Current practice in management of Crohn's disease in Wales

Crohn's disease (CD) demonstrates great heterogeneity in its presentation and severity. Management of CD is similarly diverse but the aim remains the same — remission of disease activity and improvement of health related quality of life (HR-QoL). Treatment options include steroids, 5-ASA derivatives, immunomodulators and surgery. The aim of this study was to define the variation in practice of consultant gastroenterologists and colorectal surgeons treating CD in Wales. Methods: Consultant gastroenterologists and colorectal surgeons treating CD in Wales were sent a questionnaire aimed at determining their current practice and their responses were analysed. Results: Eighty-eight consultants — 46 (52%) gastroenterologists and 42 (48%) surgeons — were invited to participate in the survey. Sixty-one (69%) of them responded. Coherent practice was seen across Wales, especially with respect to diagnosis of CD in line with British Society of Gastroenterology guidelines. Variation was detected in disease severity assessment and some aspects of management. Conclusion: Practice in Wales is in line with the guidelines for managing CD. While the diagnostic process follows a standard approach, variations exist in treatment and monitoring of disease. Validated disease measurement instruments are seldom used in routine practice. Disease assessment tools need to be simpler to use if they are to help objective measurement of disease activity and treatment decisions.