There are a number of reasons for this. It is obviously important to be sure that the Inflammatory Bowel Disease is completely controlled by the medications administered. That can be a little difficult in the case of Crohn’s Disease, particularly where it affects the small bowel, but there are ways to do that. One useful test that is appearing at the present time is a faecal calprotectin. Royal Brisbane performs this for us at the present time, but there is an application to MSAC for funding of this test in the long term.
However, the issue is more often that the disease does seem to have settled yet symptoms persist. Professor Peter Gibson at Monash has had a great interest this area, together with a dietician attached to his unit, Sue Shepherd, and has investigated this phenomenon for some years now. It was out of that question that the concept of FODMAPS arose. These, as you may be aware, are Fermentable Oligo-, Di-, Mono-saccharides And Polyols. These are constituents of many foodstuffs, especially fruits and vegetables, and probably account for the symptoms of looseness, distension and gas that persist in some patients after adequate treatment of Inflammatory Bowel Disease. They are a potential cause of such symptoms in a proportion of patients with IBS as well. Other triggers for irritable bowel symptoms are no less likely to affect those with treated inflammatory bowel disease either, so there is a third potential explanation. A low FODMAP diet booklet can be obtained from the Monash University dept of medicine website.