Adherence of gastroenterologists to European Crohn's and Colitis Organisation consensus on ulcerative colitis: A real-life survey in Spain

Received 25 March 2010; received in revised form 11 June 2010; accepted 11 June 2010. published online 05 July 2010.
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Abstract

Background & aims

A European consensus on the management of ulcerative colitis (UC) was recently published; however, there is no adequate evidence about adherence to such guidelines among gastroenterologists. This knowledge would allow the local evaluation of the situation and the adoption of actions to reduce the existent clinical variability.

Methods

A cross-sectional survey was conducted in Spain to assess the adherence to the European Crohn's and Colitis Organisation (ECCO) guidelines on mild to moderate UC. We surveyed 700 gastroenterologists, and finally a total of 530 gastroenterologists specialised in inflammatory bowel disease (GSIBDs) and general gastroenterologists (GGs), responded to the survey (76%).

Results

Agreement with the guidelines was high; discrepancies included that only 25% of the GGs used the combination of oral and topical 5-aminosalycilic acid (5-ASA) for treating extensive UC vs 45% of the GISBDs. In addition, topical rectal steroids were considered as effective as topical mesalazine by 48% of the GGs vs 31% of the GSIBDs, indefinite treatment with 5-ASA was prescribed by only 26% of the GGs vs 41% of the GSIBDs, and the once daily dosing of 5-ASA was generally used by 46% of the GGs vs 51% of the GSIBDs.

Conclusions

The questionnaire showed a high degree of agreement between GGs and GSIBDs. Nevertheless, the GSIBD group showed closer agreement with the ECCO guidelines. Furthermore, some shortcomings were found in the GG group, in which increased maintenance treatment with 5-ASA, the use of a single daily dose of 5-ASA, and the use of combined oral and topical treatment for distal colitis should be advised.

Abbreviations: UC, Ulcerative Colitis, ECCO, European Crohn's and Colitis Organisation, GG, General Gastroenterologist, GSIBD, Gastroenterologist Specialised in inflammatory Bowel disease, IBD, Inflammatory Bowel Disease, NA, Not Applicable, 5-ASA, 5-aminosalicylic acid, EL, Evidence Level, RG, Recommendation Grade.

Keywords: Ulcerative colitis, ECCO clinical guidelines, Inflammatory bowel disease, 5-ASA, Mesalazine, Questionnary

a Departamento de Gastroenterología. Hospital Universitario La Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

b Departamento de Gastroenterología. Hospital Clínico Universitario de Zaragoza and CIBEREHD, Spain

c Departamento de Gastroenterología. Hospital de Manises. Valencia, Spain

d Departamento de Gastroenterología. Hospital Ramón y Cajal. Madrid. IBDnet, Spain

Corresponding author. Playa de Mojácar 29. Urb. Bonanza. 28669 Boadilla del Monte. Madrid, Spain. Tel.: +34 913093911; fax: +34 914022299.

1 All authors contributed equally to this work.

PII: S1873-9946(10)00091-7

doi:10.1016/j.crohns.2010.06.001