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The 2021 National report from IBD UK included responses from over 10 000 patients with inflammatory bowel disease, over 70% of whom reported having at least one flare in the last 12 months. As the first-line treatment for patients with mild and moderate ulcerative colitis, the action and delivery mechanisms of mesalazine are crucial for successful management of the disease. The choice of the most appropriate formulation of mesalazine and securing patient concordance and adherence to treatment remains a challenge for healthcare professionals. This article details the outcome of a roundtable discussion involving a group of gastroenterology consultants and specialist nurses which considered the importance of ensuring that patients have individualised mesalazine therapy before escalation to other treatments and gives recommendations for the management of patients with mild or moderate ulcerative colitis.

Background In the IBD centre, Mercy University Hospital( MUH), all patients (Approximately 4000 patients with IBD) attend the outpatient clinic for face-to-face consultations as per prescheduled appointments regardless of disease status. Mismatch between need and access to care. Patients in remission attend for elective appointments, while patients in need of urgent specialist review may have to wait or else attend clinics which are already at capacity as an urgent appointment. The increasing strain on the OPD system calls for new models of care to be explored. Aim :develop and implement a pre-clinic screening , triage system and virtual consultations for low-risk patients & evaluate the impact on patient reported and health service outcomes. Prioritise patients with more unstable IBD symptoms for face-to-face consultations, while for patient with stable IBD to increase consultation choice (virtual or face to face) …Examine impact on patient experience …Examine impact on OPD waiting lists Methods QIP conducted over a 6 month period. 1980 patients included in the study. 1560 patients were scheduled to attend OPD in the 6month timeframe and 420 patients were on the IBD OPD waitlist for return/ first time consult. logic model planning and PDSA cycles to develop ,test, refine and implement; 1.A pre-clinic screening, assessment and triage pack to assess patients clinical status and education needs 2.Inclusion and exclusion criteria for virtual consultations 3.Clinic pathway algorithms 4.Weekly virtual IBD MDTs Results 95% of patients completed the pre-clinic screening and triage pack, of these 37% were eligible for telephone consultation and 89% of those deemed eligible were happy to switch from face to face to telephone consultation. 30% of patients who attended for pre-clinic screening and triage assessment required fast tracking of OPD appointments due to unstable disease and received earlier interventions e.g. colonoscopies, MRI’s and medication optimisation. IBD waiting list of 420 patients was cleared with this initiative, all patients were offered a telephone or OPD consultation based on the result of the pre-clinic triage assessment and patient preference. 83% of patients would be happy to continue with the new model as it was perceived as more convenient , time efficient and less disruptive to everyday life. Conclusion This study highlighted that virtual management of IBD is acceptable to patients, significantly decreased clinic visit utilisation and can reduce the growing burden of IBD on health care resources .This initiative had many positive organisational outcomes including the elimination of the IBD OPD waiting list, reduction in non-essential clinic attendances and potential cost savings.

Background Patients with Inflammatory Bowel Disease (IBD) often experience the problematic and burdensome symptom of fatigue, both during periods of relapse and remission. The optimal management of fatigue in IBD is uncertain, however there is evidence suggesting that physical activity is likely to be a beneficial way of managing the symptom. The aim of this study is to explore the relationship between fatigue and objective measurements of both physical activity metrics and varying intensities of physical activity for individuals with IBD. Methods A multi-centred, European, cross-sectional, correlational study was employed. A consecutive sample of 187 patients with Crohn’s disease (59%) or ulcerative colitis (41%) were recruited from six IBD centres in the Republic of Ireland (42%), United Kingdom (40%) and Denmark (18%). Fatigue was measured using the IBD-Fatigue (IBD-F) scale, including both the level of fatigue (IBD-F, Section 1) and impact of fatigue (IBD-F, Section 2). Physical activity was objectively measured using scientifically validated triaxial accelerometers (ActiGraph wGT3X-BT) during seven consecutive days. Results A moderate level of fatigue (IBD-F Section 1 Md (IQR) = 10 (6 – 13)), predominantly intermittent in nature (72%) was reported by participants (57.4% female; 59% Crohn’s disease; 43% active disease). Participants self-reported sleeping an average of 8.7 hours over the seven nights. During the week, the intensity of activity was predominantly sedentary (Md 5 days, 22 hours, 20 minutes) or light (Md 19 hours, 35 minutes). The median moderate-to-vigorous intensity of physical activity per day was 32.2 minutes and step count over the week was 47052 steps. There was no evidence of a unique linear or non-linear relationship between each of the objective measurements of physical activity with IBD-related fatigue. This lack of evidence extended separately to patients in remission and to patients with active disease. These findings are in the context of a statistically significant moderately-strong relationship between disease activity (measured using both HBI and SCCAI) and level of fatigue for both patients of Crohn’s disease (rs = .327, p = .001, n = 96) and ulcerative colitis (rs = .353, p = .003, n = 71). Conclusion This large multi-centred study shows no association between objective measurements of physical activity and IBD-fatigue. These findings suggest that engaging or not engaging in physical activity has no differential impact on self-assessment of fatigue.

The 2021 National report from IBD UK included responses from over 10 000 patients with inflammatory bowel disease, over 70% of whom reported having at least one flare in the last 12 months. As the first-line treatment for patients with mild and moderate ulcerative colitis, the action and delivery mechanisms of mesalazine are crucial for successful management of the disease. The choice of the most appropriate formulation of mesalazine and securing patient concordance and adherence to treatment remains a challenge for healthcare professionals. This article details the outcome of a roundtable discussion involving a group of gastroenterology consultants and specialist nurses which considered the importance of ensuring that patients have individualised mesalazine therapy before escalation to other treatments and gives recommendations for the management of patients with mild or moderate ulcerative colitis.