Disparity in clinical care for patients with inflammatory bowel disease between specialists and non-specialists — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Disparity in clinical care for patients with inflammatory bowel disease between specialists and non-specialists
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
,
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
,
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
,
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
1 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
2 Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
3 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
4 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
5 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
6 Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
7 Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
8 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
9 Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
10 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long- term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera- peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.
Talley, N.J., Abreu, M.T., Achkar, J.P., et al. (2011) An evidence-based systematic review on medical therapies for inflammatory bowel disease. American Journal of Gastroenterology, 106, S2-S25. doi:10.1038/ajg.2011.58
Molodecky, N.A., Soon, I.S., Rabi, D.M., et al. (2011) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology, 142, 46-54.
Loftus Jr., E.V. (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology, 126, 1504-1517. doi:10.1053/j.gastro.2004.01.063
Ahuja, V. and Tandon, R.K. (2010) Inflammatory bowel disease in the Asia-Pacific area: A comparison with developed countries and regional differences. Journal of Digestive Diseases, 11, 134-147. doi:10.1111/j.1751-2980.2010.00429.x
Yao, T., Matsui, T. and Hiwatashi, N. (2000) Crohn’s disease in Japan: Diagnostic criteria and epidemiology. Diseases of the Colon & Rectum, 43, S85-S93. doi:10.1007/BF02237231
Yamamoto, S., Nakase, H., Mikami, S., et al. (2008) Long-term effect of tacrolimus therapy in patients with refractory ulcerative colitis. Alimentary Pharmacology & Therapeutics, 28, 589-597. doi:10.1111/j.1365-2036.2008.03764.x
Colombel, J.F., Sandborn, W.J., Rutgeerts, P., et al. (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: The CHARM trial. Gastroenterology, 132, 52-65. doi:10.1053/j.gastro.2006.11.041
Ogata, H., Matsui, T., Nakamura, M., et al. (2006) A randomised dose finding study of oral tacrolimus (FK506) therapy in refractory ulcerative colitis. Gut, 55, 1255 1262. doi:10.1136/gut.2005.081794
Shibolet, O., Regushevskaya, E., Brezis, M. and Soares Weiser K. (2005) Cyclosporine A for induction of remission in severe ulcerative colitis. Cochrane Database of Systematic Reviews, 25, Article ID: CD004277.
Rutgeerts, P., Sandborn, W.J., Feagan, B.G., et al. (2005) Infliximab for induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 353, 2462-2476. doi:10.1056/NEJMoa050516
Rutgeerts, P., Van Assche, G. and Vermeire, S. (2004) Optimizing anti-TNF treatment in inflammatory bowel disease. Gastroenterology, 126, 1593-1610. doi:10.1053/j.gastro.2004.02.070
Kornbluth, A. and Sachar, D.B. (2010) Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology, 105, 501-523. doi:10.1038/ajg.2009.727
Lichtenstein, G.R., Hanauer, S.B. and Sandborn, W.J. (2009) Management of Crohn’s disease in adults. American Journal of Gastroenterology, 104, 465-483.
Mowat, C., Cole, A., Windsor, A., et al. (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut, 60, 571-607. doi:10.1136/gut.2010.224154
Matsui, T. and Ueno, F. (2010) Crohn’s disease practice guidelines in Japan. Nihon Shokakibyo Gakkai Zasshi, 107, 1887-1896.
Hibi, T., Ueno, F., Matsuoka, K. and Lee, T. (2010) Guidelines for the management of ulcerative colitis in Japan. IBD Research, 4, 189-239.
Reddy, S.I., Friedman, S., Telford, J.J., Strate, L., Ookubo, R. and Banks, P.A. (2005) Are patients with inflammatory bowel disease receiving optimal care? Ame rican Journal of Gastroenterology, 100, 1357-1361. doi:10.1111/j.1572-0241.2005.40849.x
Stange, E.F., Travis, S.P., Vermeire, S., et al. (2006) European evidence based consensus on the diagnosis and management of Crohn’s disease: Definitions and diagnosis. Gut, 55, i1-i15. doi:10.1136/gut.2005.081950a
Bergman, R. and Parkes, M. (2006) Systematic review: The use of mesalazine in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 23, 841-855. doi:10.1111/j.1365-2036.2006.02846.x
Sutherland, L. and Macdonald, J.K. (2006) Oral 5-amino salicylic acid for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, 3, Article ID: CD000543.
