The doctors leading the way in gut conditions

WHILE inflammatory bowel disease may not kill people, it is an ‘underrated illness’ that can ruin lives, says John Abercrombie, a colorectal surgeon at Nottingham City Hospital.

Inflammatory bowel disease (IBD) is an umbrella term that includes Crohn’s disease and ulcerative colitis — they are forms of autoimmune disease where the digestive tract is attacked by the immune system, causing progressive damage.

If it’s not controlled adequately, the symptoms — diarrhoea, agonising abdominal cramps, exhaustion and weight loss — can be crippling. ‘In severe cases people talk about their life being “on hold”, not being able to travel, socialise or work. They feel incredibly isolated and there is a huge amount of shame,’ adds Dr Gareth Parkes, a consultant gastroenterologist at the Royal London Hospital and BMI The London Independent Hospital.

Up to 350,000 people in the UK are affected — double the number 30 years ago. One explanation is changes in the gut microbiome (bacteria in the gut) may play in the onset of symptoms, explains Dr Naila Arebi, a consultant gastroenterologist at St Mark’s Hospital in London.

‘The changes may be caused by any number of environmental factors, including greater use of antibiotics,’ says Dr Arebi. Diet may play a role.

Essentially the gut loses its ability to distinguish friendly bacteria that aid digestion and damaging bacteria. ‘So it starts treating healthy bacteria as an infection it needs to attack,’ says Professor Simon Travis, a gastroenterologist at John Radcliffe Hospital in Oxford. ‘This leads to uncontrolled inflammation.’

With ulcerative colitis this inflammation is limited to the inner lining of the colon and rectum. With Crohn’s it can affect the full thickness of gut wall anywhere from the mouth to the bottom, causing narrowing and blockages; these pave the way for abscesses — pus-filled pockets — that burrow through the gut wall, creating tunnels (fistulae) that break into surrounding structures such as the bladder or even skin.

IBD patients are first treated by gastroenterologists who try to keep disease at bay with drugs, but 70 per cent of Crohn’s patients and 25 per cent of those with ulcerative colitis will need surgery.

Surgery for Crohn’s will often mean cutting out a diseased part of the gut and re-joining the ends — further surgery at the same site is likely. The resulting shortened gut can also affect the patient’s nutritional status. Surgery for ulcerative colitis may entail removing the colon and a colostomy bag.

IBD patients need a compassionate gastroenterologist with an extraordinary mix of skills — someone who can empathise with the embarrassment and social isolation many patients experience, who’s able to tailor the latest science to their needs while negotiating the tightrope between drug treatments and surgery — and getting the timing perfect for each.

To identify the best IBD experts we canvassed the view of around 30 gastroenterologists and colorectal surgeons from around the country. Here, we reveal their choices . . .