Medication Use and Guideline Adherence in Inflammatory Bowel Disease Management: A Retrospective Study from a Tertiary Care Hospital in Pakistan (2019–2024)

Background: Inflammatory bowel disease (IBD) remains understudied in Pakistan. This retrospective observational study assessed the management of IBD patients at Shifa International Hospital, Islamabad, from January 2019 to June 2024. Methods: Adherence to UK NICE 2019 guidelines (NG129 for CD, NG130 for UC) was evaluated. Data from 167 adult IBD patients (from initial 238 identified; 141 ulcerative colitis, 26 Crohn’s disease) were extracted from electronic medical records after excluding inactive cases (n = 60), paediatric patients (n = 7), pregnant women (n = 3), and unconfirmed diagnoses (n = 1). Demographics, medications, comorbidities, surgeries, and diagnostic findings were analysed. Results: Steroids were administered to 54.5% of patients (52.7% UC, 1.8% CD), aminosalicylates to 53.9% (50.3% UC, 3.6% CD), and immunosuppressants to 43.7% (40.2% UC, 3.5% CD). Discharge medications included steroids (46.1%), aminosalicylates (49.1%), and immunosuppressants (31.1%). Only 3/9 UC and 5/9 CD guideline recommendations were followed. Biologic use (anti-TNF) was low (8.9%), and 18% underwent surgery (total proctocolectomy most common). Diabetes (31%) and hypertension (28%) were prevalent comorbidities. Abdominal pain (52%) and diarrhea (46%) were frequent complaints. Colonoscopy (43%) and biopsies (20.4%) were key diagnostic tools. Histopathology revealed mild inflammation (29.4%) and moderate-severe inflammation (17.4%). Conclusion: IBD management showed significant deviation from international guidelines, particularly regarding biologic utilization (8.9%) and surgical rates (18%). These findings highlight urgent need for resource-stratified treatment protocols and enhanced clinical training to bridge the gap between evidence-based recommendations and real-world practice in resource limited settings.