Using corticosteroids appropriately in inflammatory bowel disease: a guide for primary care

Inflammatory bowel disease (IBD) is a chronic relapsing–remitting inflammatory condition of the gastrointestinal tract, with extra-intestinal manifestations that can affect the skin, joints, eyes, and liver. The two main subtypes are Crohn’s disease (CD) and ulcerative colitis (UC). IBD affects 1 in 250 people in the UK, with the typical GP practice having 30–40 registered patients with the condition. Oral corticosteroids are highly effective in inducing remission in IBD and have been the mainstay of treatment of flare-ups since the 1950s. However, judicious prescribing is essential to avoid potential side effects. Doses of 20 mg or higher of prednisolone per day for more than 2 weeks increase the risk of infection.1 Patients with IBD flare-ups usually present with a combination of diarrhoea, abdominal pain, or rectal bleeding, although atypical presentations including weight loss, anaemia, and failure to thrive can occur, and the severity of symptoms may not reflect the severity of inflammation, particularly in children. The Royal College of Physicians national IBD audits have shown that patients are often seen by a GP in the month before emergency admission, but medical therapy is not escalated. Half of the GPs surveyed as part of the Royal College of General Practitioners Inflammatory Bowel Disease Spotlight Project in 2017 say they lack confidence in managing IBD, and two-thirds requested further education. An online toolkit (www.rcgp.org.uk/ibd) and an eLearning resource are now available (www.elearning.rcgp.org.uk/ibd). Wherever possible, objective evidence of disease activity …