How should I approach the management of a patient with newly diagnosed inflammatory bowel disease in primary care?

In primary care, the management of a patient with newly diagnosed inflammatory bowel disease (IBD) involves several key steps tailored to the type of IBD (Crohn's disease or ulcerative colitis) and the patient's clinical status. Initial assessment should include excluding alternative causes of symptoms such as infection or medication side effects, and assessing symptom severity and impact on quality of life. Referral to specialist gastroenterology services is essential for confirmation of diagnosis, initiation of appropriate induction therapy, and ongoing management planning. Symptom management in primary care may include cautious use of analgesia (preferably paracetamol, avoiding NSAIDs), dietary advice, and managing diarrhoea or constipation with guidance from specialists. Maintenance treatment should be optimised in collaboration with specialists, including the use of aminosalicylates or immunosuppressants as indicated. Monitoring for complications such as anaemia, fatigue, and osteoporosis risk is important, with appropriate investigations and referrals as needed. Patient education and support are critical, including providing information about the disease, treatment options, lifestyle modifications (such as smoking cessation in Crohn's disease), and psychosocial support. Shared-care agreements with specialists can guide the extent of primary care involvement in medication monitoring and symptom management. Emergency referral is warranted if there are signs of severe disease, bowel obstruction, or toxic megacolon. Overall, primary care plays a supportive role in symptom control, monitoring, and coordination of care while ensuring timely specialist involvement for disease-specific treatment and complications management.

Key points for primary care management:

• Exclude alternative causes of symptoms and assess severity.
• Refer promptly to gastroenterology for diagnosis confirmation and treatment initiation.
• Manage symptoms conservatively: use paracetamol for pain, avoid NSAIDs, provide dietary advice.
• Support smoking cessation, especially in Crohn's disease.
• Monitor for anaemia, fatigue, and osteoporosis risk; arrange investigations or referrals as needed.
• Provide patient education and access to support resources.
• Follow shared-care protocols for medication monitoring and maintenance therapy.
• Urgently refer if severe symptoms or complications arise.

This approach aligns with NICE and British Society of Gastroenterology guidelines for Crohn's disease and ulcerative colitis management in adults and children in the UK.