Clinical Review: National guidelines were developed for the management of inflammatory bowel disease in Chile.
Background & Rationale
Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, presents a growing healthcare challenge worldwide, including in Chile. Prior to this work, Chile lacked nationally endorsed, evidence-based guidelines for IBD management. Existing international guidelines do not fully account for the unique epidemiological, healthcare system, and resource constraints present within the Chilean context. The need for locally adapted guidelines necessitated a systematic review of current literature and a consensus-building process involving Chilean gastroenterologists, surgeons, and other relevant healthcare professionals. This initiative aimed to standardise IBD care across the country, improve patient outcomes and optimise resource allocation.
Study Design
A consensus-based guideline development process was employed. A panel of 20 Chilean experts in IBD – including gastroenterologists, surgeons, radiologists, pathologists, and representatives from patient associations – participated. The process began with a systematic literature review, encompassing guidelines published by major international organisations (e.g. ECCO, AGA, ASCOL) and relevant clinical trials. This review focused on diagnostic criteria, therapeutic strategies (pharmacological and surgical), and monitoring protocols for both Crohn’s disease and ulcerative colitis. A modified Delphi process involving several rounds of questionnaire distribution and discussion enabled consensus on key recommendations.
Patient Population
These guidelines are intended for the management of adult patients diagnosed with Crohn’s disease or ulcerative colitis within the Chilean healthcare system. No specific demographic restrictions were applied during the guideline development, intending broad applicability to the national patient population. The guidelines account for variations in disease severity, presentation, and co-morbidities commonly encountered in clinical practice.
Key Findings
The resulting guidelines address various aspects of IBD management. Diagnostic evaluation should include a combination of clinical assessment, endoscopy, histology, and imaging. For ulcerative colitis, initial treatment with aminosalicylates is recommended for mild-to-moderate disease. Moderate-to-severe disease warrants consideration of corticosteroids or biological therapies. For Crohn’s disease, initial treatment strategies vary depending on disease location and severity. Budesonide is indicated for ileal Crohn’s disease, whilst corticosteroids, immunomodulators, or biological therapies are considered for more extensive or severe presentations.
Step-up therapy is generally favoured, although early biological therapy may be appropriate in select high-risk patients. Monitoring recommendations include regular clinical assessments, endoscopic surveillance to screen for dysplasia, and biochemical markers, such as C-reactive protein and faecal calprotectin. Surgical management is recommended for complications such as strictures, fistulas or in cases of refractory disease. Nutritional support, including enteral nutrition and, when necessary, parenteral nutrition, is considered an adjunct to pharmacological therapy.
Discussion
The development of these national guidelines represents a significant step forward in standardising IBD care in Chile. By synthesising global evidence with local considerations, the guidelines intend to improve diagnostic accuracy, optimise therapeutic decision-making, and ensure appropriate monitoring of patients with IBD. Their implementation should facilitate more consistent and equitable access to high-quality care throughout the country. The guidelines noted that data regarding drug availability and cost within the Chilean public health system were taken into account during the consensus process.
Overall tolerability of recommended therapies was also considered, with emphasis on minimising adverse effects and maintaining treatment adherence. Furthermore, the guidelines address the importance of a multidisciplinary approach to IBD management, involving gastroenterologists, surgeons, radiologists, pathologists, dietitians, and psychologists. The consensus process involved acknowledging the challenges in real-world implementation, such as timely endoscopic access and the availability of specialised treatment centres.
Authors’ Conclusions
The authors conclude that these national guidelines provide a practical framework for the diagnosis and management of Crohn’s disease and ulcerative colitis in adult patients within the Chilean healthcare context. They emphasise the need for ongoing evaluation and refinement of the guidelines based on emerging evidence and clinical experience, alongside continued efforts to improve access to optimal IBD care for all Chilean patients.
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 médica de Chile. 2026;10.4067/s0034-98872026000100105. DOI: 10.4067/s0034-98872026000100105.