Monitoring in IBD

Infl ammatory bowel disease (IBD) fl uctuates between relapse and remission, semi-relapse and semi-remission. Monitoring is covalently linked to outcomes.

The goal of monitoring is to change the course of the disease, to improve the QoL of the patients and prevent complications.

Zealots advocate monthly FCal/FBC/CRP, colonoscopy and biopsy 12 weeks after change in therapy, bowel ultrasound in every visit, annual colonoscopy, annual B12/vit D/ferritin, annual MRE for CD and triennial DEXA.

Pragmatists prefer continuity of care (look after your patients and patients will look after you), clinical assessment, FCal if it is unclear whether the symptoms are due to active disease or other cause, Flexi (rather than colonoscopy) if symptoms change and careful discussion on review to check adherence and achieve tailored care for individual patients.

Monitoring means to observe and check the progress or quality of the disease over a period of time.

When there are no symptoms, but there is endoscopic (or FCal/CRP activity), talk with the patient, explain that no one yet knows whether treatment escalation is best. Check compliance with current therapy. Be guided by the previous pattern of disease, drug safety and patient preference. Make a decision and check disease progression after an interval.

Remember the patient; our role as HCPs is to care, not just to prescribe therapy. The goals of medicine are to improve the QoL and limit the consequences of the disease. IBD and its consequences are complex, so care becomes complex