'Lottery' of bowel disorder care

There are wide variations in the care provided for people with bowel disease, a national audit has found. The expert bodies who carried out the work said there were significant differences in the resources given to services and the care people receive. Three quarters of UK hospitals took part in the audit, which found 44% did not have a dedicated nurse specialist.

Inflammatory bowel disease, including ulcerative colitis and Crohn's disease, affects around one in 400 in the UK. Both conditions are usually diagnosed in adolescence or early adulthood. At least 80% of people with Crohn's disease and 25% with ulcerative colitis need surgery at some time.

There are about 30,000 admissions to hospital per year with complications. Both conditions can be fatal. Ulcerative colitis can kill in severe cases if surgery is not performed in time, while Crohn's disease can be fatal if a patient develops an infection or an inflamed or perforated bowel.

The audit was carried out by the British Society of Gastroenterology, the Royal College of Physicians, the Association of Coloproctology of Great Britain and Ireland and the National Association for Colitis and Crohn's Disease and was funded by a grant from the Health Foundation.

It found there was a lack of adequate toilet provision in hospitals - for a condition with diarrhoea as a major feature with, on average, one toilet for each 4.5 beds And only 42% had stool samples tested, while just 52% of patients admitted with Crohn's disease, which is associated with weight loss and malnutrition, were weighed and only 37% were seen by a dietitian. The audit also found there was a poor provision of dietetic services for gastroenterology in general.

Dr Keith Leiper, a consultant gastroenterologist who led the audit team, said: "There are clear deficits and unacceptable variation in care throughout the UK - both resources and in individual patient management. An expansion in clinical nurse specialists together with improved dietetic services are urgently required together with improved performance in key clinical aspects."

Richard Driscoll, director of the National Association for Colitis and Crohn's Disease, said: "People who have colitis and Crohn's disease have to accept that there is no cure for their illness and live with symptoms of pain, urgent diarrhoea and severe fatigue that can flare-up unpredictably at any time throughout their life. It is essential that they have ongoing support from and quick access to a gastroenterology team that is both experienced in managing these IBD and is properly resourced."