1. MichaelPattemore
advocatesforBowelCancer
UK,afterlosinghiswife
Lyndatothedisease
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DECEMBER HEALTHAWARNESS.CO.UK
READ DrNickReadonthe
scienceandsymptomsofIBSP4
INSIDE Thebenefitsofgoing
gluten-freeforcoeliacsP6
ONLINE Whyweneedtotake
allergiesinchildrenseriously
Yourguthealth
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Learn how to love your gut –
at loveyourgut.com
For the inside story on your digestive system – what it is,what it does and the unique way in which it is
communicating with you every day – visit www.loveyourgut.com.
This lively site contains up to the minute digestive health news,tips,blogs and games,plus an expert recipe section
with a wide range of delicious gut-friendly recipes.Visit today and order your free information pack to start
discovering why it’s so important to love your gut!
www.loveyourgut.com
Tel: 020 8839 3258
info@loveyourgut.com
Love Your Gut is an initiative of Core, Bowel & Cancer Research, St Mark’s Hospital Foundation, Bowel Disease Research Foundation and the Primary Care Society for Gastroenterology,
supported by Yakult UK Limited. None of the medical or charity partners endorses any specific commercial or pharmaceutical products.
T
he human gut, also
known as the alimen-
tary or digestive tract,
is an amazing organ.
It is about 30 feet long,
from themouthtothebackpassage,
and the surface area of its cellular li-
ning is the size of a tennis court.The
gut is home to a colony of 100 trilli-
onbacteria(1014)–themicrobiome-
which outnumber all the cells in the
entire body. It has its own nervous
system, known as the enteric ner-
vous system or “gut brain”, which
controls and monitors movement,
sensation, secretion and absorption
within the digestive tract.
The various functions of the gut
provide the building blocks for
growth and the energy needed for
all our activities, while helping to
keep us healthy. But the gut is also
vulnerable - to infection, inflamma-
tion, sensitivity reactions, allergies.
and to cancer. One in 10 visits to
GPs and one in 10 hospital admis-
sions happen because of problems
with our gut: these can range from
lessseriousproblemssuchasgastro-
enteritis and indigestion, more seri-
ous conditions like peptic ulcer di-
sease and inflammatory bowel di-
sease, and on to cancer. Taken as a
whole,cancersaffectingthealimen-
tarytractrepresentthelargestgroup
of cancers, and some of them, such
as cancer of the stomach, pancre-
as and oesophagus, have the worst
outlooks of all malignancies.
This supplement on the gut looks
at a number of ways in which di-
seases of the alimentary tract can be
recognised, treated and, where pos-
sible,avoided or prevented.
One of the commonest disorders
of the gut, for which an exact cau-
se still remains elusive, is Irritable
Bowel Syndrome (IBS), where abdo-
minal pain and bloating accompa-
ny disturbances of bowel function,
The secret life of your amazing gutOne in 10 GP visits and hospital admissions involve problems with the gut. But what can we do to improve our gut health?
Professor Roger Jones
President, the Primary Care
Society for Gastroenterology and
Emeritus Professor of General
Practice, King’s College, London
“It has its own
nervous system,
known as the enteric
nervous system or
‘gut brain’”
READ MORE ON HEALTHAWARENESS.CO.UK
IBS uncovered
Dr Anton Emmanuel,
consultant
gastroenterologist, on
the difference between
IBS and IBD
P5
Avoiding danger
Professor Aziz
Sheikh warns of the
need to be aware of
food allergy-triggered
anaphylaxis
P6
Online now
The rise in food
allergies is linked to
environmental changes
says Professor Adnan
Custovic of Imperial
College London
often leading to greatly reduced
quality of life. Fortunately, our un-
derstanding of some of the mecha-
nisms involved in IBS and the deve-
lopment of effective ways of dealing
with its symptoms, has improved
over recentyears.
A more serious set of conditions,
sometimes confused with IBS, are
known as Inflammatory Bowel Di-
sease (IBD) - consisting mainly of
Crohn’s Disease and Ulcerative Coli-
tis - where there are major, inflam-
matorystructuralchangestothelar-
ge and small bowel,requiring potent
therapy and, sometimes, surgery.
