Our Services

Transabdominal gastrointestinal ultrasound

Transabdominal gastrointestinal ultrasound (TAGUS) is an exciting new tool and is only available at a handful of locations in Australia. TAGUS is used to assess the small and large bowel. In combination with other tests, it can assist with the diagnosis and monitoring of IBD. It is helpful where patients want to limit exposure to radiation and contrast agents. It is helpful if a patient gets claustrophobia associated with other modalities. TAGUS is perfect for patients needing frequent assessments.  

Ultrasound team

St Vincent’s Hospital Sydney is the only NSW IBD centre of excellence to have more than four gastroenterologists trained in TAGUS. The team performs, teaches and conducts research in TAGUS. 

Dr Simon Ghaly and Dr Brandon Baraty are two of the most experienced TAGUS experts in NSW. They are skilled with challenging anatomy and IBD cases. Dr Craig Haifer and Dr Letisia Sin are nationally accredited and have special interests in the use of TAGUS in research, IBD and other non-IBD conditions. Together the group has more experience than any other unit in Sydney and NSW.

The ultrasound procedure

Patients are asked to lie on a bed with only their abdomen exposed. This is usually done with their shirt pulled up to their chest. The ultrasound probe is covered with lubricating gel. It is then moved over the skin of the abdomen to take images of the large and small bowel. Ultrasound is very safe and there is no radiation or requirement for bowel cleanse or any contrast dyes. There are also no tight spaces to cause claustrophobia. 

Before the ultrasound, there is no preparation required. Patients do not need to fast. Please avoid carbonated drinks in the hour before the appointment. If you have proctitis, a full bladder is helpful.

Information for referring Gastroenterologists

TAGUS is accepted nationally and internationally. It is listed in guidelines for diagnosis and monitoring of IBD. Some circumstances that you may consider referring for a TAGUS include: 

  • Suspected IBD or symptom changes in a patient with established IBD
  • No symptoms, but worsening stool or blood tests in a patient with established IBD
  • Therapeutic monitoring (assess the success of new or changed IBD medications)
  • Patients not able to undergo MRI or CT evaluations of IBD
  • Assessment of areas of the small bowel not reached by colonoscopy  Stricture length assessment (to determine if appropriate for dilatation
  • Elderly or co-morbid patients with IBD
  • Patients suspected of having functional symptoms
  • Can also be helpful for patients suspected of having immune-checkpoint-inhibitor colitis

Note for referring doctors: Please let your patients know that changes will not be made to their care, unless specified. Patients will need to see you to discuss the ultrasound results. If you wish, you can request a specific Gastroenterologist to perform the TAGUS. Please specify this on the request form.

Referral form for GP’s specialists

Nurse services
IBD Advice Line

The IBD Advice Line is a dedicated email and telephone answer machine service. This service is available to patients attending St Vincent’s Sydney IBD service. Specialist IBD nurses manage the advice line. The main purpose is to provide advice on disease flares between clinic appointments. Please note, the telephone service is an answer machine service. Please leave a voice message with your name, return phone number, and the details of your request.

We endeavour to respond to disease flare queries within 24 hours. We will respond to all other matters within five working days. The IBD Advice line contact details are: 

IBD Nurse-led clinic

The IBD Nurse-led clinics take place on Tuesday and Friday afternoons. This is in tandem with the Gastroenterologist-led IBD Clinic. The clinic allows for patients to talk through all aspects of their IBD care with the nurse. You may attend for self-injection supervision and training. Your Gastroenterologist may offer a nurse-led appointment as an interim between Gastroenterologist appointments. This may be to review your response to recent changes in treatment. To book an IBD Nurse clinic appointment please contact the nurses on:

  • Email: SVHS.IBD@svha.org.au 
  • Phone: 02 8382 2388

Please note, the telephone service is an answer machine service. Please leave a voice message with your name, return phone number, and the details of your request.

Dietitian services

The IBD dietitian clinic runs weekly on Tuesdays, 1pm to 5pm. This is in tandem with the Gastroenterologist-led IBD Clinic. You must be under the care of a St Vincent’s Hospital Sydney IBD Gastroenterologist to access this service. Your St Vincent’s Hospital Sydney gastroenterologist, IBD nurse or dietitian can refer you. This clinic allows for patients to talk through all aspects of food and nutrition in relation to IBD.

