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Management of Crohn’s disease – are guidelines transferred to clinical practice?

Background Management of Crohn’s disease (CD) is a clinical challenge. In terms of an evidence-based approach, clinical guidelines help to deal with this challenge. However, little is known about guideline adherence concerning the management of CD in Germany. Objective To survey German gastroenterologists with regards to their guideline adherence in daily clinical care. Method A web-based national survey was conducted among German gastroenterologists. Results A total of 175 inflammatory bowel disease (IBD) practitioners responded to the survey. Overall, in the different clinical situations covered in the questionnaire guideline adherence is good. However, the 5-aminosalicylic acid (5-ASA) prescribing habits represent a striking exception. About 10–36% use 5-ASA as mono-therapy in CD, depending on the clinical scenario. Predominantly it is used in mild CD and in colonic involvement. To maintain a surgically achieved remission, therapeutic decisions broadly rely on individual approaches with azathioprine and 5-ASA being used by about 30% of the respondents. Cessation of smoking as a “therapeutic” strategy of maintenance therapy is used by only half of the surveyed physicians. Conclusion Amongst German IBD practitioners, the guideline adherence is good overall. Reflecting ongoing uncertainty about the efficacy of mesalazine, its use in Crohn’s disease is still heterogeneous.