Once again the development of new
drugs, including the “biologicals”,
has considerably improved mana-
gement of these difficult conditions.
Another very common gut pro-
blem is Coeliac Disease, which is
caused by an inflammatory reaction
to the plant protein gluten, and can
leadtogeneralillhealth,weightloss,
malnourishment, and anaemia, as
well as a number of troublesome bo-
wel symptoms. It affects 1% of the
entire population of the UK and, alt-
hough it can be diagnosed with a
simple blood test,many sufferers re-
main unrecognised.
Finally, food allergies and sensiti-
vities are widespread, and are some-
times linked to other allergic condi-
tions such as asthma and eczema,
although food intolerance can be
highly idiosyncratic, and specific to
an individual. Careful assessment is
needed to ensure that appropriate
dietary modifications are made, and
also that parents and families only
make the adjustments to their diets
forwhich there is clear evidence.
There is truth in the old adage
“You are what you eat”.As the role of
the microbiome becomes clearer, it
is likely that we will realise just how
much a healthy gut contributes to a
healthy life.
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IN THIS ISSUE
3.
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I
BS and IBD - what’s the diffe-
rence?Theycanbothbeapain
in the guts. But there are dif-
ferences, and correct diagno-
sis means a better chance of
effectivetreatment.
“Thereisagreatdifferencebetween
IBS and IBD but they can be incor-
rectly confused,” says Anton Emma-
nuel, consultant gastroenterologist
at University College Hospital Lon-
don. “There can be misdiagnosis by
non-specialists, where people with
IBD are diagnosed as having IBS, but
things are improving as awareness is
increasing and better tests are availa-
ble,”saysEmmanuel.
IBS, or irritable bowel syndro-
me, is caused by disturbance of the
rate and co-ordination of the gut
movement, resulting in it being too
fastortooslow.Thiscanbeassociated
with abnormal sensations, typically
felt as abdominal pain. Characteris-
tically, the pain occurs when the rate
ofmovementchanges.Nogutinflam-
mationisinvolved.
IBS affects about 15 per cent of the
population and is more common in
women, especially those of childbe-
aring age. There is no genetic link -
instead the causes are found within
the patient’s environment. “Symp-
toms can be triggered by stressful life
events,”saysEmmanuel.
IBD, or inflammatory bowel di-
sease,affects less than one per cent of
the population.It involves inflamma-
tion,whichcanbeseeunderamicros-
cope or even with the naked eye, and
itcanaffectthecolon,thesmallbowel
orboth.
IBD symptoms include abdominal
pan, diarrhoea which may be bloody,
and,ifthesmallintestineisinflamed,
malnutrition and lethargy caused by
malabsorptionoffood.
With IBD, there is a strong
genetic link. “Certain genes are as-
sociated with, for instance, Crohn’s
disease, which is a type of IBD,”
saysEmmanuel.
So, if you suspect you have IBS or
IBD,whatcanyoudo?
Do not rely on the internet for a di-
agnosis.GoalongtoyourGP.
Newscreeningprocedurescanhelp
in the diagnosis of IBD. Simple stool
tests will reveal the level of the in-
flammatory protein calprotectin. “If
IBS and IBD, both painful gut problems, are often
confused. Here a consultant gastroenterologist
explains the difference, and what to do if you think
you have symptoms
IBSandIBD:
causes,symptoms
andtreatments
By Linda Whitney
INSPIRATION
Irritable Bowel
Syndrome
MEDICAL EXPERTISE
For more content healthawareness.co.uk
Irritable Bowel Syndrome (IBS) an unexplained gut
illness that comprises symptoms of abdominal pain,
bloating, diarrhoea and constipation, for which there is
no clear cause.
Italsoincludesavarietyofothersymptomsthataffectotheror-
gansandregionsofthebodyanditoverlapswithotherunexplai-
nedillnesses,notablyChronicFatigueSyndrome,Fibromyalgiaand
FunctionalDyspepsia. Anxietyanddepressionarealsoverycom-
mon,suggestingthatIBSisthevisceralexpressionofanillnessthat
affectsbothmindandgut.
