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Evidence or eminence: optimising patient outcomes by choosing the right doctor?
  1. Peter Laszlo Lakatos1,
  2. Gabor Veres2
  1. 11st Department of Medicine, Semmelweis University, Budapest, Hungary
  2. 21st Department of Paediatrics, Semmelweis University, Budapest, Hungary
  1. Correspondence to Dr Peter Laszlo Lakatos, 1st Department of Medicine, Semmelweis University, Koranyi st. 2/A, Budapest H-1083, Hungary; lakatos.peter_laszlo{at}med.semmelweis-univ.hu

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Ulcerative colitis (UC) is a chronic inflammatory disease of the large bowel, characterised by a relapsing-remitting course, frequently requiring hospitalisation.1 Despite significant advances in therapy over the past decades, a significant proportion of the patients still come ultimately to colectomy. Relatively few data (around 25%) are available on the hospitalisation rates in UC; however, it appears that despite advances in treatment algorithms, hospitalisation and colectomy rates have not decreased in the last decade in UC. In general, hospitalisation rates are two–threefold higher compared with the general population.2 Moreover, stable hospitalisation rates have been reported from the US by using 1990 to 2003 National Hospital Discharge Survey data (8.2–12.4 per 100 000 people)1 and in a population-based cohort from Canada between 1994 and 2001 (12.6–13.3 per 100 000 people), with major surgery being an important reason for hospitalisation in the latter study (55%).3 By contrast, increasing hospitalisation rates have been reported in another study done in the US by analysing the nationwide inpatient sample data between 1998 and 2004,4 with an annual 3% increase in hospitalisation rates, although surgical rates remained stable.

The reasons for hospitalisation in UC may be several, including infectious diseases, but these patients typically have acute severe colitis (ASC). ASC is a significant clinical condition affecting about 20% of UC patients during the disease course. Overall, the management of these patients is challenging. Murthy et al report an important study of the impact of gastroenterology specialist care compared with care by other providers on …

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