Introduction

Colonoscopic withdrawal time is reportedly related to the adenoma detection rate (ADR) [1]. Other endoscopist-related factors that may affect ADR, such as age, sex, specialty, years of experience, and the number of endoscopies performed, have already been evaluated [2]; however, the link between ADR and the average colonoscopic caecal insertion time, which indicates proficiency in endoscopic techniques, remains unexplored [3].
The Japan Gastroenterological Endoscopy Society launched the Japan Endoscopy Database (JED) to create a large-scale endoscopy database using routine endoscopy reports. In this study, we merged the endoscopy database constructed by JED with the pathology database. To the best of our knowledge, this is the first large-scale endoscopy database in Japan that incorporates pathological data.

Aims & Methods

This study aimed to assess the impact of various endoscopist-related factors on ADR. This report is one of the main results of a Japanese multicentre observational study (J-SCOUT study) that used a colonoscopy database to evaluate factors that affect colonoscopy outcomes (No: UMIN000040690). We included all individuals aged ≥20 years who underwent colonoscopy at the participating institutions between 2010 and 2020. The exclusion criteria were as follows: (1) patient’s refusal to participate in the study; (2) colonoscopy performed within 6 months; (3) colonoscopy for previously identified colorectal lesions; (4) inflammatory bowel disease; (5) emergency endoscopy; and (6) unknown indications for colonoscopy. The following endoscopist-related factors were assessed: sex, specialty, average caecal insertion time, average withdrawal time when no polyps were found, and number of colonoscopies performed during the study period. The odds ratios of endoscopist-related factors were analysed using a generalised linear mixed model.

Results

The ADR of 47,705 colonoscopies performed by 189 endoscopists across four hospitals out of a total of 186,293 colonoscopies were analysed. Most colonoscopies were performed by gastroenterologists, with male endoscopists accounting for approximately 80%.
Compared to endoscopists with an average caecal insertion time of <5 min, those with insertion times of 5–9 min, 10–14 min, and ≥ 15 min had odds ratios of 0.84 [95% confidence interval (CI): 0.71, 0.99], 0.68 [95% CI: 0.52, 0.90], and 0.45 [95% CI: 0.25, 0.78], respectively. Compared to endoscopists with an average withdrawal time of <6 min, those with withdrawal times of 6–9 min, 10–14 min, and ≥ 15 min had odds ratios of 1.38 [95% CI: 1.03, 1.85], 1.48 [95% CI: 1.09, 2.02], and 1.68 [95% CI: 1.04, 2.61], respectively. The endoscopist’s specialty, sex, and number of examinations did not significantly affect ADR.

Conclusion

Individual mean colonoscopic withdrawal and caecal insertion times can serve as quality indicators of the procedure. These results provide a benchmark for achievable skills of endoscopists.

References

1. Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541.
2. Sekiguchi M, Westerberg M, Ekbom A et al. Endoscopist characteristics and polyp detection in colonoscopy: cross-sectional analyses of screening of Swedish colons. Gastroenterology 2023; 164: 293-295.
3. Sekiguchi M, Westerberg M, Ekbom A et al. Detection rates of colorectal neoplasia during colonoscopies and their associated factors in the SCREESCO study. J Gastroenterol Hepatol 2022; 37: 2120-2130.

Disclosure

Takuji Kawamura and Yoji Takeuchi received honoraria from Olympus Corporation for lectures, presentations, or educational events.

Introduction

Several studies have shown that a low quality of colonoscopy reduces its effect in preventing colorectal cancer (CRC), but it is not clear to which extent a low-quality colonoscopy is still effective compared to no colonoscopy. We aimed to compare the 13-year risk of developing CRC between persons with I) a high-quality screening colonoscopy, II) a low-quality screening colonoscopy and III) without a screening colonoscopy.

Aims & Methods

Using observational data from a German claims database (GePaRD; 20% population coverage) we emulated a target trial with three arms: High-quality screening colonoscopy (highQualSC) vs. low-quality screening colonoscopy (lowQualSC) vs. no screening colonoscopy (noSC) at baseline. The quality of baseline colonoscopy was categorized based on the polyp detection rate of the examining physician. We included persons at average CRC risk aged 55–69 years and without a colonoscopy, polypectomy or fecal occult blood test before baseline. We estimated adjusted cumulative CRC incidence over 13 years of follow-up.

