Gaps between European Crohn's and Colitis Organisation quality standards of care and the real world on diagnosis and monitoring inflammatory bowel disease across Europe: results from the E-QUALITY survey

Abstract

Background and aims: Quality of care in inflammatory bowel disease (IBD) management is crucial for early detection and prevention of disease progression and complications. The European Crohn's and Colitis Organisation (ECCO) developed evidence-based recommendations and quality of care (QoC) standards for IBD management, but gaps between these standards and real-world practices still exist. The E-QUALITY task force aimed to evaluate processes related to quality standards of IBD diagnosis and management across European institutions and identify barriers to meet ECCO QoC standards.

Methods: A web-based survey was conducted from September 2022 to October 2024 among 245 institutions in 35 European countries. The survey assessed processes used to diagnose and monitor disease activity, to prevent infections, and to detect colorectal cancer in IBD. Subgroup analyses were performed based on institution type, patient volume, and geographical distribution.

Results: Across participating European centers, most ECCO recommendations were followed in 85% of institutions. Monitoring disease activity and severity within the recommended time occurred in 75% of institutions, although audit mechanisms are lacking in the majority of centers. The main challenges are difficulties in scheduling endoscopy/imaging within the recommended time frame, lack of uniform behavior among physicians in the same unit, and patients' reluctance to undergo regular monitoring.

Conclusion: Significant gaps in QoC standards remain across European IBD units. Most units lack specific auditing mechanisms to track true standard compliance. Enhanced support from ECCO, through education on guidelines and implementation strategies, and adaptation of recommendations to accommodate real-world challenges may help to bridge these gaps.

Keywords: Crohn’s disease; colorectal cancer surveillance; diagnosis; infections; inflammatory bowel disease; monitoring; quality of care; ulcerative colitis.