Prevalence and management of inflammatory bowel disease

OBJECTIVES: To estimate the prevalence of inflammatory bowel disease (IBD) from the information in general practitioners' records and to describe patient management, including the prescribing of 5-aminosalicylates and adherance to treatment in ulcerative colitis, and frequency of advice given concerning cessation of smoking. METHODS: Fifteen general practices were recruited through the Trent Focus Collaborative Research Network, UK, to take part in a cross-sectional study. They identified confirmed cases of IBD and used a pro-forma to collect data for collation and analysis. RESULTS: Searches identified 344 IBD cases from a combined list of 86 801 patients, suggesting a prevalence of 396 per 100 000 (95% confidence interval, 356-440). Practices considered 32% of patients to be under the sole care of general practitioners; only 59% had been seen in secondary care during the previous year and the numbers of outpatient and general practitioner consultations were similar. Smoking cessation advice was documented for similar numbers of smokers with Crohn's disease and ulcerative colitis. Excluding patients who had undergone surgery, only 65% of patients with ulcerative colitis had been prescribed a 5-aminosalicylate in the previous 6 months and good treatment adherence was suggested in only 42% of ulcerative colitis patients taking a 5-aminosalicylate. Prescribing of aminosalicylates was more common in patients under specialist or shared care than those under general practitioner care only; this remained significant in a regression model also including extent of disease (P < 0.0001). CONCLUSIONS: General practitioners play an important role in caring for patients with IBD and may need relevant education and support. Aminosalicylates appear to be under-used in patients with ulcerative colitis.