Which IBD Patients Should You Refer to a Specialist?

Sunanda V. Kane, MD, MSPH

Disclosures

January 25, 2013

Question

When is it appropriate for a primary care provider to refer patients with ulcerative colitis or Crohn disease to a gastroenterologist?

Response from Sunanda V. Kane, MD, MSPH
Professor of Medicine, Mayo Medical College; Consultant, Mayo Clinic, Rochester, Minnesota

In a patient with inflammatory bowel disease (IBD), either ulcerative colitis or Crohn disease, a referral to a gastroenterologist is appropriate in certain circumstances. Typically, patients with IBD will have initially been diagnosed by a gastroenterologist, but they may not have seen this specialist for some time.

If the patient has ulcerative colitis and is doing well on a 5-aminosalicylic acid drug such as sulfasalazine or mesalamine, and laboratory values are normal, then the primary reason to refer is for surveillance colonoscopy. If the patient with ulcerative colitis is "fine" but is taking steroids, a referral is appropriate to discuss the possible use of steroid-sparing agents. If the patient is hospitalized with severe ulcerative colitis, data[1] suggest that the patient should be on the gastroenterology service and not just have a gastroenterology consult.

The story is different with Crohn disease. Most of these patients have already had surgeries, and many have experienced some complication of their disease such as reduced bone health, malabsorption issues, or infection. Almost all patients with Crohn disease are taking at least 1 immunosuppressant drug, and they require routine monitoring. With the management recommendations changing frequently for Crohn disease, gastroenterology care and input are in the patient's best interest. Just as for hospitalized patients with ulcerative colitis, research[2] shows that patients have better outcomes when regularly followed by a gastroenterologist -- they have less exposure to steroids, fewer surgeries, and better overall outcomes.

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