IBS maystartwithanattackofgastroenteritisand/oratrauma-
ticexperience. Bothmayleadtodepletionofcolonicbacteria,in-
creasesingutpermeability,excitationofthegutimmunesystem
andchangesintheemotionalcentresofthebrainandtheircon-
nectionswiththegut,resetting thegutcontrolsystemstobemore
sensitivetodietandstress(foodandmood). Reducingintakeoffat
andfermentablesugars(FODMAPs)inthedietmaycalmIBSsymp-
tomsascanamorebalanced,measuredandrelaxedlifestyle. Medi-
cations,whichincludeantispasmodicsandbowelregulators,offer
reliefforspecificsymptoms.
IBSoftenfluctuatesaccordingtowhatishappeninginaperson’s
life. Thusitisimportanttohelppeopleunderstand thecontext
oftheirillnessandhelpthemdealwithit. Selfhelpinvolvesdiet,
stressreductionand overthecountermedication forreliefofsymp-
toms,whilechanginglifesituationandperceptionandadoptinga
positivefocusmaygiverisetolongertermremission.
Dr Nick Read
Chair and Medical Adviser,
The IBS Network
The UK charity supporting
people living with IBS.
Become a member of
the network and join a
community of support
and advice.
Go to
www.theibsnetwork.org
or call
0114 272 3253
for more information patient@patientVisit patient.info
18 million people
a month trust
our health
information
C
M
Y
CM
MY
CY
CMY
K
generic-ad-100.8-112.pdf 1 14/08/2015 02:37:35
WE
TURN
INTEREST
INTO
ACTION
Readmoreonhowtokeepyourgut
healthyat
healthawareness.co.uk
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the level is low and you have none of
the characteristic symptoms of IBD,it
is usually ruled out,” says Emmanuel.
“If the levels are high you may be re-
ferred for a colonoscopy, gastroscopy
or MRI, depending on whether IBD
is suspected to affect the colon or
smallbowel.”
Once diagnosed, IBD patients may
be referred to an IBD nurse specialist
- a service in which the UK leads the
world - and which has transformed
access to care. Treatments vary but
usuallyincludedrugsorlesscommon-
lysurgery.
There is no specific test for IBS.
“When suspected it is common for
patients to be sent away with
general advice to look after them-
selves, but patients need better
guidance,”saysEmmanuel.
Treatment and care depends on the
type of IBS, and Emmanuel suggests
that if simple measures don’t help,
patients ask for referral to a teamwith
an interest. Care may include lifest-
yle changes to minimise stress, die-
tary advice, including eating two to
threemealsaday,anddrinkingatleast
1.25 litres of liquid daily (as dehydra-
tion can worsen constipation as part
ofIBS).
Patients should search out
reliable sources of information
from charity sites such as
corecharity.org.uk,
theibsnetwork.org, and
crohnsandcolitis.org.uk.
“Do not rely on
the internet for
a diagnosis. Go
along to your GP”
PHOTO: CHAMPJA
Dr Anton Emmanuel
Spokesperson for the British
Society of Gastroenterology and
Medical Director, Core – The
Digestive Disease Foundation
Barrett’s Oesophagus
Barrett’s oesophagus is a condition where part
of the lining of the oesophagus (the name for
the tube which connects the mouth to the sto-
mach) changes in response to frequent and
long term acid reflux (heartburn).
Barrett’soesophagusisapre-cancerouscondition,soitis
vitalthatitisdiagnosedandtreated.
Diagnosisismadebygastroscopy,wherealongflexible
cameraisinsertedthroughthenoseormouthandisused
tolookdirectlyattheoesophagus,stomachandpartofthe
smallbowel;diagnosisisconfirmedbysmallsamplesta-
kenatthetime.
Thecurrentbesttreatmentisadailytablettocontrol
theproductionofacidbythestomachandregulargast-
roscopytoexamineandsampletheBarrett’sarea.There
areother,morepermanent,treatmentsavailablewhich
areundergoingtrialspresentlytoassesstheirlongterm
benefits.
RiskfactorsfordevelopingBarrett’sincludechronicre-
flux,malesex,age>50andobesity.
