British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Abstract

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.

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

Figure 1

Management of proctitis.

Figure 2

Management of acute severe ulcerative colitis.

Figure 3

Medical prophylaxis after ileocolonic resection for Crohn’s disease.

Figure 4

Anti-TNF therapeutic drug monitoring.

Figure 5

Osteoporosis prevention and management in IBD.

Figure 6

Use of faecal calprotectin in primary care.

Figure 7

The IBD multidisciplinary team (MDT). It is important that the MDT meets regularly to review cases and make recommendations. All members of the team should have input as appropriate, but those in the inner box should be present at all regular MDT meetings. Staff in the middle box can and should be encouraged to attend these meetings, but this may not always be possible and they should nevertheless be encouraged to contribute reports or opinions. Staff in the outer box are part of the wider MDT and may contribute to team function through clinical input outside of these team meetings, such as through combined clinics or working to shared protocols. Staff in the grey circle should attend as a valuable part of their training.