Inter-Physician Variation in Treatment for Patients with Crohn's Disease

Choi, Hwang; Kim, Sang Woo; Lee, Kang Moon; Lee, Bo In; Cheung, Dae Young; Kim, Min Kuk; Jung, Hyun Jung; Kim, Hyung Keun; Ji, Jeong Seon; Park, Soo Heon; Chae, Hiun Suk; Choi, Myung Gyu; Choi, Kyu Yong; Chung, In Sik

Abstract

BACKGROUND/AIMS
The incidence and prevalence of Crohn's disease are increasing in Korea. However, the guidelines for the management of Crohn's disease have not been established in Korea. In the current study we determined the difference in the treatment methods between physicians in Korea for Crohn's disease.
METHODS
We retrospectively analyzed the use of medical and surgical treatment modalities in 92 patients with newly diagnosed Crohn's disease. We compared the treatment strategies among 4 physicians at 3 different institutions.
RESULTS
Prednisone, 5-aminosalicylates, antibiotics, immunomodulators, infliximab, and surgery were prescribed or preformed in 64%, 92%, 24%, 35%, 9%, and 22% of the patients, respectively. The surgical procedures included 12 bowel resections and 8 fistulectomies. The prescription rates for 5-aminosalicylates, prednisone, antibiotics, and infliximab did not differ, but of the use of immunomodulators was significantly different between physicians (p=0.012). The mean interval between diagnosis and the start of immunomodulators was 14 months, and was not different between physicians. The median dosage of immunomodulators was 50 mg per day, and was not different between physicians.
CONCLUSIONS
A difference in medical treatment strategies for Crohn's disease between physicians exists in Korea. Specifically, there was a significant difference in the use of immunodulators between physicians. The development of treatment guidelines for Crohn's disease, together with efforts to decrease the inter-physician difference for treating Crohn's disease are needed.