Results

Overall, we included 142,960 persons in the highQualSC arm, 62,338 persons in the lowQualSC arm and 124,040 persons in the noSC arm. The adjusted 13-year risk of any CRC was 1.77% in the highQualSC arm, 2.09% in the lowQualSC arm and 2.74% in the noSC arm. Compared to the noSC arm, the adjusted relative risk (aRR) was 0.76 (95% CI: 0.70-0.84) in the lowQualSC arm and 0.65 (95% CI: 0.60-0.69) in the highQualSC arm.

Conclusion

Our study demonstrated that the effect of screening colonoscopy in preventing CRC is substantially lower in persons with a low-quality as compared to a high-quality screening colonoscopy. However, it also showed that attending a low-quality screening colonoscopy still markedly reduces the risk of CRC compared to no screening colonoscopy.

Introduction

The use of artificial intelligence (AI) systems in gastrointestinal endoscopy has become increasingly common. However, these systems are typically trained using data sourced exclusively from a single type of processor, limiting their use. In addition, the availability of expertly annotated images is limited in the medical field, which reduces the variability of the data and consequently the performance of AI systems.​​​​

Aims & Methods

The objective of this study is to develop and validate a novel AI-based system (EndoStyle) capable of generating multiple endoscopic images from a single source, simulating images captured by different processors from various manufacturers (Olympus EZ1500, Olympus CV-190, Olympus CV-170, Pentax EPK-i7000, and Storz-s1). Leveraging the StarGAN-v2 architecture, our AI model was fine-tuned using 239 875 images of 5 different endoscopic processors. Data was split into 90% for training and 10% for validation. The Fréchet Inception Distance (FID) was used as a metric to assess the quality of images created by the generative model. To further evaluate the performance of the developed AI model, 10 experienced endoscopists initially visualized 28 ten-second colonoscopy sequences in the testing phase. Subsequently, they were presented with three images and tasked with identifying those taken during the same colonoscopy procedure they viewed in the video. These images comprised images from another processor modified to resemble the processor of the video sequence (EndoStyle group), images from the same video sequence (positive control group), and images from distinct processors (negative control group).​​​​

Results

EndoStyle obtained an FID score of 38.5 during the validation phase (FID < 50 is considered excellent). In the testing phase, endoscopists selected in 60.1 % (220/366) that the Endostyle group image belonged to the displayed video. The positive and negative control groups were selected in 86.8 % (243/280) and in 4.6 % (9/185), respectively. The proportion of selected images in the Endostyle group was significantly different to the proportion of the positive and negative control group (both p<0.05).​​​​

Conclusion

This study demonstrates the potential of EndoStyle to mimic the visual characteristics of different endoscopic processors. The results suggest that EndoStyle successfully replicated the visual attributes of the targeted processor, as confirmed by endoscopists’ selections. EndoStyle allows customizing the style of data to train AI models for a particular system. In addition, it could function as a data augmentation method to increase the variability, and hence the performance, of new AI models.

Introduction

The Swiss Eosinophilic Esophagitis Cohort Study (SEECS) is a national prospective cohort for adults with eosinophilic esophagitis (EoE) that was established in 2015 with the aim of improving quality of care considering EoE’s increased incidence. The SEECS allows for documentation of EoE’s natural history, patients’ quality of life (QoL) and monitoring of treatment efficacy and safety. It also aims to promote clinical and translational research projects with the availability of standard operating procedures (SOPs) for the submission of scientific protocols. The first cohort update was published in 2017. Between 2020 and 2022, paper questionnaires were gradually replaced by fully electronic data capture using Research Electronic Data Capture (REDCap) software. We aim to provide a second update of the cohort, eight years after its launch.

Aims & Methods

The SEECS includes adult patients (age ≥18 years) with EoE, gastro-esophageal reflux (GERD) and healthy controls (HC) using strict eligibility criteria in line with the most recent guidelines. Upon inclusion and follow-up (typically once a year), patients and physicians complete questionnaires in REDCap which are available in German, French, and English. Patients reported outcomes (PROs) and biologic activity are assessed all on the same day using validated instruments (EEsAI PRO for symptoms; EoE-QoL-A for QoL; EREFS for endoscopic activity; modified EoE-HSS for histologic activity). The SEECS biobank includes biosamples (blood samples, esophageal biopsies) from patients with EoE, GERD, and HC.

