Quality improvement project identifies factors associated with delay in IBD diagnosis.
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
29
01
2020
revised:
23
02
2020
accepted:
24
05
2020
pubmed:
24
6
2020
medline:
18
11
2020
entrez:
24
6
2020
Statut:
ppublish
Résumé
Delay in the diagnosis of inflammatory bowel disease (IBD) is common and contemporary UK studies are lacking. To determine factors associated with, and the consequences of, a prolonged time to diagnosis in IBD. This quality improvement study included 304 adults with a new IBD diagnosis made between January 2014 and December 2017 across 49 general practices (GP) and gastroenterology secondary care services. Outcome measures were demographic, clinical and laboratory factors associated with a delayed time, defined as greater than upper quartile, to: (a) patient presentation (b) GP referral (c) secondary care diagnosis, and factors associated with a complicated disease course (hospitalisation and/or surgery and/or biologic treatment) in the year after diagnosis. The median [IQR] diagnosis sub-intervals were: (a) patient = 2.1 months [0.9-5.1]; (b) GP = 0.3 months [0.0-0.9]; (c) secondary care = 1.1 months [0.5-2.1]. 50% of patients were diagnosed within 4 months and 92% were diagnosed within 2 years of symptom onset. Diagnostic delay was more common in Crohn's disease (7.6 months [3.1-15.0]) than ulcerative colitis (3.3 months [1.9-7.3]) (P < 0.001). Patients who presented as an emergency (P < 0.001) but not those with a delayed overall time to diagnosis (P = 0.35) were more likely to have a complicated disease course. Time to patient presentation is the largest component of time to IBD diagnosis. Emergency presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.
Sections du résumé
BACKGROUND
Delay in the diagnosis of inflammatory bowel disease (IBD) is common and contemporary UK studies are lacking.
AIM
To determine factors associated with, and the consequences of, a prolonged time to diagnosis in IBD.
METHODS
This quality improvement study included 304 adults with a new IBD diagnosis made between January 2014 and December 2017 across 49 general practices (GP) and gastroenterology secondary care services. Outcome measures were demographic, clinical and laboratory factors associated with a delayed time, defined as greater than upper quartile, to: (a) patient presentation (b) GP referral (c) secondary care diagnosis, and factors associated with a complicated disease course (hospitalisation and/or surgery and/or biologic treatment) in the year after diagnosis.
RESULTS
The median [IQR] diagnosis sub-intervals were: (a) patient = 2.1 months [0.9-5.1]; (b) GP = 0.3 months [0.0-0.9]; (c) secondary care = 1.1 months [0.5-2.1]. 50% of patients were diagnosed within 4 months and 92% were diagnosed within 2 years of symptom onset. Diagnostic delay was more common in Crohn's disease (7.6 months [3.1-15.0]) than ulcerative colitis (3.3 months [1.9-7.3]) (P < 0.001). Patients who presented as an emergency (P < 0.001) but not those with a delayed overall time to diagnosis (P = 0.35) were more likely to have a complicated disease course.
CONCLUSION
Time to patient presentation is the largest component of time to IBD diagnosis. Emergency presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
471-480Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Brown JSS, Humphreys WGG, Parks TGG. Some clinical aspects of Crohn’s disease in Northern Ireland: an aid to earlier diagnosis? J R Coll Gen Pract. 1988;38:549-551.
Vavricka SR, Spigaglia SM, Rogler G, et al. Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:496-505.
Nahon S, Lahmek P, Lesgourgues B, et al. Diagnostic delay in a French cohort of Crohn’s disease patients. J Crohn’s Colitis. 2014;8:964-969.
Burisch J, Katsanos KH, Christodoulou DK, et al. Natural disease course of ulcerative colitis during the first five years of follow-up in a European population-based inception cohort - an Epi-IBD study. J Crohn’s Colitis. 2019;13:198-208.
Burisch J, Pedersen N, Čuković-Čavka S, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut. 2014;63:588-597.
Schreiber S, Colombel J-F, Bloomfield R, et al. Increased response and remission rates in short-duration crohn’s disease with subcutaneous certolizumab pegol: an analysis of PRECiSE 2 randomized maintenance trial data. Am J Gastroenterol. 2010;105:1574-1582.
Colombel J-F, Reinisch W, Mantzaris GJ, et al. Randomised clinical trial: deep remission in biologic and immunomodulator naïve patients with Crohn’s disease - a SONIC post hoc analysis. Aliment Pharmacol Ther. 2015;41:734-746.
