
3. Intra-Individual Variability of Faecal Calprotectin: A Prospective Study In Patients With Active Ulcerative Colitis | Journal of Crohn’s and Colitis | Oxford Academic (oup.com)
4. Colonoscopy and ileoscopy: essential tests for diagnosing IBD – Adacyte
5. What is ulcerative colitis? – Adacyte
6. Ulcerative colitis and Crohn similarities – Adacyte

Diarrhoea, abdominal pain, blood in stool, anaemia, fatigue, fever, weight loss. These are signs that can signal a digestive problem. As soon as it is suspected that a patient might have an inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, the healthcare professional needs reliable diagnostic tools to confirm these conditions, ruling out other types of diseases with similar symptomatology.

In addition to analytical tests on both blood and stool and radiological tests, endoscopic tests are a fundamental and invaluable technique for diagnosing IBD.

Enteroscopy, endoanal ultrasound, capsule endoscopy, upper gastrointestinal endoscopy or gastroscopy, and lower gastrointestinal endoscopy or ileocolonoscopy are included within these endoscopic tests. We will explain what this last technique, which includes colonoscopy and ileoscopy, consists of.

Ileocolonoscopy as a diagnostic tool

Ileocolonoscopy is one of the most common endoscopic tests performed to diagnose IBD. Thanks to it, healthcare professionals can view the intestinal mucosa directly, both the colon (colonoscopy) and the end of the small intestine or terminal ileum (ileoscopy).

Thus, it is possible to know whether a patient has Crohn’s disease or ulcerative colitis as the endoscopic features are singular and different to one another. Furthermore, it helps to choose the more suitable therapeutic option and surgical procedure, if necessary. The point is that the extent and severity of the damage, as well as its exact location in the colon and terminal ileum, can be visualised.. In the case of Crohn’s disease, it is normal for the ileum to be affected, hence the appropriateness of performing an ileoscopy alongside a colonoscopy in these cases.

On the other hand, these techniques are effective tools for ruling out drug-induced diseases, like anti-inflammatory drugs, or other types of conditions with similar symptoms, such as infectious colitis. Moreover, it is possible to take a biopsy (tissue samples) during the test, where necessary, to perform an anatomical-pathological examination or therapeutic procedures. This is the case of polypectomy (removal of polyps) or dilation of strictures (reduction of internal diameter of the intestine).

Long-term monitoring of a patient with IBD

Performing a long-term follow-up of the inflammatory disease’s progression is fundamental to anticipate flare-ups, assess the efficacy of the treatment and modify it if necessary. In this case, ileocolonoscopy is very useful as the extension and evolution of the condition can be viewed in the colon and the end of the small intestine or terminal ileum.

Patients with long-standing IBD are more likely to develop colorectal cancer than the general population. This risk that is higher or lower depending on the duration and extension of the disease. For this reason, endoscopic monitoring via ileocolonoscopy can be an effective tool for detecting pre-malignant lesions and acting as soon as possible, thus reducing the mortality rate associated with colorectal cancer. Another situation where it is very useful to perform an ileocolonscopy is after surgery. In fact, it is considered the ‘gold standard’ as it allows to establish the onset of morphological recurrence and its severity, which is directly related to the long-term clinical course¹.

How should the patient prepare for the test?

Like any endoscopic procedure, both colonoscopy and ileoscopy require the patient to undergo pre-test preparation. These preparations include a special diet and, occasionally, the withdrawal of some of the drugs they are taking. In this latter case, the healthcare professional will inform you how to proceed with these drugs in order to avoid complications that may hinder the examination.

As for the diet² that the patient should follow before the test, two days before it, he/she should start a low-residue diet. This means that fatty cheeses, full-fat dairy products, oily fish, fatty meats, cold meats, wholemeal products, fruits, vegetables, legumes, chocolate, pastries and dried fruit are forbidden.

On the other hand, the foods that can be eaten during the special diet are: skimmed milk and natural yoghurt, fresh cheeses, hard cheeses and a bit of butter; white bread or non-wholemeal toast and biscuits; soups without vegetables; non-wholemeal rice and pastas; skinless mashed or boiled potatoes; grilled or cooked white meat and fish; skinless quince, peaches in syrup, cooked or roasted apples or pears; tea, coffee or light infusions.

Colon cleansing will be started the day before the colonoscopy or ileoscopy, with preparations given by the medical professional. These can be polyethylene glycol solutions, magnesium salts, sodium phosphate solutions or enemas. However, the patient must stop eating solid foods 3 or 4 hours before starting the colon cleanse.From then on, they can only have clear liquids, in other words, water, infusions, filtered soups, coffee or tea, strained fruits juices and clear soft drinks. On the day of the test, the patient must stop drinking clear liquids 3-4 hours before the colonoscopy or ileoscopy is performed.