Results

As of July 2023, the SEECS includes 778 patients [716 (92%) with EoE, 29 (3.8%) with GERD, and 33 (4.2%) HC; 559/778 (71.9%) are male]. Mean age±SD (years) according to diagnosis is as follows: EoE 41.9±12.9, GERD 53.6±16.4, HC 51.7±17.2. Mean diagnostic delay for the EoE group is 89.6±96.2 months. Concomitant GERD is found in 200 patients (27.9%) of the EoE cohort. Concomitant allergic disorders (asthma, rhinoconjunctivitis, neurodermitis) are present in 500 patients (74.4%) with EoE. At inclusion, 694 (96.9%) of EoE patients have an ongoing treatment [orodispersible budesonide tablet: 290 patients (41.8%); budesonide/fluticasone syrup: 281 patients (40.5%); PPI: 162 patients (23.3%); elimination diets: 103 patients (14.8%); esophageal dilation at last visit: 166 patients (23.9%)]. Esophageal biopsies are available from 525/778 (67.5%) patients including 468 EoE patients (65.4%).

Conclusion

Our findings are in line with the available literature on EoE’s natural history. To our knowledge, the SEECS is the only national cohort for EoE adult patients that includes both GERD and healthy controls with their biosamples. Data capture is based on validated instruments and is fully electronic using REDCap. The SEECS offers up-to-date epidemiologic data on EoE and promotes research projects.

Disclosure

Jeanine Wakim has no relevant financial, professional, or personal relationships to disclose. Ekaterina Safroneeva reports (i) consulting fees from Avir Pharma, Inc., Aptalis Pharma, Inc., Celgene Corp., Novartis, AG, and Regeneron Pharmaceuticals Inc; (ii) being an employee of Tillotts Pharma AG. Catherine Saner has no relevant financial, professional, or personal relationships to disclose. Jean-Benoit Rossel has no relevant financial, professional, or personal relationships to disclose. Sven Trelle has no relevant financial, professional, or personal relationships to disclose. Marcel Zwahlen has no relevant financial, professional, or personal relationships to disclose. Luc Biedermann received consulting fees and/or speaker fees and/or research grants from Adare/Ellodi Pharmaceuticals, Inc., AstraZeneca, AG, Switzerland, Receptos-Celgene-BMS, Dr. Falk Pharma, GmbH, Germany, Glaxo Smith Kline, AG, Nestlé S. A., Switzerland, Novartis, AG, Switzerland, and Regeneron-Sanofi Pharmaceuticals. Andrea Kreienbuehl has no relevant financial, professional, or personal relationships to disclose. Thomas Greuter received consulting fees and/or speaker fees and/or research grants from Adare/Ellodi Pharmaceuticals, Inc., AstraZeneca, AG, Switzerland, Receptos-Celgene-BMS, Dr. Falk Pharma, GmbH, Germany, Glaxo Smith Kline, AG, Nestlé S. A., Switzerland, Novartis, AG, Switzerland, and Regeneron-Sanofi Pharmaceuticals. Philipp Schreiner received consulting fees and/or speaker fees from Dr. Falk Pharma, GmbH, Takeda, Regerenon-Sanofi Pharmaceuticals, Abbvie, Janssen-Cilag, Receptos-Celgene-BMS. Peter Netzer has no relevant financial, professional, or personal relationships to disclose. Annett Franke has no relevant financial, professional, or personal relationships to disclose. Stephan Brand has no relevant financial, professional, or personal relationships to disclose. Chantal Hasler has no relevant financial, professional, or personal relationships to disclose. Patrick Aepli has no relevant financial, professional, or personal relationships to disclose. Emanuel Burri has no relevant financial, professional, or personal relationships to disclose. Achim Weber has no relevant financial, professional, or personal relationships to disclose. Christine Sempoux has no relevant financial, professional, or personal relationships to disclose. Ruggero Biral has no relevant financial, professional, or personal relationships to disclose. Wolfram Jochum has no relevant financial, professional, or personal relationships to disclose. Joachim Diebold has no relevant financial, professional, or personal relationships to disclose. Niels Willi has no relevant financial, professional, or personal relationships to disclose. Alex Straumann received consulting fees and/or speaker fees and/or research grants from Adare/Ellodi Pharmaceuticals, Inc., AstraZeneca, AG, Switzerland, Receptos-Celgene-BMS, Dr. Falk Pharma, GmbH, Germany, Glaxo Smith Kline, AG, Nestlé S. A., Switzerland, Novartis, AG, Switzerland, and Regeneron-Sanofi Pharmaceuticals. Alain Schoepfer received consulting fees and/or speaker fees and/or research grants from Adare/Ellodi Pharmaceuticals, Inc., AstraZeneca, AG, Switzerland, Receptos-Celgene-BMS, Dr. Falk Pharma, GmbH, Germany, Glaxo Smith Kline, AG, Nestlé S. A., Switzerland, Novartis, AG, Switzerland, and Regeneron-Sanofi Pharmaceuticals.

