References
Nurse-led early evaluation following corticosteroid prescription in patients with inflammatory bowel disease
Abstract
Background:
The Toronto consensus for management of ulcerative colitis (UC) recommends early evaluation of UC patients 2 weeks after initiation on corticosteroids. A system for early evaluation of inflammatory bowel disease patients was established by specialist nurses in a secondary care centre.
Aim:
To compare outcomes following early evaluation to the previous service.
Methods:
All patients undergoing early evaluation over a 1-year period were prospectively audited and compared to a retrospective cohort of patients receiving prednisolone in the preceding year.
Findings:
Of 140 patients included, 76 (54.3%) underwent early evaluation. All patients in the early evaluation group received drug education and details of the nurse helpline (17.1% of patients did not already have this). Of patients, 81.6% were prescribed Adcal, and 83.9% were on 5-aminosalicylates. Fewer admissions were observed within 6 months following early evaluation (8.6% vs. 23.4%, p=0.013).
Conclusion:
Multiple benefits of early evaluation were observed, including a potential reduction in hospital admissions.
Inflammatory bowel disease (IBD) is a term that covers ulcerative colitis (UC), Crohn’s disease (CD) and IBD-unclassified (when the disease is not definitively UC or CD). Corticosteroids, such as prednisolone and budesonide, are regularly used in the treatment of IBD. Their mechanism of action is to suppress the inflammatory response that causes IBD symptoms.
Oral prednisolone is recommended as a treatment for exacerbations of moderate-to-severe UC or when 5-aminosalicylate (5-ASA) preparations have been ineffective or not tolerated (Harbord et al, 2017; Ko et al, 2019; Lamb et al, 2019). Prednisolone is similarly indicated for colonic CD or as an alternative to budesonide for inflammatory small bowel CD (Lamb et al, 2019). Prednisolone is rapidly effective at controlling symptoms in a majority of patients (Lennard-Jones et al, 1960; Truelove et al, 1962; Benchimol et al, 2008; Ford et al, 2011). Patients have reported clinical improvements in symptoms at 2 weeks following initiation in a prospective clinical trial (Rhodes et al, 2008). However, prednisolone is not effective at maintaining remission of inflammatory bowel disease (IBD) in the longer term when compared with placebo (Lennard-Jones et al, 1965). The use of prednisolone is also associated with significant side effects (including acne, insomnia, mood disturbance, diabetes and acid reflux), even with short-term use (Baron et al, 1962; Ford et al, 2011).
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