scholarly journals P769 Prevalence and duration of gastrointestinal symptoms in the 10 years before diagnosis of inflammatory bowel disease: A national cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S610-S610
Author(s):  
J Blackwell ◽  
S Saxena ◽  
N Jayasooriya ◽  
I Petersen ◽  
M Hotopf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Diagnostic Delay ◽  
Care Physician ◽  
Gi Symptoms ◽  
Inflammatory Bowel ◽  
Incident Cases ◽  
Diagnosis Date

Abstract Background Gastrointestinal (GI) symptoms of Inflammatory Bowel Disease (IBD) may go undiagnosed resulting in diagnostic delay. Aims: To determine the frequency and duration of GI symptoms in the decade before the diagnosis of Crohn’s Disease (CD) and ulcerative colitis (UC) and risk factors for delayed specialist review. Methods We used the Clinical Practice Research Datalink, a nationally representative research database, to identify incident cases of CD and UC diagnosed from 1998 to 2016. Comparison cohorts without IBD were matched 4:1 for age and sex and assigned the IBD diagnosis date of their matched IBD patient as a pseudo-diagnosis date. We compared the prevalence of GI symptoms between the IBD and comparison cohorts in the 10 years before IBD diagnosis. We identified individuals with chronic GI symptoms lasting more than 6 weeks and measured their time to receiving a specialist review with a gastroenterologist, paediatric gastroenterologist or colorectal surgeon. We identified risk factors for receiving specialist review after presenting with chronic GI symptoms. Results We identified 5874 incident cases of CD, 13,681 incident cases of UC and comparison cohorts of 78,114 individuals. 10% of the CD and UC cohorts reported GI symptoms to their primary care physician 5 years before diagnosis. Fewer than 50% of patients were reviewed by a specialist within 18 months of presenting to their primary care physician with chronic GI symptoms. Patients with a previous diagnosis of Irritable Bowel Syndrome (IBS) or depression were less likely to receive timely specialist review (IBS: HR 0.77, 95%CI 0.60–0.99, depression: HR 0.77, 95%CI 0.60–0.98). Conclusion A substantial number of individuals experience GI symptoms many years before receiving a diagnosis of IBD. IBS and depression are risk factors for delayed specialist review. Rapid diagnostic pathways should be established to reduce the burden of diagnostic delay in IBD.

scholarly journals Prevalence and Duration of Gastrointestinal Symptoms Before Diagnosis of Inflammatory Bowel Disease and Predictors of Timely Specialist Review: A Population-Based Study

2020 ◽  
Author(s):  
J Blackwell ◽  
S Saxena ◽  
N Jayasooriya ◽  
A Bottle ◽  
I Petersen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
Gastrointestinal Symptoms ◽  
Care Physician ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Background Population ◽  
Gi Symptoms ◽  
Inflammatory Bowel

Abstract Background and Aims Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal [GI] symptoms can result in delayed diagnosis of inflammatory bowel disease [IBD]. Aims To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s disease [CD] and ulcerative colitis [UC]. Methods This is a case control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998 to 2016. Results We identified 19 555 cases of IBD and 78 114 controls. One in four cases of IBD reported GI symptoms to their primary care physician more than 6 months before receiving a diagnosis. There was a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome [IBS] or depression were less likely to receive timely specialist review (IBS: hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.60–0.99, depression: HR = 0.77, 95% CI 0.60–0.98). Conclusions There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population, probably attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.

scholarly journals Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery

2015 ◽  
Vol 10 (3) ◽  
pp. 306-314 ◽  
Author(s):  
Roxana Zaharie ◽  
Alina Tantau ◽  
Florin Zaharie ◽  
Marcel Tantau ◽  
Liana Gheorghe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Risk ◽  
Diagnostic Delay ◽  
Disease Course ◽  
Inflammatory Bowel

scholarly journals Incidence and prevalence of inflammatory bowel disease in UK primary care: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036584 ◽  
Author(s):  
Thomas Joshua Pasvol ◽  
Laura Horsfall ◽  
Stuart Bloom ◽  
Anthony Walter Segal ◽  
Caroline Sabin ◽  
...  
Keyword(s):  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
Bowel Disease ◽  
Temporal Trends ◽  
Population Based ◽  
Average Decrease ◽  
Primary Care Patients ◽  
Inflammatory Bowel ◽  
Incident Cases

ObjectivesWe describe temporal trends in the recorded incidence of inflammatory bowel disease (IBD) in UK primary care patients between 2000 and 2018.DesignA cohort study.SettingThe IQVIA Medical Research data (IMRD) primary care database.ParticipantsAll individuals registered with general practices contributing to IMRD during the period 01 January 2000–31 December 2018.Main outcome measuresThe primary outcome was the recorded diagnosis of IBD.Results11 325 025 individuals were included and 65 700 IBD cases were identified, of which 22 560 were incident diagnoses made during the study period. Overall, there were 8077 incident cases of Crohn’s disease (CD) and 12 369 incident cases of ulcerative colitis (UC). Crude incidence estimates of ‘IBD overall’, CD and UC were 28.6 (28.2 to 28.9), 10.2 (10.0 to 10.5) and 15.7 (15.4 to 15.9)/100 000 person years, respectively. No change in IBD incidence was observed for adults aged 17–40 years and children aged 0–9 years. However, for adults aged over 40 years, incidence fell from 37.8 (34.5 to 41.4) to 23.6 (21.3 to 26.0)/100 000 person years (average decrease 2.3% (1.9 to 2.7)/year (p<0.0001)). In adolescents aged 10–16 years, incidence rose from 13.1 (8.4 to 19.5) to 25.4 (19.5 to 32.4)/100 000 person years (average increase 3.0% (1.7 to 4.3)/year (p<0.0001)). Point prevalence estimates on 31 December 2018 for IBD overall, CD and UC were 725, 276 and 397 per 100 000 people, respectively.ConclusionsThis is one of the largest studies ever undertaken to investigate trends in IBD epidemiology. Although we observed stable or falling incidence of IBD in adults, our results are consistent with some of the highest reported global incidence and prevalence rates for IBD, with a 94% rise in incidence in adolescents. Further investigation is required to understand the aetiological drivers.

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