Introduction The British Society Gastroenterology (BSG) guidelines for Inflammatory Bowel Disease (IBD) advise escalating treatment to immunosuppressives (IS) in severe relapsing disease and cases requiring repeated corticosteroids (CS). Anti-TNF (aTNF) therapy is recommended as 2nd line therapy. We used data collected in the 3rd Round UK IBD Audit to see how newly diagnosed and established patients with IBD are treated following hospital admission.
Methods Retrospective patient data from 198 UK sites were collected using an online form with up to 40 patients per site. Inclusion criteria were age >17 years, admission date from September 2010 to August 2011 and a discharge diagnosis of IBD. Relevant ICD10 and OPCS codes were provided. Data items collected included established/new diagnosis of IBD and drug treatment on discharge from hospital following admission with active disease. Incomplete data were excluded. Statistical analysis used Fishers exact test.
Results Approximately 15%–20% newly diagnosed IBD patients are discharged with IS and/or aTNF therapy (CD 19.4%, 67/345; UC 15.0%, 63/420, p=0.18). Treatment patterns for established and newly diagnosed IBD patients are broadly similar but established CD patients are more frequently discharged with IS and/or aTNF compared with established UC (CD 52.1%, 924/1773; UC 39.8%, 638/1602, p<0.0001). 1/4 newly diagnosed CD patients are discharged on no treatment, significantly less than in UC (CD 26.4%, 91/345, UC 10.7%, 45/420, p<0.0001). Patients with established CD are twice as likely to be discharged on IS combined with aTNF compared with established UC (CD 12.5%, 221/1773; UC 5.5%, 88/1602, p<0.0001).
Conclusion The treatment of new IBD in the UK is relatively aggressive with 15% of UC and 20% of CD patients discharged after their first admission with IS or aTNF therapy. This is in contrast to those with established IBD. Only 50% of established CD patients are on IS or aTNF. Effective control of inflammation may prevent long term complications and there may be room for improvement with these patients.
Competing interests None declared.
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