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P344. Common misconceptions in the management of outpatients with inflammatory bowel disease (IBD)

M. Chaparro, J.P. Gisbert

Hospital de la Princesa, Madrid, Spain

Objective: To identify the most common misconceptions in the management of the outpatient with IBD.

Methods: IBD outpatients referred for a second opinion to our IBD Unit since January 2010 are being prospectively included. Data were obtained from the medical reports provided by the patients. When it was necessary, patients were asked to obtain missing information. Data regarding diagnostic, therapeutic and preventive strategies previously performed to the patient due to the IBD were recorded, and they were compared with the recommended procedures, based on the best available scientific evidence.

Results: 49 patients have been included (median age 42 years, 53% females, 59% ulcerative colitis (UC)). 74% of patients had been cared by gastroenterologists, 10% by gastroenterologists expert on IBD, 4.3% by pediatricians, 4.3% by internal medicine doctors, 4.3% by surgeons and 2% by primary care doctors. The median time since the diagnosis to the fisrt visit to our unit was 90 months. Smoking habit had been investigated in 37% of CD patients and 25% of patients had been asked to quit smoking. Mantoux test had been performed in 11% of patients, serological markers of hepatitis B virus (HBV) infection had been determined in 8%, markers of hepatitis C virus in 5%, and markers of human immunodeficiency virus infection in 3% of patients. Varicela-zoster virus serological markers had not been measured in any of the included patients. HBV and influenza vaccines had been administered in 2.7% of patients. No patient had been vaccinated against tetanus and pneumococcus. 57% of patients for whom the treatment with aminosalicylates would had been recommended, received it. 90% of patients on aminosalicylates had received a dose for induction of remission lower than the established, and 89% received mulitiple dosing per-day. 54% of patients on aminosalicylates had received a dose for maintenance of remission lower than the established, and 84% received multiple dosing. 40% of patients for whom the treatment with aminosalicylates was not recommended, received it. Only 44% of patients who might have been on rectal aminosalicylates, received it. 26% of patients had ever been on systemic steroids; from them, 12% had been on calcium and vitamin D while receiving steroids. The presence of low bone mineral density had been investigated only in 22% of patients who had been on steroids for a long time. 46% of patients for whom the treatment with immunossuppresants might had been recommended, were receiving it. Screening for colorectal dysplasia with colonoscopy had been started in 61% of suitable patients. The screening had been started at the adequate time in 37% of patients, and in 43% of cases the endoscopies were repeated with the recommended interval.

Conclusions: Misconceptions in the management of outpatients with IBD are very common and relevant. Therefore, new estrategies to avoid them and to increase the effectiveness in the management (preventive, diagnostic and therapeutic) of these patients are needed.