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P640 Evaluation of dietetic services and the impact of diet on disease activity for patients with inflammatory bowel disease at Imperial College Healthcare NHS Trust

H. Sandhar*1, N. Direkze2, S. Peake2

1Imperial College London, Faculty of Medicine, London, UK, 2Imperial College Healthcare NHS Trust, Gastroenterology, London, UK

Background

There are 4500 patients with inflammatory bowel disease (IBD) under review at Imperial College Healthcare NHS Trust (ICHNT). However, there are only 647 dietetic slots per year. This initial audit aimed to assess the dietetic services for IBD patients within ICHNT as well as determine patient views on the service they have received and identify dietary factors that exacerbate their symptoms.

Methods

The audit was carried out over a 10 week period in the IBD outpatient clinic. All patients had a confirmed diagnosis of IBD and were aged ≥18 years. Patients that consented to participate were given a questionnaire to complete. The questionnaire comprised of two components; (i) Patient opinion of the dietetic services both in general and within the ICHNT and (ii) identification of a link between food types and IBD symptoms.

Results

In total, 131 patients completed the questionnaire. Only 56 (43%) patients had received a dietetic consultation in relation to IBD. Of these patients, 46 (82%) had found dietetic input beneficial. Forty-four patients (78.5%) had seen a dietician within the Trust, with the remainder having accessed dietetic services privately or in the community. Of the patients who saw a Trust dietician, 34 (77%) found the consultation helpful. The majority of those receiving dietician appointments found the services at ICHNT adequate, good, or excellent. However, 7 (13%) felt the service was poor and 6 (11%) felt the service fell below average.

A total of 100 (76%) patients believed that specific foods directly exacerbate their IBD. Specific trigger foods that were identified included, tomatoes, red meat, fatty/fried foods, and onions. Symptoms precipitated by these foods included diarrhoea, bloating, constipation, and abdominal pain. A number of patients reported rectal bleeding after consumption of food including dairy products, alcohol and red meat.

Conclusion

The majority of those accessing dietetic services find dietary advice helpful. However, there are insufficient dietetic resources for IBD patients being seen at ICHNT. A number of specific food types were identified that patients feel contribute to a ‘flare’ of their IBD. Symptoms include increased bowel frequency, abdominal pain, and bloating. These are non-specific and could be related to co-existent irritable bowel syndrome or related to high FODMAP foods. Interestingly, there were a group of patients who reported rectal bleeding in relation to foods such as dairy products, alcohol and red meat—a finding which warrants further assessment. Increasing dietetic services for IBD patients at ICHNT would improve the care provided for this group and could help patients manage their symptoms more effectively.