P277. How frequent are misconceptions in the management of outpatients with inflammatory bowel disease?
M. Chaparro1, J.P. Gisbert1
1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain
Background: 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 were 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: 74 patients were included.68% of patients had been cared by gastroenterologists, 14% by gastroenterologists expert on IBD, 6.9% by pediatricians, 5.6% by internal medicine doctors, 2.8% by surgeons and 2.8% by primary care doctors. The median time since the diagnosis to the first visit to our unit was 64 months. Smoking habit had been investigated in 50% of CD patients, and 29% of patients had been asked to quit smoking. Mantoux test had been performed in 16% of patients, serological markers of hepatitis B virus (HBV) infection had been determined in 16%, markers of hepatitis C virus in 14%, markers of human immunodeficiency virus infection in 11% of patients and varicella-zoster virus serological markers in 6.5%. HBV vaccine had been administered in 6.5% of patients, and influenza, tetanus and pneumococcus vaccine in 3.2% of them. 67% of patients for whom aminosalicylates would had been recommended, received them. The dose of amynosalycilates was lower than the established in 93% of patients for induction and in 30% for maintenance. The majority of patients received multiple dosing. 42% of patients for whom aminosalicylates were not recommended, received them. Only 41% of patients who might have been on rectal aminosalicylates received them. From the patients who had ever been on systemic steroids, only 13% had been on calcium and vitamin D.37% of patients for whom the treatment with immunosuppressants might had been recommended were receiving it on time. Screening for colorectal cancer with colonoscopy had been started in 56% of suitable patients. It had been started at the adequate time in 33% of patients, and in 33% of cases the endoscopiesnwere repeated with the recommended interval.
Conclusions: Misconceptions in the management of outpatients with IBD are very common and relevant. Therefore, new strategies to avoid them and to increase the effectiveness in the management of these patients are needed.