Introduction

Use of antithrombotics including antiplatelet agents and anticoagulants is associated with upper and lower GI bleeding, thus a higher rate of positive findings is reasonable to be expected when patients receiving these drugs undergo SBCE for the investigation of SBB. However, the results of published studies concerning the impact of antithrombotics on the SBCE diagnostic yield remain conflicting. Furthermore, the clinical outcome of patients under antithrombotics who undergo SBCE for the investigation of SBB is not currently known.

Aims & Methods

We aimed to determine the diagnostic yield and outcome of patients receiving antithrombotic drug therapy subjected to small bowel capsule endoscopy (SBCE) for the investigation of small bowel bleeding (SBB). Multicenter retrospective analysis of collected data from all patients undergoing SBCE for the investigation of SBB from March 2003 to June 2023. The diagnostic yield of SBCE was defined as the detection of positive findings that could explain the cause of the patient’s bleeding. Rebleeding was defined as evidence of bleeding within 1 year after the index episode.

Results

During the study period, 8401 patients underwent SBCE for SBB investigation. Bleeding lesions were detected in 1103/2535 (43.5%) patients receiving antithrombotics, compared to 1113/5866 (18.9%) not receiving these drugs (p<0.00001). Following capsule endoscopy, a therapeutic intervention was possible in 390/2216 (17.5%) patients with a bleeding lesion. Rebleeding occured in 927 (36.5%) of patients receiving antithrombotics (36.5%), compared to 795 (13.5%) not receiving these drugs (13.5%, p<0.00001).

Conclusion

Both the diagnostic yield of SBCE and the rebleeding rate were higher in patients with SBB receiving antithrombotics. Therapeutic intervention was possible in a real world setting only in a minority of patients with positive findings.

References

1. Sherwood MW, Nessel CC, Hellkamp AS, et al. Gastrointestinal bleeding in patients with atrial fibrillation treated with rivaroxaban or warfarin: ROCKET AF trial. J Am Coll Cardiol 2015; 66: 2271–2281.
2. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of PPI and thienopyridines: focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Am J Gastroenterol 2010; 105:2533–2549.
3. Maiden L, Thjodleifsson B, Seigal A, et al. Long-term effects of nonsteroidal anti-infammatory drugs and cyclooxygenase-2 selective agents on the small bowel: a cross-sectional capsule enteroscopy study. Clin Gastroenterol Hepatol. 2007;5:1040–1045.
4. Nagata N, Niikura R, Yamada A, et al. Acute middle gastrointestinal bleeding risk associated with NSAIDs, antithrombotic drugs, and PPIs: a multicenter case-control study. PLoS ONE. 2016;11:e0151332.
5. Lepileur L, Dray X, Antonietti M, et al. Factors associated with diagnosis of obscure gastrointestinal bleeding by video capsule enteroscopy. Clin Gastroenterol Hepatol. 2012;10:1376–1380.
6. Shiotani A, Honda K, Murao T, et al. Combination of low-dose aspirin and thienopyridine exacerbates small bowel injury. Scand J Gastroenterol. 2011;46:281–286.

Introduction

The advent of new therapeutic agents might change the management of acute severe ulcerative colitis (ASUC) by reducing the risk of colectomy and thereby changing the natural history of the disease. Thus, the effectiveness and safety of sequential treatment should be elucidated in patients admitted for ASUC. The main aim was to evaluate colectomy-free survival in patients with ASUC refractory to intravenous corticosteroids who failed to infliximab (IFX) or ciclosporin (CyA) and received a second-line (2L) therapy. The secondary aims were to evaluate the short- and long-term effectiveness and to assess the safety of this strategy.

