Palliative care in inflammatory bowel disease: An evidence-based approach

The management of the patient with inflammatory bowel disease (IBD) is chal lenging for both the physician and the patient. IBD imposes both a physical and emotional burden on patients' lives. Palliative care is important for IBD patients because it focuses on improving quality of life. While palliat ive care does not change the natural history of the disease, it provides re lief from pain and other distressing symptoms. This article focuses on vari ous aspects of care for IBD patients including pain control, management of oral and skin ulcerations, stomal problems in IBD patients, control of naus ea and vomiting, management of chronic diarrhea and pruritus ani, evaluatio n of anemia, treatment of steroid-related bone disease, and treatment of ps ychological problems associated with IBD. Each of these areas is reviewed u sing an evidence-based approach. Evidence in category A refers to evidence from clinical trials that are randomized and well controlled. Category B Ev idence refers to evidence from cohere or case-controlled studies. Category C is evidence from case reports or flawed clinical trials. Evidence from ca tegory D is limited to the clinical experience of the authors. Evidence lab elled as category E refers to situations where there is insufficient eviden ce available to form an opinion. Algorithms for management of pain and naus ea in IBD patients are presented.