Update on British guidelines for management of IBD in adults
Please find below a summary of the recently published British guidelines on the management of inflammatory bowel disease in adults.
- All IBD patients should be reviewed 2-4 weeks after completing loading doses of anti-TNF therapy to assess response and optimize maintenance dosing.
- IBD patients receiving immunomodulators or biologics should have an annual review of treatment, including consideration of response and treatment continuation, optimization or cessation.
- Treatment options for failure of initial anti-TNF therapy (option 1: increase dose / option 2: shorten dosage interval / option 3: switch to alternative anti-TNF /option 4: switch to different drug class) may be informed by the clinical context and by measurement of serum drug and anti-drug antibody concentrations.
- It is appropriate to have serum drug and anti-drug antibody concentrations measured in patients with secondary loss of response.
- In the context of Therapeutic de-escalation, anti-TNF therapy may be withdrawn in patients with prolonged corticosteroid-free remission and mucosal healing.
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.
British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H; IBD guidelines eDelphi consensus group, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB.Gut. 2019 Dec;68(Suppl 3):s1-s106.