Inflammatory bowel disease: epidemiology and management in an English general practice population

Background: Inflammatory bowel diseases have significant long-term morbidity and healthcare resource consequences. Studies based on secondary care records may have underestimated the contribution of general practitioners (GPs) to its management. Aims: To describe the epidemiology and management of inflammatory bowel disease using GP records as the primary data source. Methods: A systematic search of GP clinical records in northern England, identifying cases of inflammatory bowel disease, patient consultation behaviour, prescribing patterns, and extent of specialist care. Results: In a population of 135 723, the incidence of ulcerative colitis was 13.9/100 000 per year (CI: 7.5-20.3) and for Crohn's disease 8.3/100 000 per year (CI: 3.4-13.2). The age-sex adjusted point prevalence for ulcerative colitis on 1st January 1995 was 243.4/100 000 (CI: 217.4-269.4) and for Crohn's disease 144.8/100 000 (CI: 124.8-168.8). The mean number of consultations (s.d.) with specialists and GPs were similar, both in the first 12 months after referral (specialists 3.94 +/- 3.15, GPs 3.34 +/- 3.55) and in the most recent 12 months (1.02 +/- 2.02, 1.04 +/- 2.04). Only 29.9% of all patients were definitely under specialist care. Conclusions: Prevalence rates, but not incidence rates, for inflammatory bowel disease are substantially higher than previously described in UK populations. General practitioners make a significant contribution to meeting the healthcare needs of these patients.