Symptom relief key for common 'distressing' bowel condition

Symptom relief through the range of recommended drugs and treatments available should be the primary outcome for patients with ulcerative colitis, according to NICE.

Symptom relief through the range of recommended drugs and treatments available should be the primary outcome for patients with ulcerative colitis, according to NICE.

Ulcerative colitis is the most common type of inflammatory disease of the bowel affecting around 146,000 people in the UK. The condition can occur at any age, but is most common between 15 and 25. It is currently unknown what causes the condition to develop.

Symptoms include bloody diarrhoea, an urgent need to defecate and abdominal pain. It is common for these symptoms to disappear, only to reappear later on. The disease is life-long, and can affect a person's social and psychological wellbeing if it is poorly controlled.

High-profile people with the condition include the footballer Darren Fletcher, who has lived with ulcerative colitis and managed symptoms for most of his life but was forced to take an extended career break due to relapsing symptoms.

While there is no cure, medical approaches focus on treating the disease to address symptoms, improve quality of life and maintain remission.

NICE's first clinical guideline on ulcerative colitis contains recommendations that range from tackling mild to acute forms of the condition, and cover maintaining symptom remission.

Around ten per cent of inpatients with inflammatory bowel disease report a lack of information about drug side effects on discharge from hospital. Consequently, NICE recommends that healthcare professionals should discuss the disease, associated symptoms, treatment options and monitoring with the person with the condition and their family members or carers as appropriate. This should all also be discussed with the multidisciplinary team at every opportunity.

The guideline also describes how best to induce remission in people with mild to moderate first presentation or inflammatory exacerbation of proctitis or protosigmoiditis.

For people who have little or no improvement within 72 hours of starting corticosteroids, or whose symptoms worsen at any time despite corticosteroid treatment, healthcare professionals should consider adding intravenous ciclosporin to intravenous corticosteroids, or consider surgery.

Healthcare professionals should ensure that there are documented local safety monitoring policies and procedures for people receiving treatment that needs monitoring. A member of staff should be nominated to act on abnormal results, and should communicate with GPs and people with ulcerative colitis, and their parents or carers as appropriate.

The likelihood of needing surgery for people admitted to hospital with acute sever ulcerative colitis should be assessed and documented on admission and then daily.

For those people considering surgery, healthcare teams should ensure that a specialist such as a gastroenterologist or a nurse specialist gives the person and their family and carers information about all the available treatment options, and that these should be discussed with them. This information should include the benefits and risks of different treatments.

Following surgery a specialist with knowledge about stoma should give information about managing bowel function. This should be specific to the type of surgery performed and include a range of information .

Healthcare professionals should consider a once-daily dosing regimen for oral aminosalicylates when used for maintaining remission.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Few conditions cause as much distress as this life-long condition. Ulcerative colitis can develop at any age, but teenagers and young people between the ages of 15 and 25 are most susceptible. There is no cure but it is possible to control the symptoms for long periods of time, leaving those who suffer able to live life to the full as much as possible.

"This is demonstrated by Manchester United's Darren Fletcher who until recently was able to play both top flight football for his club and captain the Scottish team all whilst having his ulcerative colitis symptoms controlled by the correct medication."

A range of implementation tools have been produced to support the implementation of this guideline. These include audit tools, a costing report and a costing template.