Outpatient care for inflammatory bowel disease at a primary referral hospital in Turin

Abstract

Aim: This was a retrospective survey of 88 inflammatory bowel disease patients (43 with ulcerative colitis, 38 with Crohn's disease, 7 with indeterminate colitis) who were visited between January 2008 and June 2009 at a newly established out-patient service at a primary care hospital in Turin.

Methods: Treatments included corticosteroids (48 courses), mesalamines (79 courses), thiopurines (46 courses), and biological drugs (three treatments). With more extra-intestinal manifestations, more steroid needs, more visits and more surgeries, Crohn's proved more fastidious than ulcerative colitis. All of the drugs used gave side-effects that required skillful action for control: switch to mercaptopurine was advantageously used to react to azathioprine intolerance.

Results: Percentages of steroid needs, of stable remission, and resort to surgery were 30, 50, <20 and 40, 27, 30, respectively in ulcerative colitis and Crohn's. Thiopurines played a crucial role in the maintenance of remission of ulcerative colitis: the patients maintaining remission in the absence of azathioprine had either been resected or had left-sided disease only; left-sided disease proved also fairly responsive to beclomethasone. The unusual conduction of this service by a single doctor caused an increased trust-in-physician, but also more bias and placebo effects as drawbacks.

Conclusions: The results suggest that in the last 30 years management of inflammatory bowel disease has still improved mainly due to refinement of the use of traditional drugs.