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.

Review article: faecal calprotectin and histologic remission in ulcerative colitis

“…Histologic healing is associated with better clinical outcomes including reduced risks of hospitalisation, colectomy and colorectal cancer . Colonoscopy currently represents the gold standard for disease monitoring, as it allows to evaluate endoscopic healing and to perform biopsies for histologic analysis . However, colonoscopy is a relatively invasive procedure, and it is poorly tolerated by patients .…”

Review article: determination of the therapeutic range for therapeutic drug monitoring of adalimumab and infliximab in patients with inflammatory bowel disease

“…This has led to recent American Gastroenterology Association (AGA) guidelines stating the available evidence for TDM in IBD to be of low quality . Interestingly, recent British Society of Gastroenterology (BSG) guidelines advocate use of TDM and management changes based on therapeutic or sub‐therapeutic drug levels, without actually defining what those levels should be. There are no current European Crohn's Colitis Organisation (ECCO) guidelines to help guide clinicians, further highlighting some of the ambiguity in this field.…”

Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

“…At the present time, it does not seem appropriate to recommend discontinuing immunosuppressant treatment in patients with IBD (11). There is a risk of reactivation of the disease for those patients who stop their treatment, and active inflammation is associated with an increased risk of hospitalization, surgery, infection, and exposure to steroids (which should be avoided in the context of COVID-19) (20,30).…”