Aims & Methods

Multicentre study of patients admitted with ASUC refractory to corticosteroids who received a 2L therapy after failing either CyA or IFX during the same hospitalisation. Clinical activity was classified based on partial Mayo score and Lichtiger activity index. Patients who stopped the 2L therapy due to disease activity or adverse events were considered failures. Patients were followed-up until colectomy or one year after 2L initiation. Predictors of short-term colectomy-free survival were assessed by logistic regression analysis, while long-term was evaluated by Kaplan-Meier curves and Cox regression models.

Results

A total of 78 patients from 24 European centres were included. As first-line therapy (after failing corticosteroids), IFX was administered to 32 patients, and CyA to 46. The median age at hospital admission was 35 years (IQR 26-47), and 42 (54%) were men. The prescribed therapy after IFX failure was: CyA in 17, tofacitinib in 13, and ustekinumab (UST) in two patients. After CyA failure, IFX was prescribed in 45 patients, and UST in one. At last study visit, 26 patients (33%) were still under the 2L therapy (IFX in 15, CyA in two, tofacitinib in two, and UST in one).

A total of 29 patients (37%) underwent colectomy during the follow-up; the majority of them (93%) within the first eight weeks. Median time to colectomy after starting the 2L therapy was 14 days (IQR 3-23). The main indication of colectomy was primary non-response in 23 patient (79%). In multivariate analysis, older age at hospital admission (OR 1.1, 95%CI 1.0-1.1), the use of CyA as rescue therapy (OR 8.0, 95%CI 1.3-48), and severe disease (vs. moderate) before the rescue therapy initiation (OR 8.7, 95%CI: 2.0-38) were associated with the likelihood of colectomy.
A total of 31 patients (44%) at week 12 and 18 (30%) at week 52 achieved clinical remission under the 2L therapy; 39 patients (55%) at week 12 and 20 patients (33%) at week 52 reached clinical response (including remission). Corticosteroid-free clinical remission was maintained in 26% and 19% of patients at week 12 and at week 52, respectively. Clinical relapse was observed in 43 patients (55%); of them, six patients (14%) intensified the therapy and five (83%) regained response.
25 patients (32%) had adverse events (AE); 14 had serious AE. Resolution with no sequelae was observed in 20 patients (80%). Infections were the most frequent AE, reported in 12 patients (15%), followed by infusion reactions in five (6%). No differences in AEs between the 2L therapies prescribed were observed. There were two deaths: one due to cerebral thrombophlebitis and another due to bacteriemia after colectomy, both when CyA was the therapy prescribed.

Conclusion

A 2L salvage therapy avoids colectomy in a considerable percentage of patients admitted by ASUC and therefore it can be considered after IFX or CyA failure. The individual therapeutic approach must be discussed with patients due to the risk of serious AE

