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TIME TO INFLAMMATORY BOWEL DISEASE DIAGNOSIS FOR PATIENTS PRESENTING WITH ABDOMINAL SYMPTOMS IN PRIMARY CARE AND ASSOCIATION WITH EMERGENCY HOSPITAL ADMISSION AND SURGERY; A RETROSPECTIVE COHORT STUDY

Nosheen Umar 1,2, Phil Harvey 3, Nicola Adderley 2, Shamil Haroon 2, Nigel Trudgill 1

Affiliations

1 Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom

2 University of Birmingham, Birmingham, United Kingdom

3 New Cross Hospital, Wolverhampton, United Kingdom

Summary

AI Generated

A UK primary care study of 28,092 IBD patients found median time to diagnosis was 15.6 months, with longer delays associated with female sex, minority ethnicities, comorbidities, and medication use, while faecal calprotectin testing reduced diagnostic delay.

Median time to IBD diagnosis was 15.6 months overall, 13.8 months for ulcerative colitis and 17.8 months for Crohn's disease, with no improvement observed between 2010-2011 and 2018-2019
Female sex, Black or Asian ethnicity, older age, obesity, smoking, lower socioeconomic status, anxiety, depression, NSAID use, loperamide use, and higher comorbidity scores were associated with diagnostic delays exceeding 12 months
Only 11.3% of patients had faecal calprotectin testing, but higher FC levels were associated with shorter time to diagnosis, with median 4.0 months from FC test to diagnosis
Patients with longest diagnostic delays had more IBD-related emergency admissions after diagnosis but lower risk of surgery within one year
This study is relevant for clinicians and healthcare systems seeking to identify barriers to timely IBD diagnosis and target interventions to reduce diagnostic delay

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Making an Inflammatory Bowel Disease (IBD) diagnosis can be challenging as symptoms may mimic more common conditions such as irritable bowel syndrome or haemorrhoids. This can lead to delays in IBD diagnosis, which can be associated with the need for more complex treatment or surgery.

Aims & Methods

This study aims to quantify the time to diagnosis for IBD and examine associations with patient characteristics and faecal calprotectin (FC) and its impact on surgery and emergency hospital admissions.
A retrospective cohort study was conducted using Clinical Practice Research Datalink (CPRD AURUM) from 1st Jan 2007 to 31st Dec 2019. Adult patients were followed from when they first presented with symptoms, signs, test results or alternative diagnosis potentially related to IBD in primary care in the 3 year period prior to IBD diagnosis. The association between patient level factors and FC with the time to IBD diagnosis were examined using logistic regression analysis. We examined changes in time to IBD diagnosis over the 10 year study period. The association of time to IBD diagnosis with IBD related surgeries and emergency admissions was also examined.

Results

Of 28,092 IBD patients: 60.0% ulcerative colitis (UC) and 40.0% Crohn’s disease (CD). Median age 43(IQR 30-58) years; 51.9% female. Median time to diagnosis 15.6 (IQR 4.3- 28.1) months; UC 13.8 (3.2-27.1) months and CD 17.8 (6.5-29.2) months.
Factors associated with over 12 months to IBD diagnosis: female ((OR 1.64(95%CI 1.56-1.72)); Black (1.45(1.20-1.76)) or Asian ethnicity (1.55(1.40-1.72); older age compared to 18-30 years (>70 1.14(1.03-1.27)); obesity (1.09(1.01-1.17)); smoking (1.13(1.06-1.20)); lower socioeconomic status (1.15 (1.06-1.25)); anxiety (1.15(1.07-1.24)); depression (1.19(1.11-1.28)); non-steroidal anti-inflammatory drugs (NSAIDs) (1.45(1.33-1.59)); loperamide (1.56 (1.31-1.86)) and increasing comorbidity Charlson score >2 (1.46(1.32-1.61)).
Only 11.3% of IBD patients had FC testing. Time to diagnosis from FC date was median 4.0 (IQR 1.8- 8.8) months. Higher FC levels were associated with decreasing time to IBD diagnosis: 500-1000 (0.76 (0.66-0.89)),>1000 (0.61(0.51-0.72)).
No improvement in time to IBD diagnosis was observed over the last 10 years: 2010-2011 (14.4 (3.6 -27.6) months) compared to 2018-2019 median (15.6 (4.8-28.8) months).
Patients with time to diagnosis in highest quartile were at lower risk of surgery within a year of diagnosis (HR 0.91(0.81-1.03) but had more IBD related emergency admissions after diagnosis (IRR 1.06 (1.01-1.11).

Conclusion

Longer times to diagnoses were associated with females, minority ethnicities, increasing age, increasing comorbidity, deprivation, obesity, anxiety, depression, NSAIDs and loperamide use. Faecal calprotectin testing reduced time to diagnoses. Higher number of IBD related emergency admissions were observed in patients with a prolonged time to diagnosis.

Disclosure

No conflict of interest to declare

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Summary: Strategies in proctology: From diagnosis to multidisciplinary management

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