Professor Bjarnason takes an individualised broad-based and holistic approach to each patient. He avoids as much as possible uncomfortable invasive investigations, but there are times that these are unavoidable and he will make every step to ensure that comfort and dignity is maintained.
When a diagnosis has been made he aims to provide first-class treatment for all gastroenterological diseases by conventional means as dictated by evidence-based medicine. In particular he takes a multi-disciplinary approach to the treatment of Irritable Bowel Syndrome where the combination of a gastroenterological, dietary and psychological approach with his liaison psychiatrist (http://sloanecourtclinic.com/cv_RH.php) which delivers optimal outcomes for this common and often relentless disease.
The Professor is a super-specialist in the non-invasive investigation and diagnosis of gastrointestinal disease. The latest addition to the growing number of such investigations is the Cologuard test (Thomas F. Imperiale, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. N Engl J Med 2014; 370:1287-1297) that the Professor has made available at his Cromwell practice. This is a highly sensitive (over 90%) and specific (over 85%) non-invasive screening test for colorectal cancer, which also picks up many polyps and is a possible alternative to colonoscopy for those concerned about this disease (FDA approved, but UK insurers do not reimburse the £375 cost).
Colorectal cancer is one of the most common cancer in men and women. The prognosis of colorectal cancer has not changed appreciably in the last few decades. The best hope for reducing mortality and improving prognosis is to diagnose the cancer at an early asymptomatic stage (when surgery is associated with a 90% - 5 year survival, as opposed to less than 20% for more advanced lesions) or to detect pre-cancerous lesions such as large colonic polyps that can be removed during colonoscopy.
Professor Bjarnason is a highly skilled and competent colonoscopist and is happy to carry out colonoscopies in patients worried about the possibility of colorectal cancer. Indeed some Americans advocate a screening colonoscopy at the age of 50 years. However for those who are concerned about the invasiveness of the procedure, the Cologuard provides a very good alternative.
Don’t sit around hoping for the best! Have the investigations and be reassured with a normal result. In the event you have a lesion we will remove this or we will hopefully pick it up at a stage where treatment is very effective if not curative.
It is a diagnosis made by the exclusion of "organic" intestinal disease, which can be made in many patients without reverting to invasive tests (such as endo- and colonoscopy).
IBS is a condition with a highly significant impact on day to day living with frequent and often continuing symptoms, which are variably severe.
Many of these symptoms are difficult to treat effectively and collectively but a multi-path approach coordinated by a gastroenterologist with a specialist interest in the disease and who works closely with dietitians and dedicated psychiatrists/ clinical psychologists is proving to yield the best results.
Professor Ingvar Bjarnason has introduced new non-invasive procedures and tests that are primarily aimed to quickly and effectively distinguish between IBS and Inflammatory Bowel Disease (IBD), such as ulcerative colitis and Crohn’s disease.
The aims are to provide a first-class treatment for all Gastroenterological diseases by
conventional means as dictated by evidence-based medicine.
For distinguishing between IBS and IBD we now have a battery of non-invasive
tests such as:
• Faecal calprotectin test - which quantitates intestinal inflammation.
• Intestinal absorption-permeability test.
• Intestinal disaccharidase test - which measures intestinal sucrase and lactase activities.
• Capsule enteroscopy - which allows direct visualisation of the whole of the small bowel non-invasively.
These tests can exclude non-IBS conditions with an accuracy approaching 100%.
Once the diagnosis of IBS is made it is imperative to implement treatment appropriate to each patient. Whereas more common treatments would involve implementation of appropriate dietary treatment for constipation / diarrhoea and the use of anti-spasmodics / anti-diarrhoeal agents (like questran), these approaches are unfortunately well-known to be ineffective in the long-term.
By contrast, Professor Bjarnason’s approach is significantly more directed in employing probiotics like Symprove which are increasingly used to manage IBS symptoms, especially for constipation and abdominal pain. Wheat-free diets are also highly effective for reducing bloating and a lactose-free diet is advocated in patients with intestinal lactase deficiency. The latest and possibly the most effective dietary treatment is the so called low FODMAP diet that seems to work a treat for bloating, especially in women with IBS
In the most resistant cases, eradication regimes for intestinal Candida albicans and/or a major dietary intervention treatment such as food exclusion diets or elemental diets for up to 6 weeks followed by serial re-introduction of foods in order to detect food intolerances might be employed, but this is rarely the case.