Schreiber S, Reinisch W, Colombel JF, et al. Subgroup analysis of the placebo-controlled CHARM trial: Increased remission rates through 3years for adalimumab-treated patients with early Crohn’s disease. J Crohn’s Colitis. 2013;7:213-221.
Safroneeva E, Vavricka SR, Fournier N, et al. Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn’s disease. Aliment Pharmacol Ther. 2015;42:977-989.
Lee D-W, Koo JS, Choe JW, et al. Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery. World J Gastroenterol. 2017;23:6474-6481.
Ghosh S, Mitchell R. Impact of inflammatory bowel disease on quality of life: results of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) patient survey. J Crohn’s Colitis. 2007;1:10-20.
Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46:78-82.
Holtedahl K, Vedsted P, Borgquist L, et al. Abdominal symptoms in general practice: frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer. Heliyon. 2017;3:e00328.
Stapley SA, Rubin GP, Alsina D, Shephard EA, Rutter MD, Hamilton WT. Clinical features of bowel disease in patients aged <50 years in primary care: a large case-control study. Br J Gen Pract. 2017;67:e336-e344.
Jellema P, van der Windt DAWM, Schellevis FG, van der Horst HE. Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care. Aliment Pharmacol Ther. 2009;30:695-706.
Black TP, Manolakis CS, Di Palma JA. “Red flag” evaluation yield in irritable bowel syndrome. J Gastrointest Liver Dis. 2012;21:153-156.
Referral Support in Devon - Northern, Eastern and Western Devon Clinical Commissioning Group [Internet]. [cited 2019 Jun 15]. https://www.newdevonccg.nhs.uk/information-for-patients/devon-referral-support-services-your-right-to-choose-100178
Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohn’s Colitis. 2019;13:144-164.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(suppl a):5A-36A.
MHCLG. English Indices of Deprivation 2015 - LSOA Level [Internet]. 2015 [cited 2019 Jun 15]. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015
NHS Health Research Authority.Is my study research? [Internet]. [cited 2017 Dec 22]. http://www.hra-decisiontools.org.uk/research/index.html
Nguyen VQ, Jiang D, Hoffman SN, et al. Impact of diagnostic delay and associated factors on clinical outcomes in a U.S. inflammatory bowel disease cohort. Inflamm Bowel Dis. 2017;23:1825-1831.
Cantoro L, Di Sabatino A, Papi C, et al. The time course of diagnostic delay in inflammatory bowel disease over the last sixty years: an Italian multicentre study. J Crohn’s Colitis. 2017;11:975-980.
Van den Houte K, Carbone F, Pannemans J, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United Eur Gastroenterol J. 2019;7(2):307-315.
Card TR, Siffledeen J, Fleming KM. Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome? Report of a case-control study in the general practice research database. United Eur Gastroenterol J. 2014;2(6):505-512.
Goodhand JR, Kamperidis N, Joshi NM, et al. The phenotype and course of inflammatory bowel disease in UK patients of Bangladeshi descent. Aliment Pharmacol Ther. 2012;35:929-940.
IBD organisational audit - Adult report - round four 2014 | RCP London [Internet]. 2014 [cited 2019 Jun 16]. https://www.rcplondon.ac.uk/projects/outputs/ibd-organisational-audit-adult-report-round-four-2014
Quarterly performance of the NHS provider sector: quarter 3 2018/19 | NHS Improvement [Internet]. [cited 2019 Jun 16]. https://improvement.nhs.uk/resources/quarterly-performance-nhs-provider-sector-quarter-3-201819/
Walker GJ, Moore L, Heerasing N, et al. Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study. Aliment Pharmacol Ther. 2018;47:1103-1116.
Angelberger S, Vogelsang H, Novacek G, et al. Public awareness of Crohn’s disease and ulcerative colitis: a national survey. J Crohn’s Colitis. 2009;3:157-161.
Bethune R, Marshall MJ, Mitchell SJ, et al. Did the “be clear on bowel cancer” public awareness campaign pilot result in a higher rate of cancer detection? Postgrad Med J. 2013;89:390-393.
Hall SJ, Peacock JDH, Cochrane LA, et al. The bowel cancer awareness campaign “be clear on cancer”: sustained increased pressure on resources and over-accessed by higher social grades with no increase in cancer detected. Color Dis. 2016;18:195-199.