Current practice in management of Crohn's disease in Wales.
Crohn's disease (CD) demonstrates great heterogeneity in its presentation and severity. Management of CD is similarly diverse but the aim remains the same--remission of disease activity and improvement of health related quality of life (HR-QoL). Treatment options include steroids, 5-ASA derivatives, immunomodulators and surgery. The aim of this study was to define the variation in practice of consultant gastroenterologists and colorectal surgeons treating CD in Wales.


METHODS
Consultant gastroenterologists and colorectal surgeons treating CD in Wales were sent a questionnaire aimed at determining their current practice and their responses were analysed.


RESULTS
Eighty-eight consultants--46 (52%) gastroenterologists and 42 (48%) surgeons-- were invited to participate in the survey. Sixty-one (69%) of them responded. Coherent practice was seen across Wales, especially with respect to diagnosis of CD in line with British Society of Gastroenterology guidelines. Variation was detected in disease severity assessment and some aspects of management.


CONCLUSIONS
Practice in Wales is in line with the guidelines for managing CD. While the diagnostic process follows a standard approach, variations exist in treatment and monitoring of disease. Validated disease measurement instruments are seldom used in routine practice. Disease assessment tools need to be simpler to use if they are to help objective measurement of disease activity and treatment decisions.
Dhruva
P K Rao
PK
Department of Colorectal Surgery, Cardiff and Vale NHS Trust, Cardiff.
Price
P E
PE
Torkington
J
J
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003107:Colorectal Surgery; D003424:Crohn Disease / Q000145:classification / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D003430:Cross-Sectional Studies; D005762:Gastroenterology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014852:Wales
D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019804:Mesalamine; D011239:Prednisolone