Intended for healthcare professionals

Rapid response to:


Ulcerative colitis: diagnosis and management

BMJ 2006; 333 doi: (Published 10 August 2006) Cite this as: BMJ 2006;333:340

Rapid Response:

management of ulcerative colitis should be patient-centred


Many patients with ulcerative colitis are not under specialist care
[1] and Collins and Rhodes have provided a welcome clinical update on
ulcerative colitis for GPs [2]. However, they fail to address some of the
important patient management issues encountered in primary care.

Most patients recognize the importance of drug therapy in controlling
symptoms of ulcerative colitis, but negative attitudes to drug therapy and
concerns about side-effects are widespread [3]. A significant minority of
patients is not fully adherent to drug therapy [4] and self-management of
drugs, including variation in dose of 5ASA and the use of supplies of
steroids in case of relapse, appears to be common [3] . Further, there is
little awareness among patients of the protective role of 5ASA for
colorectal cancer. At the same time the use of guided self-management
provides a framework that engages patients with their care, is highly
acceptable and has demonstrable treatment benefits [5].

Understanding therapeutic adherence, supporting self-management and
the negotiation of concordance are all elements of general practice care
and an important role for the GP in the shared management of patients with
ulcerative colitis.

Greg Rubin
Professor of Primary Care

Nicola Hall
Research Associate

Centre for Primary and Community Care
University of Sunderland

[1] Rubin GP, Hungin APS, Chinn D, Dwarakanath D. Quality of life in
patients with established inflammatory bowel disease: a UK general
practice survey. Aliment Pharmacol and Therapeutics 2004; 19: 529-535

[2] Collins P, Rhodes J. Ulcerative colitis: diagnosis and management.
BMJ 2006; 333: 340-343

[3] Hall NH, Rubin GP, Dougall A, Hungin APS, Neely J. The fight for
“health-related normality”: A qualitative study of the experiences of
individuals living with established inflammatory bowel disease (IBD).
Journal of Health Psychology. 2005; 10 (3): 443-455.

[4] Rubin GP, Hungin APS, Chinn D, Dwarakanath AD, Green L, Bates J. Long
term aminosalicylate therapy is underused in patients with ulcerative
colitis: a cross sectional survey. Alimentary Pharmacol and Therapeutics
2002; 16: 1889-1894

[5] Robinson, A, Thompson DG, Wilkin D et al. Guided self-management and
patient-directed follow-up of ulcerative colitis: a randomized trial.
Lancet, 2001; 358 (9268): 976-981

Competing interests:
None declared

Competing interests: No competing interests

18 August 2006
Greg Rubin
Professor of Primary Care
Nicola Hall
University of Sunderland SR1 3PZ