All dietary treatment is carried out in close collaboration with dietitians, to ensure nutritional adequacy during the treatment.
Additionally and just as importantly in these circumstances, a holistic approach is made as well as a biomedical one. This may involve referral to our liaison psychiatrist
Dr Roger Howells (www.sloanecourtclinic.com) and his team who specialise in overcoming lifestyle issues using cognitive behavioural therapy techniques and other means to deal with “coping” strategies and the frequent and accompanying anxiety and depression which go with IBS.
The overall and realistic objective is to get patients 70-80% better and the coordinated investigation and treatment methods described here have undoubtedly proven successful in Professor Bjarnason’s practice.
In the forefront of investigating and treating IBD -
ulcerative colitis and Crohn's disease.
The methods that Professor Bjarnason has developed (measurement of intestinal permeability and inflammation) allow fast, accurate and non-invasive diagnostic discrimination between patients with the Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD).
These investigations allow assessments of the prognosis of inflammatory bowel disease that are instrumental in deciding whether medical or surgical treatment is in the patient’s best interest.
With these comprehensive tests come the most accurate clinical predictors of IBD relapse, thus allowing interventional medical treatment at a stage where there are minimal side-effects. When surgery is the best option, close professional collaboration with the expertise of minimally-invasive surgeons, ensures maximum safety and speed of recovery.
Professor Bjarnason treats patients with active Crohn’s Disease and Ulcerative Colitis by established methods (such as 5-aminosalicylic acid, prednisolone, azathioprine (or 6-Mercaptopurine), elemental diets (and other dietary regimes), antibiotics, cyclosporine, surgery etc, as appropriate for the severity of the disease). He has a particular expertise in treating patients with active Crohn’s Disease with elemental diets (having been instrumental in establishing their efficacy and mode of action) and the new anti-cytokines or so called Biological Treatments.
For those who are concerned about the side-effects of treatment there is the option of white cell apheresis (removal) namely Adacolumn™ treatment. This treatment selectively removes certain white cells from the circulation by filtering the blood through a column and it is without any major side effects. Professor Bjarnason is in the position of being uniquely experienced in Europe with Adacolumn™ treatment (White cell apheresis/removal), in particular having developed its usage through clinical application and controlled-trials cases conducted by us at King’s College Hospital as part of developer-led studies since 2001.
Adacolumn™ is particularly attractive and effective in all stages of Ulcerative Colitis (and in many patients with Crohn's Disease). Recent studies show that it can be used effectively in preventing clinical relapse in patients with IBD who are at significant risk.
Professor Bjarnason is internationally known for his research (inventing, developing and validating) non-invasive methods that allow accurate assessment of intestinal function. A recent addition to this is the use of wireless capsule enteroscopy. This is a new investigation that allows clinicians to obtain a video picture of the whole of the small bowel, in a non-invasive manner. This technique is superceding conventional radiology for the detection of small bowel disease, such as obscure gastrointestinal bleeding, Crohn's disease or the side effects of NSAIDs – (the so-called non-steroidal anti-inflammatory drugs) thus facilitating the detection of disease where none was thought to exist. __With pinpoint detection of abnormality allows biopsies for diagnosis (balloon aided small bowel flexible enteroscopy). The Professor is in the forefront of wireless capsule enteroscopy research having published widely on the subject as well as being an author of chapters in textbooks and atlases.
Professor Bjarnason has developed a number of non-invasive small bowel tests that are uniquely helpful for the differential diagnosis of various intestinal diseases. These include tests of intestinal permeability, intestinal sugar metabolism (disaccharidases), malabsorbption, bile acid-induced diarrhoea, intestinal inflammation, pancreatic function, etc.
One of the most recent research findings is that that the bacterium Helicobacter pylori which is the main culprit in the development of gastric and duodenal ulcers as well as stomach cancer, has a detrimental effect on patients with Parkinson’s disease. Successful eradication treatment of Helicobacter pylori appears to reverse many of the features of Parkinson’s disease and indeed the evidence is that this alters the natural history of the disease. Patients with Parkinson’s disease will be assessed by a multi-disciplinary team which includes clinical neuro-pharmacologists and specialised Parkinson’s disease nurses in order to optimize treatment and treatment success.