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British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults
    1. 1 Newcastle University, Newcastle upon Tyne, UK
    2. 2 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
    3. 3 Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
    4. 4 University of Exeter, Exeter, UK
    5. 5 Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
    6. 6 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
    7. 7 Imperial College London, London, UK
    8. 8 Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
    9. 9 The Pennine Acute Hospitals NHS Trust, Manchester, UK
    10. 10 University of Manchester, Manchester, UK
    11. 11 King’s College Hospital NHS Foundation Trust, London, UK
    12. 12 King’s College London, London, UK
    13. 13 Guy’s and St Thomas’ NHS Foundation Trust, London, UK
    14. 14 Barts Health NHS Trust, London, UK
    15. 15 Barts and the London School of Medicine and Dentistry, London, UK
    16. 16 Leeds Teaching Hospitals NHS Trust, Leeds, UK
    17. 17 University of Leeds, Leeds, UK
    18. 18 New Road Surgery, Rickmansworth, UK
    19. 19 University of Cambridge, Cambridge, UK
    20. 20 Systematic Research Ltd, Quorn, UK
    21. 21 Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
    22. 22 ECD Solutions, Bridgetown, Barbados
    23. 23 University of Edinburgh, Edinburgh, UK
    24. 24 Western General Hospital, Edinburgh, UK
    25. 25 St Mark’s Hospital, Harrow, UK
    26. 26 University Hospitals Bristol NHS Foundation Trust, Bristol, UK
    27. 27 Royal Hospital for Children Glasgow, Glasgow, UK
    28. 28 Crohn’s and Colitis UK, Hatfield, UK
    29. 29 Glasgow Royal Infirmary, Glasgow, UK
    30. 30 University of Glasgow, Glasgow, UK
    31. 31 Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
    32. 32 University of Birmingham, Birmingham, UK
    33. 33 University College London, London, UK
    34. 34 University College London Hospitals NHS Foundation Trust, London, UK
    35. 35 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
    36. 36 Brighton and Sussex Medical School, Brighton, UK
    37. 37 Royal Wolverhampton NHS Trust, Wolverhampton, UK
    38. 38 University of Wolverhampton, Wolverhampton, UK
    39. 39 University Hospital of Wales, Cardiff, UK
    1. Correspondence to Dr Christopher Andrew Lamb, Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; christopher.lamb{at} and Dr A Barney Hawthorne, Department of Gastroenterology, University Hospital of Wales, Cardiff, CF14 4XW; barney.hawthorne{at}


    Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

    • Ulcerative colitis, UC
    • colitis
    • Crohn’s disease, CD
    • ileitis
    • granuloma
    • fistula
    • stricture
    • perianal
    • inflammatory bowel disease, IBD
    • pouch
    • pouchitis
    • guideline
    • classification
    • diagnosis
    • monitoring
    • endoscopy
    • endoscopic
    • colonoscopy
    • sigmoidoscopy
    • ultrasound
    • magnetic resonance, MR
    • computerised tomography, CT
    • biomarker
    • calprotectin
    • management
    • therapy
    • surgery
    • colectomy
    • adult
    • adolescent
    • suppository
    • enema
    • 5-aminosalicylate
    • 5-ASA
    • mesalazine
    • corticosteroid
    • budesonide
    • prednisolone
    • hydrocortisone
    • methylprednisolone
    • thiopurine
    • azathioprine
    • mercaptopurine
    • ciclosporin
    • cyclosporine
    • anti-TNF
    • infliximab
    • adalimumab
    • integrin
    • vedolizumab
    • ustekinumab
    • JAK
    • janus kinase inhibator
    • tofacitinib
    • therapeutic drug monitoring
    • anti-drug antibodies
    • nutrition
    • diet
    • vitamin D
    • anaemia
    • antibiotics
    • tuberculosis, TB
    • cytomegalovirus
    • CMV
    • clostridium difficile
    • cancer
    • chemoprevention
    • surveillance
    • pregnancy
    • fetus
    • breastfeeding
    • probiotic
    • antibiotic
    • faecal microbial transplant
    • vaccine
    • vaccination
    • multidisciplinary team, MDT
    • adherence
    • self-management
    • telephone clinic
    • virtual clinic
    • primary stress
    • care
    • shared care
    • fatigue
    • stress
    • psychology
    • psychotherapy
    • cognitive behavioural therapy, CBT
    • smoking

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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    • Contributors The guideline development group forms the authorship of this manuscript. All fulfil the ICMJE recommendations for authorship with appropriate involvement at all required stages of the guideline development process which followed GRADE methodology as described. All have contributed to manuscript drafting. The additional named contributors formed the IBD guidelines eDelphi consensus group, contributing to voting over three rounds of Delphi to develop the statements and good practice recommendations set out in this guideline.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Conflicts of interest for authors and contributors are presented in online supplementary table 2.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Collaborators IBD guidelines eDelphi consensus group: Ian Arnott; Kevin J Barrett; R Mark Beattie; Stuart Bloom; Keith Bodger; Richard R Brady; Matthew J Brookes; Steven R Brown; Jeffrey R Butterworth; Christopher R Calvert; Rachel Campbell; Tom Creed; Nicholas M Croft; Fraser Cummings; R Justin Davies; David Devadason; Anjan Dhar; Chris Dipper; Julie Duncan; Malcolm Dunlop; Dharmaraj Durai; Martyn D Evans; Omar Faiz; Nicola S Fearnhead; Alexander C Ford; Aileen Fraser; Vikki Garrick; Daniel R Gaya; James Goodhand; Nigel Hall; Richard Hansen; Marcus Harbord; A Barney Hawthorne; Bu’Hussain Hayee; Sarah Hearnshaw; Paul Henderson; Philip Hendy; Tariq Iqbal; Paul D Johnston; Nicholas A Kennedy; Christopher A Lamb; Jimmy K Limdi; James O Lindsay; Alan J Lobo; Miranda Lomer; Richard E Lovegrove; John C Mansfield; Simon Mclaughlin; Christopher G Mountford; Rafeeq Muhammed; Nurulamin M Noor; Simon Panter; Gareth C Parkes; Miles Parkes; Thomas D Pinkney; Chris Probert; Tim Raine; Richard K Russell; Matthew D Rutter; Mark A Samaan; Jeremy D Sanderson; Christian P Selinger; Ashit Shah; Steve J Short; Baljit Singh; Philip J Smith; Melissa Smith; R Alexander Speight; Catherine Stansfield; Helen Steed; Stuart A Taylor; Helen Terry; Tony C Tham; Nick P Thompson; Gareth J Walker; Catherine L Wall; Janindra Warusavitarne; Gethin L Williams; R Graeme Wilson; David C Wilson; Lisa C Younge. See online supplementary table 1 for affiliations of the IBD guidelines eDelphi consensus group.

    • Patient consent for publication Not required.

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