Casesofpersistentacidreflux,chronicandpersistent
heartburnandnausea/vomitingshouldalwaysbediscus-
sedwithyourGPinorderthatajudgementcanbemade
astowhetherfurthertestsarerequiredorasimplechange
indietisnecessary.
Ifyouareconcernedaboutfrequent,severeheartburn
whichisnoteasedwithoverthecounterremedies,please
makeanappointmentwithyourGP.
Dr Steve Fox
Medical Director Endoscopy,
InHealth Endoscopy Limited
EXPERT INSIGHT
“Lynda’s death left the biggest hole in my life. The
ten years I spent with her were the most wonderful
- she had such a happy, positive influence on
everyone around her. Her diagnosis of bowel
cancer came as such a shock to both of us and all
our family. Lynda would definitely approve of me
raising more awareness of this awful disease with
Bowel Cancer UK. If together we can save one
person’s life or more, it will be part of her legacy.”
Michael Pattemore
Lynda Bellingham’s husband
and patron of Bowel Cancer UK
Fullinterviewonline
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Hopeforsufferersofcoeliacdisease
intestine. It’s almost as if the bowel becomes ‘col-
lateral damage’ when the body sees gluten as a th-
reat. That reaction causes inflammation and poor
functioning of the small bowel.
He says symptoms are many and varied. “Tradi-
tionally GPs considered diarrhoea to be the main
symptom. However there can be more nebulous
symptoms such as feeling constantly tired,mouth
ulcers,Irritable Bowel Syndrome,bloating,consti-
pation, vitamin deficiencies, weight loss, vomit-
ing or anaemia.”
Dr O’Malley says there is a correct process for
diagnosis, which is free and accessible through
the NHS.
“GPs will often suggest tests based on symp-
toms or if a patient has relatives with coeliac di-
sease. We offer a simple blood test and tissue test
and then agastroscopy to take samples for an in-
testinal biopsy.The Gold Standard for testing is the
intestinal biopsy which explores the fronds of the
small bowel under a microscope.”
Dr O’Malley warns against self-diagnosis, tes-
ting kits ordered from the internet and diagnosis
by alternative practitioners, which he views
with scepticism.
“It is trendy now to say ‘I’m allergic to
gluten’butsomepeoplearemakingchoicesonpoor
information and alternative testing and could
create dietary problems in the future.
“It’s important to be tested correctly by a GP.It’s
not helpfulwhen patients make their own diagno-
sis and go off gluten because it affects the results of
medical testing.
“More testing in recent times gives the impres-
sion coeliac disease is increasing however more
cases are now being detected now than in the past.
Dr O’Malley said there is confusion between Ir-
ritable Bowel Syndrome (IBS) and coeliac disease
because sufferers have similar symptoms. “Many
patients with IBS do have coeliac disease as well.”
Dr O’Malley was a member of the National In-
stitute for Clinical Excellence (NICE) committee
in 2009 researching the assessment and manage-
ment of coeliac disease. A new set of NICE recom-
mendations were released in 2015
He recommends Coeliac UK as a “fantastic
repository of information the disease, products
and recipes.”
Having coeliac disease doesn’t have to mean
a life of misery. With proper diagnosis and
dietary changes, your health and confidence can
be restored.
Anaphylaxis is an extreme allergic reaction
and hospitalisation from episodes has
increased in the UK and US according to
Professor Aziz Sheikh.
He says: “Anaphylaxis occurs rapidly within mi-
nutes and is potentially life-threatening. It’s a ge-
neralised reaction involving a number of body sys-
tems, especially the airways causing breathing
difficulties and the cardio-vascular system cau-
sing a drop in blood pressure.
“In the context of food allergy-triggered anap-
hylaxis, if children and adults with allergies avoid
the triggers such as milk, eggs, peanuts, tree nuts,
then the risk of reaction is negligible. However in
the case of accidental exposure it’s wise to carry
an adrenaline auto-injector pen, which is self-ad-
ministered and can be life-saving.”
“Auto-injector pens can be prescribed by GPs to
patients with a history of anaphylaxis or at risk
of episodes. It is crucial to carry one in case of
emergencies. In some individuals allergies can be
treated with immunotherapy, which adminis-
ters small doses of the allergen to stimulate the
immune system’s protective mechanism.”
