Management of Crohn's disease - are guidelines transferred to clinical practice?
Thomas Klag1, Eduard F Stange2, Jan Wehkamp3
1Department of Internal Medicine I, Robert-Bosch-Hospital, Stuttgart, Germany ; Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
Background:
Management of Crohn's disease (CD) is a clinical challenge. In terms of an evidence-based approach, clinical guidelines help to deal with this challenge. However, little is known about guideline adherence concerning the management of CD in Germany.
Objective:
To survey German gastroenterologists with regards to their guideline adherence in daily clinical care.
Method:
A web-based national survey was conducted among German gastroenterologists.
Results:
A total of 175 inflammatory bowel disease (IBD) practitioners responded to the survey. Overall, in the different clinical situations covered in the questionnaire guideline adherence is good. However, the 5-aminosalicylic acid (5-ASA) prescribing habits represent a striking exception. About 10-36% use 5-ASA as mono-therapy in CD, depending on the clinical scenario. Predominantly it is used in mild CD and in colonic involvement. To maintain a surgically achieved remission, therapeutic decisions broadly rely on individual approaches with azathioprine and 5-ASA being used by about 30% of the respondents. Cessation of smoking as a "therapeutic" strategy of maintenance therapy is used by only half of the surveyed physicians.
Conclusion:
Amongst German IBD practitioners, the guideline adherence is good overall. Reflecting ongoing uncertainty about the efficacy of mesalazine, its use in Crohn's disease is still heterogeneous.
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