Inflammatory Bowel Disease

This is a guideline which seems to be aimed predominantly at specialists. From our point of view there are a few useful bits:

• Patient Information. It lists some useful sources of information for patients.
• Faecal calcoprotein can be used in the assessment. (There is a good editorial on this in the BMJ. It has a sensitivity of 93% and a specificity of 96% for inflammatory bowel disease in patients with possible disease – but studies haven’t been done in primary care yet, so they advise it only in secondary care at the moment – but it may be coming our way in the future).
• People with a flare-up should have access to specialist review within 5 days.
• The medical treatment of IBD is covered in depth. Importantly for us, it advises on the initial management of flare-ups. The BNF summary is effectively the same for the acute management, so that is a good resource.
• Smoking cessation in Crohn’s is the biggest single factor for reducing flares.
• Stopping Maintenance therapy. In those with ulcerative colitis with purely distal disease, you can consider stopping maintenance therapy if they have been clear of disease for 2 years. In patients with more extensive disease, they can consider stopping maintenance therapy after 4-6 years.
• Vitamin B12. In patients with Crohn’s who’ve had a resection < 20cm, do annual B12 tests. If there is > 20cm resected, give B12 injections (most will develop deficiency).
• Pregnancy. Any woman wishing to become pregnant should have their disease control optimised first and should have shared care with gastro and obs.