Guidelines have been published as a framework for therapy of patients with inflammatory bowel disease (IBD).
Dr Sarathchandra and colleagues from Massachusetts determined whether patients referred for a second opinion were receiving therapy in accordance with practice guidelines.
|9 of 12 patients with distal ulcerative colitis were not receiving rectal aminosalicylate therapy|
|American Journal of Gastroenterology|
The researchers enrolled 67 patients with luminal IBD.
The team reported that patients were under the care of a gastroenterologist who sought a second opinion at Brigham and Women's Hospital between 2001 and 2003.
The researchers obtained clinical information by direct patient interview at the time of initial patient visit and by a review of prior records.
The team's data included the diagnosis, clinical symptoms, prior medical therapy, preventive measures for metabolic bone disease, and colon-cancer screening.
The study population consisted of 21 with ulcerative colitis, 44 with Crohn's disease and 2 in whom the diagnosis of IBD could not be confirmed.
Of the 65 patients with confirmed IBD, the researchers noted that 56 patients had symptoms of active disease and 9 were asymptomatic.
All analyses were carried out on the 56 patients with active disease.
Of the 33 patients treated with aminosalicylates, the researchers reported that 21 were not receiving maximal doses.
The research team found that 9 of 12 patients with distal ulcerative colitis were not receiving rectal aminosalicylate therapy.
Within 6 months of their clinic visit, 35 patients had received corticosteroid therapy.
The team observed that 27 patients had been treated with corticosteroids for greater than 3 months.
The research team found that in 16 of 27 there was no attempt to start steroid sparing medications such as 6-mercaptopurine, azathioprine, or infliximab.
Of the 11 patients treated with either 6-mercaptopurine or azathioprine, 9 were suboptimally dosed without an attempt to increase dosage.
In addition, the team noted that of the 27 patients on prolonged corticosteroid therapy 21 received inadequate treatment to prevent metabolic bone disease.
The researchers also observed that 3 of 9 patients meeting indications for surveillance colonoscopy for dysplasia, had not undergone colonoscopy at the appropriate interval.
Dr Sarathchandra's team concluded, “Patients with IBD often do not receive optimal medical therapy.”
“In particular, there is suboptimal dosing of 5-ASA and immunomodulatory medications, and prolonged use of corticosteroids.”
“There is also failure to use steroid-sparing agents, inadequate measures to prevent metabolic bone disease, and inadequate screening for colorectal cancer.”