RESUMEN
BACKGROUND: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is a life-long condition with a relapsing and remitting course. As with other chronic diseases, close monitoring of UC is essential to achieving desired outcomes. Given the progressive nature of IBD and its corresponding complexities of care, monitoring of these diseases can be optimized in a collaborative, IBD-focused care center. Currently, there is no standard of care for disease monitoring in IBD. Society guidelines and the STRIDE program have recommendations on the use of patient reported outcomes (PRO), biomarkers, and endoscopy in disease monitoring. The purpose of this study is to assess the utilization of current guideline recommendations for the monitoring of UC in a community GI practice. METHODS: This study is a single-center, retrospective chart review of adult patients with moderate-severe UC receiving infusion-based drugs infliximab (IFX) or vedolizumab (VDZ) starting in January 2019. We performed a literature review of the most recent society guidelines on UC management and the STRIDE program's treat-to-target recommendations for UC. Study domains were chosen based on STRIDE targets. Twelve guidelines and recommendations were chosen for assessment based on feasibility of chart review. Demographic, treatment, and outcomes variables were collected. Data was extracted at time points relative to induction start date. RESULTS: Twelve gastroenterologists provided care for the 39 patients that met inclusion criteria. Ten patients received IFX and 29 received VDZ. All patients had documented PROs at weeks 0, 6, and 14; however, there was inter and intra-provider variability in descriptors and detail of documented PROs. A CRP was drawn prior to induction therapy, at week 6, and at week 14 or later in maintenance, 97.4%, 80%, and 87.2% of the time, respectively. A fecal calprotectin was drawn prior to induction therapy, at week 6, and at week 14 or later in maintenance, 71.8%, 41.0%, and 62.0% of the time, respectively. All patients had a colonoscopy performed prior to induction. These were performed greater than 1 year prior to induction (33.3%), between 6-12 months prior (7.7%), and within 6 months (59.0%). Only 19 (48.7%) patients had post-induction colonoscopy performed by the end of the study period. These colonoscopies were performed within 6 months of induction start (47.4%), between 6-9 months (27.8%), and after 9 months (27.8%). The overall rate of follow-up colonoscopy in the post-induction period of 9 months was 36.0%. Of the 58 colonoscopies performed, 51.7% had a documented Mayo score. CONCLUSION: Current guidelines offer recommendations on the use of PROs, biomarkers, and endoscopy in monitoring ulcerative colitis. This study highlights the presence of inconsistency in the use of these monitoring tools. When growing an IBD care center, it is necessary to identify strengths and weaknesses of the existing types and processes of care. When this care is not standardized, there in inevitably increased variability in provider care, as is evident by the results of this study. A well-defined methodology for monitoring patients with IBD should be defined and implemented to improve outcomes and stimulate growth in IBD care centers.