When travelling, patients with inflammatory bowel disease (IBD) have a higher risk of morbidity. We identified barriers to travel, specific health concerns and several areas for service improvement among patients. In total, 136 patients were given a 32-question service improvement questionnaire. Of these, 89% travelled abroad, 30% reported that IBD limited travel and 40% said it affected choice of destination. Fourty-seven percent of patients travelled abroad without health insurance and 7% were refused. Seventy-eight percent wanted pre-travel advice from doctors in the future. Popular service improvement options included providing written prescriptions (91%) and management plans (75%). Sixty-three percent of patients were unaware of needing to avoid live vaccines while on immunosuppressants. Ninety-two percent were unaware that high altitudes could precipitate flares; 27% travelled abroad to high-altitude destinations, of which 46% subsequently had flare-ups. Existing IBD travel services remain unknown such as the 'Can't wait' card (72%) and 'IBD passport' (96%). Service improvements in the IBD clinic need to be implemented to facilitate safer travel overseas.

Adherence to the 2010 guidelines in these patients was 85%. 1289 individuals with 2256 colonoscopies were identified. Low/moderate/high risk groups were 78 (60%)/382 (29%)/125 (9.7%) respectively. Interval adherence in this cohort was 82%. 20 patients were selected for case notes review. The mean age was 52 (range 31-72). Three patients had colectomy (2 refractory colitis, one DALM) and one patient moved out of area during the studied period. 72 colonoscopies were performed with 52 intervals recorded. Seven (13%) intervals were scheduled over the recommended time (mean 333 days). These were all at the patient's request. 30 intervals (58%) were performed before there intended date (mean À347 days). The most common reason for this was inappropriate yearly surveillance. Conclusions DALMs were detected in 0.5% of IBD patients undergoing colonoscopy. Almost half of these were not detected during scheduled surveillance, which may support the shorter intervals used by some clinicians.