Yamamoto, T., Umegae, S. and Matsumoto, K. (2011) High-dose mesalazine treatment for ulcerative colitis patients who relapse under low-dose maintenance therapy. Digestive and Liver Disease, 43, 386-390. doi:10.1016/j.dld.2010.11.016
Hiwatashi, N., Suzuki, Y., Mitsuyama, K., Munakata, A. and Hibi, T. (2011) Clinical trial: Effects of an oral preparation of mesalazine at 4 g/day on moderately active ulcerative colitis. A phase III parallel-dosing study. Journal of Gastroenterology, 46, 46-56. doi:10.1007/s00535-010-0308-3
Hanauer, S.B., Sandborn, W.J., Kornbluth, A., et al. (2005) Delayed-release oral mesalamine at 4.8 g/day (800 mg tablet) for the treatment of moderately active ulcerative colitis: The ASCEND II trial. American Journal of Gastroenterology, 100, 2478-2485. doi:10.1111/j.1572-0241.2005.00248.x
Ransford, R.A. and Langman, M.J. (2002) Sulphasalazine and mesalazine: Serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut, 51, 536-539. doi:10.1136/gut.51.4.536
Loftus Jr., E.V., Kane, S.V. and Bjorkman, D. (2004) Systematic review: Short-term adverse effects of 5-ami nosalicylic acid agents in the treatment of ulcerative colitis. Alimentary Pharmacology & Therapeutics, 19, 179 189. doi:10.1111/j.0269-2813.2004.01827.x
Sutherland, L. and Macdonald, J.K. (2006) Oral 5-amino salicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, 4, CD000544.
Marteau, P., Probert, C.S., Lindgren, S., et al. (2005) Combined oral and enema treatment with Pentasa (mesalazine) is superior to oral therapy alone in patients with extensive mild/moderate active ulcerative colitis: A randomised, double blind, placebo controlled study. Gut, 54, 960-965. doi:10.1136/gut.2004.060103
Faubion Jr., W.A., Loftus Jr., E.V., Harmsen, W.S., Zinsmeister, A.R. and Sandborn, W.J. (2001) The natural history of corticosteroid therapy for inflammatory bowel disease: A population-based study. Gastroenterology, 121, 255-260. doi:10.1053/gast.2001.26279
Strassburg, C.P. and Manns, M.P. (2011) Therapy of autoimmune hepatitis. Best Practice & Research Clinical Gastroenterology, 25, 673-687. doi:10.1016/j.bpg.2011.08.003
George, J.N. (2006) Management of patients with refractory immune thrombocytopenic purpura. Journal of Thro mbosis and Haemostasis, 4, 1664-1672. doi:10.1111/j.1538-7836.2006.02013.x
Dignass, A., Van Assche, G., Lindsay, J.O., et al. (2010) The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Current management. Journal of Crohn’s and Colitis, 4, 28-62. doi:10.1016/j.crohns.2010.07.001
Hibi, T., Naganuma, M., Kitahora, T., Kinjyo, F. and Shimoyama, T. (2003) Low-dose azathioprine is effective and safe for maintenance of remission in patients with ulcerative colitis. Journal of Gastroenterology, 38, 740 746. doi:10.1007/s00535-003-1139-2
Hibi, T., Iwao, Y., Yajima, T., et al. (1995) Immunosuppressive agents in the treatment of Crohn’s disease and ulcerative colitis. Journal of Gastroenterology, 30, 121 123.
Dubinsky, M.C., Yang, H., Hassard, P.V., et al. (2002) 6-MP metabolite profiles provide a biochemical explanation for 6-MP resistance in patients with inflammatory bowel disease. Gastroenterology, 122, 904-915. doi:10.1053/gast.2002.32420
Takatsu, N., Matsui, T., Murakami, Y., et al. (2009) Adverse reactions to azathioprine cannot be predicted by thiopurine S-methyltransferase genotype in Japanese patients with inflammatory bowel disease. Journal of Gastroenterology and Hepatology, 24, 1258-1264. doi:10.1111/j.1440-1746.2009.05917.x
Hindorf, U., Johansson, M., Eriksson, A., Kvifors, E. and Almer, S.H. (2009) Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 29, 654-661. doi:10.1111/j.1365-2036.2008.03925.x
Kuriyama, M., Kato, J., Suzuki, H., et al. (2010) Tolerability and usefulness of mercaptopurine in azathioprine-intolerant Japanese patients with ulcerative colitis. Digestive Endoscopy, 22, 289-296. doi:10.1111/j.1443-1661.2010.01009.x
Domenech, E., Nos, P., Papo, M., Lopez-San Roman, A., Garcia-Planella, E. and Gassull, M.A. (2005) 6-mercaptopurine in patients with inflammatory bowel disease and previous digestive intolerance of azathioprine. Scandinavian Journal of Gastroenterology, 40, 52-55.