Living with IBD: Updated national recommendations guide the comprehensive care of IBD patients.

Background & Rationale

The Chilean gastroenterological society recognised a need to update national guidelines for the management of inflammatory bowel disease (IBD), encompassing both Crohn’s disease and ulcerative colitis. Previous recommendations were considered outdated given advancements in pharmacological treatments and diagnostic techniques. This guideline aimed to provide evidence-based recommendations for diagnosis, medical management, surgical intervention, and monitoring of adult patients with IBD across various care settings. The authors sought to create a resource reflecting current international standards adapted to the realities of the Chilean healthcare system.

Study Design

This document represents a methodological guideline development process. A consensus methodology was employed, involving a panel of 19 Chilean gastroenterologists with expertise in IBD. The panel undertook a systematic review of published literature, including international guidelines (primarily those from the American Gastroenterological Association and the European Crohn’s and Colitis Organisation), meta-analyses, and randomised controlled trials, with a focus on studies published from 2010 onwards. The evidence was assessed using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Consensus was achieved through several rounds of Delphi methodology, using a specifically designed questionnaire distributed to panel members.

Patient Population

These guidelines focus on the management of adult patients (aged 18 years or older) diagnosed with Crohn’s disease or ulcerative colitis. Specific considerations are included for patients with mild to moderate disease, moderate to severe disease, and those requiring biological or small molecule therapies. The guidelines recognised the challenges of applying these therapies within a resource-limited setting, and acknowledged the need for stratified, risk-based approaches. Paediatric populations and those with rare IBD manifestations are considered outside the scope of this document.

Key Findings

The guideline details recommendations across several key areas. For newly diagnosed ulcerative colitis, initial management prioritises aminosalicylates, with options for maintenance therapy based on disease extent and severity. Corticosteroids are recommended for short-term induction of remission in moderate to severe flares. For Crohn’s disease, diagnosis necessitates a combination of clinical, endoscopic, and radiological findings. Initial therapy for mild to moderate Crohn’s disease includes immunomodulators, such as azathioprine or 6-mercaptopurine. Biological therapies, including anti-TNF agents, anti-integrins, and anti-IL-12/23 antibodies, are recommended for moderate to severe disease refractory to conventional therapies.

Specific recommendations detail step-up and top-down strategies for initiating and escalating therapy. Monitoring recommendations include regular clinical assessments, endoscopic surveillance for colitic disease (every 1-3 years depending on risk), and drug level monitoring where appropriate. Regarding surgical intervention, the guidelines state that surgery is reserved for complications such as toxic megacolon, severe bleeding, or failure of medical therapy. Nutritional support, including enteral nutrition, is considered an important adjunct particularly in paediatric Crohn’s disease cases, as well as those with malnutrition.

Discussion

These updated Chilean guidelines represent a significant effort to standardise IBD care within the country. Reflecting global trends, the guideline strongly advocates for early and aggressive medical therapy in moderate to severe disease, utilising biological agents and small molecules when indicated. The inclusion of a structured approach to monitoring addresses the importance of optimising treatment and identifying potential adverse events. The guidelines recognise the impact of socioeconomic factors on access to care, and promote a pragmatic, step-wise treatment approach. Safety monitoring for biological therapies is emphasised, including screening for latent tuberculosis and hepatitis B prior to initiation. The impact of these guidelines will need to be assessed through implementation studies.

Authors’ Conclusions

The authors conclude that these updated guidelines “provide a standardised and evidence-based approach to the diagnosis and management of IBD in adult patients in Chile.” They state that “adherence to these recommendations will contribute to improved patient outcomes and reduced healthcare costs,” and anticipate that the implementation of these guidelines “will foster a collaborative approach between gastroenterologists, surgeons, and other healthcare professionals involved in IBD care.”

Reference

Núñez F P, Alfaro I, Pavez C, Pizarro G, Estay C, Sepúlveda R, Arenas A, Quera R, Slimming J, Candia R, Hernández C, Lubascher J, Ibañez P, Figueroa C, Vergara T, Álvarez M, Agüero C, Araya M, Arriagada E. Guideline for the Treatment of Ulcerative Colitis and Crohn’s Disease in Adult Patients. Revista medica de Chile. 2026;144(1):105–122. DOI: 10.4067/s0034-98872026000100105.