Op Ed: A national consensus guideline provides recommendations for the management of IBD in Chile.
Background & Rationale
Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), presents a growing health challenge. Its incidence is increasing globally, including in Chile, necessitating standardised, evidence-based management strategies. Prior to this work, Chile lacked a nationally endorsed clinical practice guideline for IBD, leading to variable care and potential sub-optimal outcomes. The authors identified an important need for a consensus document to guide physicians in diagnosing, treating, and monitoring patients with these chronic conditions in the Chilean healthcare system. This guideline aimed to address this gap by outlining current best practices based on available evidence and expert opinions.
Study Design
A panel of 20 Chilean gastroenterologists, colorectal surgeons, and pathologists convened to develop clinical practice guidelines for the management of IBD. The guideline development process employed a modified Delphi approach. Initially, the panel conducted a systematic review of international IBD guidelines, specifically referencing those from the American Gastroenterological Association, the European Crohn’s and Colitis Organisation, and national guidelines from Canada and Australia. Literature review was supplemented by expert clinical experience. Consensus was achieved through three rounds of anonymous questionnaires where panel members rated statements regarding IBD management. Statements requiring greater than 80% agreement were included in the final guideline.
Patient Population
The guideline addresses the care of adult patients diagnosed with either CD or UC. It provides recommendations across the spectrum of disease severity, encompassing induction and maintenance therapy, perioperative management, and monitoring strategies. Inclusion criteria were broadly defined as any adult patient presenting with suspected or confirmed IBD within the Chilean healthcare context. The document acknowledges the need for tailoring treatment to individual patient characteristics and disease presentation, and explicitly addresses considerations for special populations.
Key Findings
The guideline recommends a stepwise approach to IBD management, beginning with assessment of disease extent and severity. For mild-to-moderate UC, initial treatment should involve rectal 5-aminosalicylates, with escalation to oral 5-aminosalicylates if response is inadequate. In patients with more extensive or severe UC, corticosteroids are recommended for induction therapy, followed by maintenance with azathioprine, 6-mercaptopurine, or biologic therapies. For CD, initial treatment in mild-to-moderate cases involves corticosteroids or immunomodulators. Biological therapies, including anti-tumour necrosis factor agents, anti-integrins, and anti-interleukin agents, are recommended for moderate-to-severe CD, as well as for steroid-refractory disease.
The guideline detailed specific protocols for perioperative management, including nutritional support and antibiotic prophylaxis. Monitoring recommendations included regular clinical assessments, endoscopic surveillance for dysplasia in UC, and imaging to assess disease activity and complications. Regarding vaccination, the guideline prioritises influenza and pneumococcal vaccination in IBD patients, while advising caution regarding live vaccines when receiving immunosuppressive therapy. Nutritional support is considered essential, particularly in CD, with recommendations for both enteral and parenteral nutrition as required.
Discussion
The guideline offers a practical framework for IBD management tailored to the Chilean healthcare setting. Its strength lies in the consensus-building process, leveraging expert knowledge alongside international best practices. Implementation of these standardised recommendations has the potential to reduce variability in care and improve patient outcomes. The document acknowledges the evolving landscape of IBD therapies, anticipating future updates as new evidence emerges.
Safety considerations are integrated throughout the guideline, with attention to potential adverse effects of immunosuppressive agents and biologic therapies. Routine monitoring for infections, cytopenias, and malignancy is emphasised. Tolerability of medications is highlighted as an important factor in treatment decision-making and adherence. The authors acknowledge challenges in access to some biologic therapies within the Chilean public healthcare system, and suggest strategies for optimising resource allocation and prioritising treatment based on disease severity and response to prior therapies.
Authors’ Conclusions
The authors concluded that this guideline represents a critical step toward optimising IBD care in Chile. They state it will provide clinicians with a comprehensive and evidence-based resource, ultimately improving the quality of life and clinical outcomes for individuals living with CD and UC. The guideline necessitates ongoing evaluation and adaptation to reflect advancements in IBD research and evolving clinical practice.
Reference
Núñez FP, 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;10.4067/s0034-98872026000100105.