Sheikh is involved with collaborative research
across 13 universities in his capacity as Director
of the Asthma UK Centre for Applied Research.
He works with innovative post-graduate students
and also treats children in his clinical practice.
He explains that an allergy is an aberrant im-
mune reaction to harmless material in the envi-
ronment such as food, pollen or dust mites that
triggers an inflammatory response.
“In the vast majority of cases we can improve
the quality of life, although not necessarily cure
allergies as yet. People should be reassured.We are
collaboratively moving in right direction in un-
derstanding and treating allergies.”
Agluten-freedietcanbetransformativeforpeoplewithcoeliacdisease,accordingtoManchesterGPDrJohnO’Malley.
Hesays:“Ifpatientssticktothediet,theirqualityoflifecanbetransformedafteryearsoftirednessandpoorhealth.
Peopledon’trealisehowilltheyareuntilthey’rewellagain.Theyregaintheirhealthandtheirconfidence,whichisagreat
encouragementtostaygluten-free”
Professor Somnath
Mukhopadhyay
Chair, Paediatrics at the Royal
Alexandra Children’s Hospital
and professor, Brighton and
Sussex Medical School
“We have to
do some myth
busting. This
is not a rare
condition. It
affects one to
two per cent
of the population”
D
r O’Malley points out that alt-
hough it’s become trendy to
go ‘gluten-free’ many people
are not diagnosed properly and
might not have the debilitating
disease. He says: “People with
coeliac disease do not choose to have a gluten-
free diet to be trendy.If they had a different world,
they would be eating bread and cakes like every-
body else!”
Coeliac disease is a serious condition affecting
countless thousands of people. “We have to do so-
me myth busting. This is not a rare condition. It
affects one to two per cent of the population and
we don’t know how many undiagnosed people are
out there.
“We need to think outside the box. Diarrhoea is
not the only symptom of coeliac disease. It can
show itself in lots of different ways including
chronic fatigue.”
Dr O’Malley, who has studied the condi-
tion for many years, explains: “Coeliac di-
sease is a hyper immunological disease against
gluten found in wheat, barley and rye - the
sticky part of the grain. The body attacks the
gluten and in the process attacks the small
Avoidinglife-threateninganaphylaxis
Dr John O’Malley
GP, Medical
Director, PCSG
Professor Somnath Mukhopadhyay has
devoted his career to understanding
allergies and asthma in children. And yet
the cause of allergies remains to some
extent a mystery.
Mukhopadhyay explains: “I don’t think we really
know the one cause. When your body comes into
contact with certain substances that it’s primed to
react to, reactive molecules increase in the blood
and the child is more vulnerable to developing face
swelling or other problems.This is the classic way
of defining an allergy.
“However my colleagues and I published a pa-
per in 2008 where we tracked the signs of allergy-
related disease in little babies and we could find
absolutely no effect on the blood. It is thus not
clear what an allergy is in the young child, the
most vulnerable of the population. There is still a
lot of ambiguity.
There is a great deal of support available these
days to parents and children with allergies.
“Like never before, there is now an opportunity
to access excellent information.”
Mukhopadhyay is dedicated to sharing the la-
test knowledge about allergies with GPs and nur-
ses. He believes that allergies are inextricably re-
lated to asthma and eczema. ”The skin molecu-
le called filaggrin is like a staple from a stapler
that holds together the thin paper-like sheets of
keratin. If filaggrin works well, these layers lie
firmly together; however if the staple is weak, the
keratin sheets are all over the place and the skin
becomes permeable to allergens.
“The key message I’d like to get out to parents of
children with allergies is that every child is diffe-
rent. Historically we have been guided principal-
ly by broad-based randomised controlled data, but
we now have much additional information that al-
lows us to take a more individualised approach for
patients.”
It is important for patients to continue using
their medicines as prescribed by their doctors and
to talk to their doctor or nurse if they feel their
medicine is not working.
Unravellingthecauseofallergiesinchildren
Professor Aziz
Sheikh
Primary Care Research
and Development,
University of Edinburgh
