P75 ‘IBD-Dermatology’: a novel and collaborative working model

Introduction Skin disease occurs in 10% of patients with inflammatory bowel disease (IBD), most commonly in patients with active disease and a positive family history.1 Our gastroenterology-dermatology clinic (GDC) allows patients to be reviewed jointly by a gastroenterologist and dermatologist. In this study, we aimed to analyse clinical data from our patient cohort and survey patient satisfaction. Methods We reviewed the electronic health records of patients seen within the GDC and collected demographic and clinical data. We distributed an anonymous patient survey to those attending clinic in July 2023 to evaluate satisfaction following their appointment. Results Data was gathered from ten 3-monthly clinics between July 2021–October 2023 (105 appointments). Of forty-four patients attending the GDC (16:28 male: female, median age 36 (18–76)), 89% had IBD (Crohn’s disease (CD) n=32, ulcerative colitis (UC) n=7). Dermatological diagnoses included psoriasis (n=11, 25%), eczema (n=9, 20%), hidradenitis suppurativa (HS) (n=10, 23%, Hurley stage: I (n=2), II (n=2), III (n=2), scoring not documented (n=4)), cutaneous CD (n=9, 20%) and pyoderma gangrenosum (n=5, 11%). Three patients had overlapping cutaneous CD and HS. Four patients with psoriasis were paradoxical secondary to anti-TNF therapy. Most patients attended the clinic multiple times (median attendance=2 (1–9)). Twenty-four CD patients (75%) commenced biologic therapy. Twelve had therapy initiated for both the dermatological diagnosis and CD. Most common CD Montreal classifications were A2 (n=17, 53%), L2 and L3 (n=31, 97%), B1 (N=18, 58%), P (n=14, 44%). Proactive alteration of systemic therapy was undertaken in 32% (35/105) and investigations arranged in 37% (39/105) of appointments. Patient survey (n=10) responses were positive with a median satisfaction score of 50/50 (45–50). Patients particularly valued the proactive decision-making regarding related aspects of their care at one appointment. Conclusions The joint GDC model serves a complex group of patients with IBD and medical dermatological diagnoses. Following simultaneous review by a dermatologist and gastroenterologist in the GDC, prompt initiation of appropriate systemic therapy, particularly biologics, can be carried out, often aimed to address both speciality diagnoses. We encourage other centres to adopt such a model for patients with IBD and a relevant dermatological diagnosis to optimise patient care. Reference Vavricka SR, Brun L, Ballabeni P, et al. Am J Gastroenterol. 2011;106(1):110–9.

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