Disclosure

M.J. García has received financial support for travelling and educational activities from Janssen, Pfizer, AbbVie, Takeda, Kern Pharma, Faes Farma and Ferring.
S.Riestra has served as speaker, consultant, and advisory member for or has received research funding from MSD, AbbVie, Takeda, Janssen, Pfizer, Mylan, Biogen, Kern Pharma, Ferring and Faes Farma.
A. Amiot has received consulting fees from Abbvie, Tillotts pharma, Janssen, Hospira, Takeda, Fresenius Kabi, Pfizer and Gilead as well as lecture fees and travel accommodations from Abbvie, Janssen, Biocodex, Hospira, Ferring, Biogen, Tillotts pharma, Fresenius Kabi, Takeda and MSD.
M. Julsgaard has received research grants for other investigator-driven studies from Takeda, has received consultation fee from Ferring and Takeda, and has received speaker's fees from MSD, Ferring, and Takeda.
M. Calafat has served as a speaker or has received educational or advisory fees from Takeda, Janssen, Faes Farma, Ferring, Galapagos, Gilead and MSD.
M.J. Casanova has received education funding from Pfizer, Takeda, Janssen, MSD, Ferring and Abbvie.
E.Savarino has served as speaker for AbbVie, AGPharma, Alfasigma, EG Stada Group, Fresenius Kabi, Grifols, Janssen, Innovamedica, Malesci, Medtronic, Novartis, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda and Unifarco; has served as consultant for Alfasigma, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Falk, Fresenius Kabi, Janssen, Merck & Co., Reckitt Benckiser, Regeneron, Sanofi, Shire, SILA, Sofar, Synformulas GmbH, Takeda and Unifarco; and has received research support from Reckitt Benckiser, SILA, Sofar and Unifarco. "Grants or contracts from any entity AbbVie, Janssen, Kern, Takeda, Galapagos, Pfizer Consulting fees: Janssen. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, AbbVie, Janssen, Takeda, Pfizer. Support for attending meetings and/or travelFerring, Janssen. Educational activities research projects scientific meetings or advisory boards sponsored by MSD, Ferring, Abbvie.
T. Raine has received research/educational grants and/or speaker/consultation fees from Abbvie, Arena, Aslan, AstraZeneca, Boehringer-Ingelheim, BMS, Celgene, Ferring, Galapagos, Gilead, GSK, Heptares, LabGenius, Janssen, Mylan, MSD, Novartis, Pfizer, Sandoz, Takeda and UCB and has received speaker's fees from Tillots.
J. P. Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from MSD, AbbVie, Pfizer, Kern Pharma, Biogen, Mylan, Takeda, Janssen, Roche, Sandoz, Celgene, Gilead, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, and Vifor Pharma.
M. Chaparro has served as a speaker, as consultant or has received research or education funding from MSD, AbbVie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Biogen, Gilead and Lilly.

Introduction

Faecal calprotectin (FC) is of value in differentiating Inflammatory Bowel Disease (IBD) from other causes of lower gastrointestinal (GI) symptoms and is recommended in national guidance. This study aims to examine its role and factors associated with faecal calprotectin requesting in primary care.

Aims & Methods

Retrospective open cohort study using Clinical Practice Research Datalink (CPRD Aurum) of adults aged over 18 years with lower GI symptoms between 2015 and 2019. FC requested 30 days before to 3 months after a lower GI symptom record in primary care were included. Logistic regression analysis explored patient level factors associated with FC testing. Referral pathways and outcomes (IBD diagnoses) of patients with and without FC testing were also examined.

Results

Of 741,190 symptomatic patients, only 18,320 (2.5%) had FC requested in primary care: median age 38.3 (IQR 28.9-50.7); 51.4% female. The rate of FC requesting in symptomatic patients increased from 0.02% in 2010 to 4.4% in 2019 (p=0.001).
FC value of <50 ug/g and 50-200 ug/g were predominantly seen in patients with abdominal pain (42.1% and 37.9% respectively), while FC > 200 ug/g was predominantly seen in patients with diarrhoea (45.3%). Factors associated with FC requesting included: increasing age (>70 years adjusted Odds Ratio 0.16 (95% CI 0.15-0.18)); female (0.89 (0.86-0.92); Black (0.61(0.56-0.66) or Asian (0.75 (0.70-0.80) ethnicity; obesity (0.89(0.85-0.93); lower socioeconomic status (0.91(0.86-0.98); comorbidity score >2 (0.73(0.68-0.79); current smoking (0.89(0.85-0.92)); change in bowel habit (7.31(6.90-7.75), rectal bleeding (2.04(1.95-2.13) or diarrhoea (2.88(2.78-2.99) compared to abdominal pain; and ex-smokers (1.06(1.03-1.11).
IBD was diagnosed in 21.5% of patients referred with a FC >200 ug/g, but only 2.9% of referred patients with a FC 50-200 ug/g. The only patients with a significant risk of IBD with FC 50-200ug/g were patients with rectal bleeding (8%), with the risk in all other patients only 1.7%. 27.8% patients with a normal FC test result were still referred to secondary care, of which only 0.4% had IBD.

Conclusion

Despite an increase in FC requests in recent years, only 4.4% of patients with relevant lower GI symptoms had an FC requested in primary care as recommended. Despite a negative FC test, a third of patients were still referred to secondary care, with very few diagnosed with IBD . Patients with an FC between 50 ug/g and 200 ug/g without rectal bleeding have a low risk of IBD and can be safety netted in primary care.