Clinic implementing innovative approaches for diagnosing and monitoring Inflammatory Bowel Disease

Inflammatory Bowel Disease Inflammatory Bowel Disease (IBD) is a growing concern in Nova Scotia, with one in every 80 people, or 1.25 per cent of the population, affected by the chronic conditions of Crohn’s disease or ulcerative colitis. By the year 2030, it is predicted the number of people living with IBD in the province will increase to 1 in 60, and the team at the Nova Scotia Collaborative Inflammatory Bowel Diseases Clinic is readying for the increased demand for quality patient care. 

“As a provincial network we are slowly building capacity,” said Dr. Michael Stewart, medical co-lead of the clinic, which operates at both the QEII Health Sciences Centre and Cobequid Community Health Centre. “In Nova Scotia, we have three physicians who treat IBD primarily, two nurse practitioners, some access to a dietician and a health psychologist, which both need to be increased. We recently hired a part-time social worker which is a huge bonus for us in supporting the psycho-social aspects of IBD which can be very challenging. As you can imagine, IBD can impact many aspects of your life, really impact your quality of life, and there are lots of taboos with these diseases.” 

Dr. Stewart is also enthusiastic about the development of new surrogate tools used to diagnose and evaluate IBD activity promptly, allowing for better disease management and improved patient outcomes. 

One tool is a non-invasive laboratory test, called fecal calprotectin, which helps diagnose IBD or distinguish between IBD and irritable bowel syndrome (IBS). The NS collaborative IBD program worked closely with Nova Scotia Lab Services to make this test available to Nova Scotians living with IBD. A second new non-invasive test is point of care intestinal ultrasound, which provides clinicians with accurate, real-time images of the intestinal tract, aiding in the diagnosis and monitoring of IBD activity and avoiding traditional endoscopic investigations which are invasive and expensive. 

“When a patient is having complications or symptoms that are highly suggestive of IBD, access to timely endoscopy can be difficult,” said Dr. Stewart. “But with point of care intestinal ultrasound, if we see a patient with symptoms that could be IBD, we can put the ultrasound probe on the stomach while we are in the clinic and see right away if the bowel is inflamed. In the past, we would need to book a colonoscopy, which most of the time would be normal, but with IUS we can avoid unnecessary colonoscopies. Patients like that they can avoid an invasive procedure.” 

Until recently only one intestinal ultrasound was in use in the province, in Bridgewater. But recognizing the importance of early detection and accurate monitoring of IBD, Dr. Stewart decided to implement the ultrasound into patient care protocols. He sought training for the specialized technique of performing IUS and even secured an ultrasound machine for use in the IBD clinic. Soon, Dr. Stewart’s co-lead, Dr. Jennifer Jones, will also begin IUS training so that more patients can also benefit from the innovative approach to care. 

“In the past, patients who are known to have IBD – colitis or Chron’s – were looking at enduring regular colonoscopies, which are not pleasant, and take days off work for preparation and the procedure,” said Dr. Stewart. “Now, it takes a few minutes to check the bowel with the ultrasound in clinic every few months, which is a much faster, easier way to follow the disease long term.” 

“We can also facilitate early access [to endoscopy] for a patient who comes in with abdominal pain or diarrhea using the IUS, because we can look at the bowel right away and arrange an urgent colonoscopy if we see trouble.” 

The lessons learned by the IBD team are soon being shared nationally. A recent survey of patients who received point of care ultrasound, as well as referring clinicians, was conducted to evaluate satisfaction, acceptance of other methods to assess IBD activity and the impact on quality of life. Survey results will be presented at the Canadian Association of Gastroenterology annual meeting in February 2024. The findings suggest that intestinal ultrasound is highly acceptable to patients and clinicians for investigating and monitoring their illness.

Photo of Dr. Michael Stewart, medical co-lead of the Nova Scotia Collaborative Inflammatory Bowel Diseases Clinic.