IBD outpatient Dietitian services available: 

  • Exclusive Enteral Nutrition (EEN)
  • Crohn’s Disease Exclusion Diet (CDED)
  • Poor oral intakes, malnutrition
  • New diagnosis of IBD
  • Gastrointestinal surgery
  • Fibre modification
  • Nutrition impact symptoms, e.g., nausea, vomiting, diarrhoea, constipation
  • Coeliac disease
  • Functional Gastrointestinal disorders, e.g., low FODMAP Diet

The dietitian will take a nutrition assessment and provide nutrition advice and education. If needed, the dietitian can prescribe subsidised nutritional supplements. Before your consultation, you will be asked to complete a diet history form. If you have a history of disordered eating, you may not answer all the questions if you don’t feel comfortable. Completing the form is optional. 

Nutrition in IBD

General Nutrition

In general, most people with IBD should follow healthy eating principles. Some vitamins and minerals can become depleted in IBD. Talking to the IBD dietitian about dietary intakes can help to optimise these. 

Exclusive Enteral Nutrition (EEN)
EEN is a nutritionally complete medical drink therapy, used to help induce remission in some people with active Crohn’s disease. EEN is supervised by the gastroenterologist and IBD dietitian. All foods and drinks (except water) are avoided, usually for a six to eight week period. The gastroenterologist and IBD dietitian monitor you throughout the protocol.

Crohn’s Disease Exclusion Diet (CDED)
CDED is a diet that has been shown to help induce remission in some people with mild to moderate active Crohn’s disease. This diet is supervised by the gastroenterologist and IBD dietitian. CDED includes only a limited number of foods as well as medical nutrition drinks. It is a short-term diet therapy that is usually followed for a 12 week period.

Fibre modifications
For people with IBD that experience strictures or adhesions, modifying dietary fibre may help to reduce the chances of bowel obstructions. For people with IBD that need to follow a modified fibre diet, their IBD team will work out which dietary fibres to restrict and for how long.

Low FODMAP diet
A low FODMAP diet has been shown to be effective in those people with IBD who also have functional symptoms, like bloating, distension, and gas. It is a short-term diet, usually followed for 2 to 6 weeks. The dietitian explains how to follow the low FODMAP diet and make changes to optimise gut health.

Pharmacist services

The IBD pharmacist is available Thursdays and Fridays to provide medication-related advice. Queries can be sent through the IBD Advice line for pharmacist attention. The pharmacist-led virtual oral immunomodulator clinic also runs weekly on Thursdays and Fridays. Patients are referred to the clinic by the St Vincent’s Hospital Sydney IBD team.

Pharmacist-Led Quality Use of Medicines

The IBD pharmacist works to ensure safe and optimal use of medications. The IBD pharmacist provides advice to patients and the multidisciplinary team. Topics including:

  • How medicines work, side effects and their monitoring requirements 
  • Personalised medication adjustments based on therapeutic drug monitoring (TDM) results 
  • Strategies to improve medication tolerance and adherence
  • Medication interactions and their significance
  • Safety of medicines in pregnancy and breastfeeding, and impacts on fertility
  • Accessing medications in the hospital and community settings

Virtual Oral Immunomodulator Clinic

The IBD pharmacist leads a virtual oral immunomodulator clinic. Patients are referred to the clinic by the St Vincent’s Hospital Sydney IBD team. Close monitoring is undertaken by the pharmacist. This includes patients initiating, recommencing or requiring optimisation of medicines, including:

  • Azathioprine
  • Mercaptopurine 
  • Tioguanine
  • Methotrexate
  • Ciclosporin
  • Tacrolimus
  • Tofacitinib
  • Upadacitinib
  • Ozanimod

Patients initiating therapies are seen by the pharmacist face-to-face or via telephone consultation. Follow-up will be conducted via telephone or email. Once stable on therapies, patients are discharged from the immunomodulator clinic. Transfer of care is to the patient’s GP or gastroenterologist. This is for continued medication monitoring.

Close monitoring involves:

  • Blood tests at regular intervals to assess safe use of medicines and response to therapy
  • Measurement of the amount of medicine in patients’ blood to inform the need for personalised therapy change
  • Early identification and management of medicine-related side effects

The IBD pharmacist works with the multidisciplinary team to escalate necessary monitoring results. This is to ensure patients are supported.