Why is it important?
Once a diagnosis of IBD has been confirmed, it’s important to put a treatment plan in place as soon as possible. This results in the best chance of getting symptoms under control and improving outcomes and the patient’s quality of life.
Where possible, any delays between diagnosis and the opportunity to discuss and start treatment for someone with IBD should be avoided. Even when diagnosis occurs during colonoscopy by a non-IBD specialist, immediate treatment should be offered where appropriate e.g. oral or topical mesalazine therapy for ulcerative colitis.
The pros, cons and expectations of different treatment options should be discussed with patients. These should include nutritional therapy, where appropriate.
Patients should be supported to understand the potential treatment options and enabled to participate in shared decision making. They should also receive clear guidance about what to do and who to contact if they experience side effects, continued or worsened symptoms and how and when treatment will be reviewed. This should include the number of the IBD service advice line as well as emergency/out of hours contact details.
Patients should be given appropriate information about their condition and its treatment, including details of:
- The diagnosis and distribution in their gut or elsewhere
- Their initial treatment (details of drug regimen, dietary or surgical interventions - with anticipated benefits and possible side-effects)
- Self-management, including pain and fatigue
- Monitoring and follow-up needs
- Likely course of their illness in the future, including associated conditions and potential complications
- Lifestyle advice implications including smoking, alcohol, exercise, nutrition, education, employment, social activities, sex, contraception, family planning and pregnancy
Primary care should be informed of new diagnoses and the treatment plan agreed.
With the treatment plan in place, treatment should be started immediately after confirmed diagnosis, if clinically appropriate. This includes oral mesalazine, oral corticosteroids, or topical therapies. For treatment with an immunomodulator, targeted small molecule or biologic, it is important to first complete pre-treatment screening tests to ensure treatment is appropriate and safe. Treatment should then commence within two weeks upon completion of the necessary tests, allowing time for set up of homecare delivery or infusions. Bridging therapies, such as enteral nutrition in Crohn’s disease, should be considered where appropriate.
Following diagnosis, patients should also have rapid access to surgical, dietetic, nursing, and psychological support as indicated to ensure holistic care.