Guidelines for the management of inflammatory bowel disease in adults
- M J Carter1,
- A J Lobo2,
- S P L Travis3,
- on behalf of the IBD Section of the British Society of Gastroenterology
- 1Division of Molecular and Genetic Medicine, Royal Hallamshire Hospital, Sheffield, UK
- 2Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
- 3Gastroenterology Unit, John Radcliffe Hospital NHS Trust, Oxford, UK
- Correspondence to:
Dr S Travis
Gastroenterology Unit, John Radcliffe Hospital NHS Trust, Oxford OX3 9DU, UK;
- 5-ASA, 5-aminosalicylic acid
- AZA, azathioprine
- CD, Crohn’s disease
- CRP, C reactive protein
- CsA, cyclosporin
- ESR, erythrocyte sedimentation rate
- FBC, full blood count
- IBD, inflammatory bowel disease
- IFX, infliximab
- MP, mercaptopurine
- MTX, methotrexate
- NNT, number needed to treat
- TPMT, thiopurine methyl transferase
- UC, ulcerative colitis
Ulcerative colitis (UC) and Crohn’s disease (CD) (collectively termed inflammatory bowel disease (IBD)) are complex disorders reflected by wide variation in clinical practice. These guidelines, commissioned by the Clinical Services’ Committee of the British Society of Gastroenterology (BSG) for clinicians and allied professionals caring for patients with IBD in the United Kingdom, provide an evidence based document describing good clinical practice for investigation and treatment. The guidelines are intended to bring consistency, but should not necessarily be regarded as the standard of care for all patients. Individual cases must be managed on the basis of all clinical data available for that case. Patient preferences should be sought and decisions jointly made between patient and health professional.
1.1 Development of guidelines
A comprehensive literature search was performed using electronic databases (Medline, PubMed, and Ovid; keywords: “inflammatory bowel disease”, “ulcerative colitis”, and “Crohn’s disease”) by Dr Carter. A preliminary document was drafted by Dr Carter, Dr Lobo, and contributing authors. This was summarised by Dr Travis and revised after circulation first to the committee and then to members of the IBD section of the BSG, before submission to the Clinical Services’ Committee.
1.2 Grading of recommendations1
The guidelines conform to the North of England evidence based guidelines development project. The grading of each recommendation is dependent on the category of evidence supporting it:
Grade A—requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation (evidence categories Ia and Ib).
Grade B—requires the availability of clinical studies without randomisation on the topic of consideration (evidence categories IIa, IIb, and III).
Grade C—requires evidence from expert committee reports or opinions or clinical experience of respected authorities, in the absence of directly applicable clinical studies of good quality (evidence category IV).
1.3 Scheduled review of guidelines
The content and evidence base …