The prevalence of inflammatory bowel disease (IBD) is ~0.5%–1% and rising.1 In many healthcare systems, the frequency of IBD is too rare for it to be managed solely by primary care practitioners, but still common enough to fall within the caseload of general gastroenterologists. Whilst the disease may run a relatively quiescent course, some patients face years of severe, disabling symptoms. The relatively unpredictable prognosis of IBD, combined with the ability of its extraintestinal manifestations to impact multiple organ systems, requires a nimble and individual approach to patient management. Indeed, the treating clinician must liaise closely with colleagues in other disciplines, including nursing, surgery, radiology, histopathology and numerous other medical specialties.
Advances in our understanding of IBD pathogenesis and in diagnostic modalities, therapeutic options and surgical techniques for Crohn’s disease and ulcerative colitis have fundamentally altered the landscape of IBD management in the past two decades. The challenge for physicians treating IBD is to leverage these changes to improve patient outcomes, avoiding the many potential pitfalls. Here, we discuss some of the pitfalls that may await the treating clinican, drawing upon evidence when possible and on our clinical experience. If some of these pitfalls seem contradictory, this is deliberately so, to highlight the subtleties and challenges of contemporary IBD management. Many of the pitfalls may also seem somewhat obvious when taken in isolation, and yet we believe them to be relatively common, raising important questions around how we can configure and manage our services to avoid those problems that we all still encounter in practice.