Medication Use and Guideline Adherence in Inflammatory Bowel Disease Management: A Retrospective Study from a...

Inflammatory bowel disease (IBD) remains understudied in Pakistan. This retrospective observational study assessed the management of IBD patients at Shifa International Hospital, Islamabad, from January 2019 to June 2024.

Adherence to UK NICE 2019 guidelines (NG129 for CD, NG130 for UC) was evaluated. Data from 167 adult IBD patients (from initial 238 identified; 141 ulcerative colitis, 26 Crohn's disease) were extracted from electronic medical records after excluding inactive cases (n = 60), paediatric patients (n = 7), pregnant women (n = 3), and unconfirmed diagnoses (n = 1). Demographics, medications, comorbidities, surgeries, and diagnostic findings were analysed.

Steroids were administered to 54.5% of patients (52.7% UC, 1.8% CD), aminosalicylates to 53.9% (50.3% UC, 3.6% CD), and immunosuppressants to 43.7% (40.2% UC, 3.5% CD). Discharge medications included steroids (46.1%), aminosalicylates (49.1%), and immunosuppressants (31.1%). Only 3/9 UC and 5/9 CD guideline recommendations were followed. Biologic use (anti-TNF) was low (8.9%), and 18% underwent surgery (total proctocolectomy most common). Diabetes (31%) and hypertension (28%) were prevalent comorbidities. Abdominal pain (52%) and diarrhea (46%) were frequent complaints. Colonoscopy (43%) and biopsies (20.4%) were key diagnostic tools. Histopathology revealed mild inflammation (29.4%) and moderate-severe inflammation (17.4%).

IBD management showed significant deviation from international guidelines, particularly regarding biologic utilization (8.9%) and surgical rates (18%). These findings highlight urgent need for resource-stratified treatment protocols and enhanced clinical training to bridge the gap between evidence-based recommendations and real-world practice in resource limited settings.