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P413. Management of ulcerative colitis patients in clinical practice: results of a nationwide survey (CROSSOVER) conducted in Spain

M. Barreiro-de Acosta1, I. Ordás2, R. Camargo3, C. Taxonera4, 1University Hospital Santiago de Compostela, Gastroenterology, Santiago, Spain, 2Hospital Clínic Barcelona, Gastroenterology, Barcelona, Spain, 3Hospital Clinico Virgen de la Victoria, Gastroenterology, Malaga, Spain, 4Hospital Clinico San Carlos, Department Gastroenterology, Madrid, Spain

Background

The management of ulcerative colitis (UC) patients may vary among different countries with important differences also being observed within some of them. The aim of this project is to describe how Spanish gastroenterologists diagnose and treat UC patients in routine clinical practice with the goal of identifying factors to be focused on in future educational programs.

Methods

A descriptive study based on the information obtained from a 30-question multiple-choice survey (called “CROSSOVER”) was conducted throughout the country. The questionnaire was divided into 4 sections: diagnosis, treatment, follow up/monitoring and safety. The results are shown as percentages.

Results

260 surveys were gathered using a questionnaire form. The survey was completed by 35% of general gastroenterologists and 65% of IBD specialists. 26% of physicians followed-up more than 300 patients with UC. In order to establish the diagnosis, a total of 91% performed an ileocolonoscopy with biopsies, but only 50% took biopsies of all colonic segments. 56% of the respondents ruled out an infectious etiology in the event of a flare. With regard to treatment, the main indication for anti-TNF drugs was steroid-refractoriness (62%) and severe flares requiring hospitalisation (52%). Nevertheless, the use of these drugs in steroid-dependent cases (24%) and non-hospitalised moderate disease was lower (5%) than recommended in the guidelines. In patients in remission undergoing combined therapy (anti-TNF and thiopurines) for at least a year, 52% withdrew from biological therapy, 21% thiopurines and only 27% maintained both drugs for the long term. It is important to remark the low use of activity indexes in clinical practice: only 16% used the Truelove Witts index and 11% the partial Mayo index. 50% were comfortable with the definition of clinical remission based on patients'symptoms. In patients under anti-TNF therapy, only 18% performed a colonoscopy to confirm a flare or for assessing mucosal healing. With regard to safety issues, more than 90% screened for HBV, HIV and HCV, but 6% did not screen for tuberculosis before immunosuppressive or anti-TNF treatment. 18% of physicians maintained anti-TNF drugs during the entire pregnancy period, 75% of physicians stopped anti TNF-drugs after the second trimester and 46% recommended breastfeeding in patients under anti-TNF treatment.

Conclusion

A high percentage of Spanish gastroenterologists follow current guidelines for diagnosis and safety in clinical practice. Regarding treatment and monitoring there are controversial aspects such as the following: low use of indexes for determining disease activity, the indication for starting anti-TNF therapy and the high percentage of anti-TNF withdrawals that differ from guidelines.