Practice Patterns in Inflammatory Bowel Disease in Pakistan: A National Survey of Physician Confidence and Therapeutic Strategies.

INTRODUCTION: The incidence and prevalence of inflammatory bowel disease (IBD) are increasing in South Asia, including Pakistan. Biologic therapies have transformed IBD management; however, physician confidence in initiating these therapies and real-world prescribing patterns remain variable. METHODS: A cross-sectional survey was conducted among physicians involved in IBD care across Pakistan using an online questionnaire. A total of 100 physicians were invited to participate; 99 respondents with complete data were included in the analysis. The survey assessed demographics, training background, practice setting, therapeutic preferences, physician-reported confidence in initiating biologic therapy, and perceived barriers. Descriptive statistics and comparative analyses were performed. RESULTS: Most respondents were male (83.8%), with the largest age group being 35-44 years (43.4%). Most participants had completed formal gastroenterology training (87.9%), with 17.2% reporting overseas training. Overseas training was significantly associated with greater confidence in initiating biologic therapy for UC induction (p = 0.013) and CD induction (p = 0.010). Confidence with therapy strongly corresponded with early advanced therapeutic strategies, including upfront anti-TNF and oral targeted therapy use in both UC and CD (all p < 0.05). Male physicians were more comfortable with CD maintenance therapy (p = 0.036). CONCLUSION: Physician confidence in initiating biologic therapy for IBD in Pakistan is associated with training exposure and therapeutic approach. Addressing barriers such as infection screening, cost, and access, along with strengthening IBD-focused training programs, may support more consistent and guideline-concordant care.