Endoscopy Unit Royal London Hospital Whitechapel Road London E1 1BB 26th June 2014 Patients with Inflammatory Bowel Disease and Ramadan Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract and the majority of patients with IBD will be on some form of medication. This is a very brief guide for GP’s managing Muslim patients with IBD during the fasting month of Ramadan. Patients in remission For those patients in remission, fasting should be possible with support from either the IBD team or their GP. Most IBD medications can be taken either as an OD or BD preparation and therefore can be taken as normal during the month. Some 5-ASA medications are still prescribed as TDS or even QDS, but these can safely be converted to OD: there is good evidence that once daily dosing of 5ASAs is just as effective as more frequent doses in IBD. Colazide (balsalazide) is an exception and could be switched to BD. Patients developing a relapse For those patients whose disease is flaring up, the major concern would be fluid depletion from diarrhoea and the possibility of weight loss from the combination of active disease and fasting; hot weather could worsen this risk through increased insensible fluid loss from sweating. GP advice should be the same as for any patient you have concerns for during Ramadan. Patients with a bad diarrhoeal episode may need to avoid fasting during this period depending on the severity of the attack. Stomas A small proportion of our patients will have either an ileostomy or colostomy. Most patients with colostomies should be able to cope with prolonged periods without water but should be warned about the signs of fluid depletion. For the majority of patients with ileostomies, fasting would present a significant risk of fluid depletion, especially in hot weather. Finally, if any patient has specific concerns please encourage them to contact either us or the Muslim Chaplaincy Service at the Royal London Hospital. on the helpline number below. IBD Helpline number: 02035943700 Muslim Chaplaincy Service: 02035942070 Dr Gareth Parkes – Locum Consultant in Gastroenterology Imam Ahmad Faruq Siddiqi, Muslim Chaplain Barts Health NHS Trust