Management of inflammatory bowel disease in children: a district general hospital experience

Abstract

Background Inflammatory Bowel Disease (IBD) encompasses two related but distinct disorders of as yet unknown cause. The incidence has increased substantially in recent years – 2.2 to 6.8/100000 in paediatric/adolescent population worldwide. Current therapeutic goals in children and adolescents are to diagnose/treat relapses early improve clinical management and reduce morbidity. Aim To review the management of children with Inflammatory Bowel disease presenting to the outpatients department of a district general hospital in UK. Methods A retrospective clinical audit. Recommendations of the Working group on Inflammatory Bowel Disease of the British Society of Paediatric Gastroenterology and Nutrition, 2008, formed the standards to evaluate our local practice. Data on establishing the diagnosis (history taking, examination, investigations) and treatment was collected retrospectively and compared with the standards. Results Data was obtained for a total of 14 patients presenting to the children9s outpatient department over a 5 year period. Local practice maintained 100% standards for history taking, examination, blood tests, upper GI endoscopy with biopsy and colonoscopy. Only 28% of the patients had Barium meal and follow through and 92% had faecal tests. For their treatment, children with Crohn9s disease reached 85% standard for use of elemental nutrition to induce remission and Azathioprine for maintenance of remission. Children with Ulcerative colitis fared better at achieving 100% standards. Need for replacing Barium meal follow through with Ultrasound abdomen was suggested. Conclusion Our clinical audit has helped to review the management of children with inflammatory bowel disease in a district general hospital setting. Local protocol helps to maintain good management standards as recommended by the working group. Introduction of service provision in the form of abdominal ultrasound was identified to improve quality of care.