There has been a lot of information about bowel cancer in the media recently. Here is a clip from a recent radio interview in which Dr Pollok talks about bowel cancer and describing what is involved in having a colonoscopy:
Bowel Cancer radio interview (opens in a new tab)
for further information go to Gastro problems page
Dr Pollok and his team have recently published a paper describing the changing pattern of steroid use in IBD. Steroid use has fallen in Crohn’s disease but has increased in UC.
Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20-year national population-based study.
It is unclear whether adherence to prescribing standards has been achieved in inflammatory bowel disease (IBD).
To determine how prescribing of 5-aminosalicylates (5-ASAs), steroids and thiopurines has changed in response to emerging evidence.
We examined trends in oral and topical therapies in 23 509 incident IBD cases (6997 with Crohn’s disease and 16 512 with ulcerative colitis) using a nationally representative sample between 1990 and 2010. We created five eras according to the year of diagnosis: era 1 (1990-1993), era 2 (1994-1997), era 3 (1998-2001), era 4 (2002-2005) and era 5 (2006-2010). We calculated the proportion of patients treated with prolonged 5-ASAs (>12 months) and steroid dependency, defined as prolonged steroids (>3 months) or recurrent (restarting within 3 months) steroid exposure. We calculated the cumulative probability of receiving each medication using survival analysis.
Half of the Crohn’s disease patients were prescribed prolonged oral 5-ASAs during the study, although this decreased between era 3 and 5 from 61.8% to 56.4% (P = 0.002). Thiopurine use increased from 14.0% to 47.1% (P < 0.001) between era 1 and 5. This coincided with a decrease in steroid dependency from 36.5% to 26.8% (P < 0.001) between era 1 and 2 and era 4 and 5 respectively. In ulcerative colitis, 49% of patients were maintained on prolonged oral 5-ASAs. Despite increasing thiopurine use, repeated steroid exposure increased from 15.3% to 17.8% (P = 0.02) between era 1 and 2 and era 4 and 5 respectively.
Prescribing in clinical practice insufficiently mirrors the evidence base. Physicians should direct management towards reducing steroid dependency and optimising 5-ASA use in patients with IBD.