During and after the ileocolonoscopy

The test is performed in the Endoscopy Unit of the Gastroenterology Department. The test is carried out by Digestive specialist doctors with training in diagnostic and therapeutic endoscopy from the IBD Unit itself or, failing that, with IBD training.

Nursing staff specialised in endoscopy and nursing assistants also participate. Their function during ileocolonoscopy is to care for and look after the patient, help the endoscopist perform the test and administer the necessary medication.

Regarding the duration of the test, it can range from 20 to 60 minutes. It depends on the amount of intestine to be examined and, if it is necessary to perform any therapeutic procedure during the test. Moreover, sedation and intravenous analgesics are often administered to avoid discomfort for the patient and to perform the test without any pain.

After completing the examination, the patient is taken to another room where they will awaken with a feeling of abdominal bloating and discomfort that is similar to intestinal colic. This is due to the insufflated air inside the intestine during the examination. This discomfort will disappear after a few hours.

1.  http://scielo.isciii.es/pdf/diges/v107n10/es_editorial.pdf
2. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082007000200010

Inflammatory bowel disease (IBD) is considered a systemic inflammatory disease. In other words, in addition to intestinal damage, conditions may also develop in other organs and systems, like the eyes. They are known as extraintestinal manifestations (EIM), diseases that do not need to be closely linked to inflammatory activity in the intestine, despite occurring simultaneously. In fact, their triggering mechanisms are not precisely known, although it is believed that the cause can be linked to the interaction of genetic and environmental factors and changes in the gut microbiota. Ocular extraintestinal manifestations are not common in patients with IBD, affecting only 10%¹. The consequence of this low prevalence is that both medical professionals and patients themselves overlook the possibility that symptoms like pain or eye redness are symptomatology linked to ulcerative colitis² or Crohn’s disease. A mistake that can have serious consequences for patients that can be avoided with a multidisciplinary approach, including a complete ophthalmological examination.

The most common ocular alterations in patients with IBD are scleritis, episcleritis and uveitis. In the first two cases, the affected eye structure is the sclera, known as the white part of the eye; and in uveitis, damage is found in the uvea, the layer located below the sclera. It must be emphasised that onset of the three conditions often coincides with other skin and joint manifestations, which may provide a lead to the early detection of eye conditions.

Symptoms and treatment of episcleritis and scleritis

Episcleritis and scleritis are ocular extraintestinal manifestations that affect the white part of the eye, although each of them do so at different degrees.

Episcleritis occurs when the thin tissue layer covering the white part of the eye (episclera) is inflamed and irritated. An inflammation that often coincides with a flare-up of the disease. Its symptomatology is emphasised by a burning sensation in the eye that does not worsen on palpation, redness, watering and mild pain or discomfort.

Episcleritis treatment depends on the severity of the symptoms. The condition normally resolves with IBD treatment, even though it is sometimes combined with non-steroidal anti-inflammatory eye drops to relieve discomfort.

If episcleritis is not treated correctly on time, it is likely to develop into scleritis, a more severe eye issue that can result in vision loss. The symptoms of scleritis are severe eye pain that worsens on palpation and radiates to the forehead, cheek or paranasal sinuses; and more eye redness than during episcleritis.

In addition to ulcerative colitis and Crohn’s disease treatment, systemic corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) or immunosuppressants, like methotrexate, are prescribed to treat and control scleritis.

How to detect uveitis

Uveitis is another ocular extraintestinal manifestation that is more common in patients with IBD. It often appears during both remission periods and flare-ups, or even before diagnosis of the inflammatory disease. It is characterised by inflammation of the layer located below the white part of the eye, the uvea, where a large amount of blood vessels are found.

When inflammation occurs in the frontal part of the eye, it is called anterior uveitis. It is the most common form of uveitis and its symptoms are eye redness, sensitivity to light (photophobia), eye pain, watering and blurred vision. If this symptomatology is combined with reduced vision and/or appearance of floaters, the patient may suffer from posterior uveitis.

If they experience one of the symptoms described above, they should visit their doctor as soon as possible because the consequences can be serious, even leading to permanent vision loss. The symptomatology can either occur suddenly and worsen at short notice, or they may begin gradually. It is therefore an ophthalmological emergency and an early diagnosis is necessary to avoid complications.

Uveitis treatment involves the application of cycloplegic eye drops to relieve the pain and avoid posterior ocular adhesions. Topical, ocular, periocular or systemic corticosteroids and even immunosuppressants are often used in the most severe cases.

1. https://educainflamatoria.com/manifestaciones-extraintestinales/oftalmologia/
2. What is ulcerative colitis? – Adacyte