Question:
Can people living with Crohn’s disease or ulcerative colitis donate blood?

Answer:
Australian Red Cross Blood Service does accept donors with IBD to donate provided they are well and off immunosuppressive medication for a minimum of 4 weeks. The Australian Red Cross Blood service is only able to use the plasma component of the donation for transfusion purposes. Donors presenting to donate are in most circumstances referred to the duty Medical Officer, in order to assess whether they are suitable.

Answer:
The most important thing that an IBD patient should understand is that they should have a normal or very near normal quality of life with few, if any restrictions and they should not be happy until they do! So it is absolutely OK to travel and all you need to do is take some common sense precautions. The first is to make sure you are well (in remission) prior to travelling - going away while you are flaring would make things difficult. Next, you need to make sure that you have an adequate supply of medications for your entire trip as you do need to stay on medicines while you are away. This is really a practical issue but I believe it would be best to have your supply of medicines from Australia.

Therefore you will need to take some with you initially and have a system worked out on how to get repeats sent over - this will be far easier than getting them abroad which would be expensive, especially in the US, and availability may be different to home. I think this is the most important practicality to sort out before you go. The most important thing is that you keep taking the medicines exactly as if you were at home. A brief letter from your doctor saying that you have IBD may be helpful in expediting sending and receiving of medicine, and also some form of travel insurance would be a good idea. In the event that you do have a flare, it needs to be treated quickly just as if you were at home.

I would use the IBD websites overseas to find a doctor with IBD experience such as http://www.ccfa.org/ in the USA. Contact your home doctor, as they may know someone with IBD experience where you plan to travel. It is difficult to be more specific than this as obviously you'll be moving around. Careful planning regarding medical insurance and contacts is important in the event that you need medical attention while abroad. Otherwise it makes sense to drink bottled water in less developed areas, as travellers should anyway, just because you can get an infectious diarrhea just like anyone else. With regard to diet there are no particular restrictions, but obviously just avoid anything you notice triggers your symptoms at home. I hope this is helpful to you. Happy and safe travels,

Dr. Miles Sparrow
Director Inflammatory Bowel Disease Clinical Trials
Department of Gastroenterology
Box Hill Hospital
Melbourne

Question:
I suffer with Crohn's disease and have 2 children who are 6 and 9 years old. Please can you let me know what the chances are of them also developing the disease and if there is anything I can do to reduce this risk?

Answer:
We know that genes play an important role in the development of IBD. It is, therefore, unsurprising that people who have IBD sometimes worry about the risk of one of their children also getting the disease. However, research has shown that there is more than one gene involved with more being discovered every year.

It is also important to remember that many other factors are involved in the development of IBD. It is, therefore, difficult to give exact estimates of the risk getting IBD if you have a first-degree relative (i.e. a parent, sibling or child) who has either Crohn's disease or ulcerative colitis.

Currently, we think the risk of an offspring of someone with Crohn's disease also developing Crohn's is probably in the order of 5-10%, while that for UC is a little less. The risk is a slightly higher than this for siblings of someone with IBD, but a little less for parents. We also know that having more than one first degree relative with IBD increases the risk further and that in the very rare situation of both parents having IBD, that there is a considerable increase in risk that any of their children will also develop IBD.

As with many conditions in which genes play a role, there are some racial groups who are at higher risk. For example, in some parts of the Jewish community the risk is a little higher than those quoted above.

As to preventing offspring getting Crohn's, breast-feeding is probably protective and children of parents with Crohn's should never smoke (when they are old enough!). Possibly passive smoking is a risk but there is very little data on this. If either parent is a smoker then they should probably stop.

Dr Peter Irving, MD, MRCP, MA, MBBS
Gastroenterology Fellow,
Box Hill Hospital, Vic

Question:
I am a 40-year-old man with Crohn's disease. I have had two resections of my small bowel and take Imuran and Mesalazine. My doctor tells me my Crohn's disease is in remission but I am constantly troubled with diarrhoea. Is there anything I can do to help reduce the amount of diarrhoea I suffer?

Answer:
Diarrhoea is a common symptom associated with Inflammatory Bowel Disease (IBD), including Crohn's disease and ulcerative colitis.

Diarrhoea in IBD may be a result of active disease in the colon where there is swelling and ulceration (inflammation). The colon therefore does not absorb the excess water in stools, resulting in loose stools or diarrhoea. It is imperative to treat the underlying inflammation in order to relieve the symptoms and to prevent worsening of the condition.

Another common cause of diarrhoea is bile salt irritation. Bile is produced by the liver and is important for fat digestion. It is usually reabsorbed in the terminal ileum (the last part of the small bowel). If the terminal ileum is affected by active Crohn's disease or if it has been removed by surgery, excessive bile is released into the large bowel and subsequently results in diarrhoea.

A lower fat diet or the use of Questran (Cholestyramine) may help this. Your specialist can advise on the dose, which needs to be titrated carefully to avoid constipation. Questran may interfere with the absorption of some drugs so it is important to check with your doctor or pharmacist.

A number of people may have diarrhoea due to food sensitivity (or intolerance). This is not the same as food allergy, which is very rare and involves the body immune system producing antibodies to a specific food substance.

In some cases sensitivity results in a reaction to some food substances although the immune system is not involved. Some of these culprits may be milk, wheat, excessive fibre and fructose (a common sugar found in fruit). They may cause abdominal discomfort, bloating, abdominal pain and diarrhoea. Identifying the problem foods and reducing their intake may provide relief. Advice from a qualified dietitian would be worthwhile.

Common drugs used to treat IBD can also cause diarrhoea in some people. These include the 5-Aminosalicylates such as Olsalazine (Dipentum), Mesalazine (Salofalk or Mesasal) and Balsalazide (Colazide). It may be possible to change to a different formulation if this is indeed the cause of the diarrhoea. Your specialist will be able to advise. Iron supplements can also cause diarrhoea (or constipation) in people with IBD.

The use of antidiarrhoeal medication can be helpful such as Lomotil and Loperamide (Gastrostop). However it is important to ensure that any inflammation caused by Crohn's disease and ulcerative colitis is treated first.

Lai Wan
IBD Clinical Nurse Specialist