Ulcerative colitis management: a survey on current practice by Australian gastroenterologists

Abstract

The degree of variability in the clinical management of ulcerative colitis (UC) in Australia is unknown. Availability of faecal biomarkers, therapeutic drug monitoring and rescue therapy may differ between centres. These factors impact upon the care of these patients. Methods: This online questionnaire was distributed to Australian gastroenterologists who manage Inflammatory Bowel Disease (IBD), identified by membership of the Australian IBD Association. Results: Thus far, twenty responses have been received from the initial email survey. Of these respondents, 85% work in a tertiary hospital, with a variable IBD casemix. Although 5-aminosalicylate prescribing for left-sided colitis was similar between most clinicians, there was inconsistence in 5-aminosalicylate prescription patterns for proctitis and flares of extensive colitis. Eighty-five per cent of clinicians have access to faecal bio-markers, predominantly faecal calprotectin (72%). The most common starting doses of prednisolone therapy are 40 mg and 50 mg for refractory UC, with a 4–6 week taper most frequently observed. Sixty per cent of doctors would start an immunomodulator at the second course of oral steroids, while 35% do so with the first course of oral steroids. There is discrepancy in the utilisation of thiopurine methyltransferase testing. Sixty-seven per cent have access to biologic therapy for refractory UC, which is most commonly hospital approved infliximab. The majority of respondents usually manage cases of severe colitis as inpatients, with 50% of clinicians basing their decision to admit on Truelove-Witts criteria and 25% using clinical judgement. Seventy-two percent of gastroenterologists use the Oxford Index on day 3 to assess response. Rescue therapy is usually administered at day 4–5 of intensive steroid therapy by the majority (72%) of physicians and at day 8–10 by 22%. Half of the clinicians surveyed usually prescribe infliximab as rescue therapy, with an inconsistent number of infusions commonly given (1–3). After administration of infliximab, 30% of clinicians refer for colectomy for refractory severe UC at 4–5 days, 50% at 6–7 days and 20% after 10 days. Most clinicians (78%) have access to an onsite colorectal service. Conclusions: Differences were seen in 5-aminosalicylate prescription, timing of thiopurine initiation and monitoring, and access to biologic therapy for refractory ulcerative colitis. There is variability in the timing, administration and assessment of response to rescue therapy for severe UC.