Patients with Inflammatory Bowel Disease and Ramadan

Endoscopy Unit
Royal London Hospital
Whitechapel Road
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
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