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Inflammatory bowel disease

Colonoscopic surveillance for patients with inflammatory bowel disease

From Dr J?Richardson, MBBS, FFPH

I noticed that the article on inflammatory bowel disease (IBD) management in the March 2011 edition of Clinical Pharmacist (2011;3:78) does not mention the National Institute for Health and Clinical Excellence’s clinical guideline on surveillance [EDITOR — the guideline was published after the issue went to press].

In March 2011, NICE published a clinical guideline on colonoscopic surveillance for the prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas. For pharmacists involved in the long-term care of patients with IBD I believe it is important to be aware of these patients’ ongoing requirement for surveillance.

The guideline recommends that colonoscopic surveillance should be offered to people with IBD whose symptoms started 10 years ago and who have:

  • Ulcerative colitis (but not proctitis alone) or
  • Crohn’s colitis involving more than one segment of colon

A baseline colonoscopy should be offered, with chromoscopy and a targeted biopsy of any abnormal areas, to people with IBD who are being considered for colonoscopic surveillance to determine their risk of developing colorectal cancer.

The guideline also recommends that people with IBD should be offered subsequent colonoscopic surveillance based on the following risks of developing colorectal cancer as determined at their last complete colonoscopy:

  • Low risk — offer colonoscopy with chromoscopy at five years
  • Intermediate risk — offer colonoscopy with chromoscopy at three years
  • High risk — offer colonoscopy with chromoscopy at one year

A repeat colonoscopy should be offered with chromoscopy if the colonoscopy is incomplete.

The guideline is available on the NICE website at

Judith Richardson

Associate Director, Centre for Clinical Practice, National Institute for Health and Clinical Excellence

Citation: The Pharmaceutical Journal URI: 11074700

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