Specialist assessment

Specialist assessment

Statement 3.1

All newly diagnosed IBD patients should be seen by an IBD specialist and enabled to see an adult or paediatric gastroenterologist, IBD nurse specialist, specialist gastroenterology dietitian, surgeon, psychologist and expert pharmacist in IBD as necessary.

Statement 3.2

After diagnosis, all patients should have full assessment of their disease, nutritional status, bone health and mental health, with baseline infection screen, in order to develop a personalised care plan.

Why is it important?

Every patient is different, so their initial assessment should be personalised, based on their physical, social and emotional needs.

Getting specialist assessment at diagnosis is also key to ensuring patient-centred care on an ongoing basis.

The initial assessment should be multidisciplinary and holistic, taking in the major concerns of patients, family or carer(s), to help identify the immediate and long-term impact of the condition on their wellbeing.

It should include:

  • Expert establishment of disease activity and distribution
  • Complementary investigation to establish a full and correct diagnosis
  • Assessment of malnutrition and malabsorption – this should involve nutrition screening, then providing sources of general dietary advice or referral to specialist dietary support for patients at risk of malnutrition, with stricturing disease, or those with further dietary concerns
  • Immunisation and tuberculosis (TB) status
  • Assessment of fatigue and iron deficiency status
  • Assessment of continence concerns
  • Any extraintestinal manifestations such as skin, joints, eyes
  • Advanced pain assessment
  • Risk identification including osteoporosis, stopping smoking, colorectal cancer, serious psychological distress
  • Identification of realistic treatment plan and targets with patient, family and carers

The patient’s psychological needs should also be considered, including:

  • Awareness of the impact of IBD on their sex life and sexual function
  • Referral or signposting to suitable psychological therapies if necessary

Using a standardised IBD nutrition assessment and treatment algorithm will help us identify those at risk of nutrition complications and can lead to more patients getting the right dietary treatment.

Dr Miranda Lomer, Guy's and St Thomas' NHS Foundation Trust