Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery

Lee, Jun Young; Koo, Ja Seol; Choe, Jung Wan; Suh, Sang Jun; Kim, Seung Young; Hyun, Jong Jin; Jung, Sung Woo; Jung, Young Kul; Yim, Hyung Joon; Lee, Sang Woo

doi:10.3748/wjg.v23.i35.6474

Cited by 90 publications

(96 citation statements)

References 23 publications

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“…For 6/8 patients with IBD-colitis, first f-Hb concentration was >10 mg Hb/g and this is in accordance with a primary care study reporting the majority of IBD patients are identifiable by FIT [20]. The consequences of diagnostic delay in IBD are far less serious than for CRC, even though it may be associated with an increased risk of surgery [21]. But efforts to avoid false negative results are obviously vital and this may involve a search for any other factor common factor in CRC patients with low f-Hb concentrations.…”

Section: Discussionsupporting

confidence: 86%

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Tsapournas

Hellström

Cao

et al. 2020

Scandinavian Journal of Gastroenterology

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Objective: Determine diagnostic accuracy of a quantitative faecal immunochemical haemoglobin test (QuikRead go V R FIT, Orion Diagnostica Oy) in symptomatic patients referred for colonoscopy, at various cutoffs and for one or two tests. Methods: Patients referred to four endoscopy units in mid-Sweden between 2013 and 2017 provided information on lower abdominal symptoms and faecal samples from two separate days prior to colonoscopy. Results: In all, 5.4% (13/242) patients had colorectal cancer (CRC). For one FIT at cutoff 10 mg Hb/g faeces, sensitivity for CRC was 92% (95% CI 78-100%) and specificity 77% (95% CI 72-83%); equal to 74%; 95% CI 68-80 (178/242) colonoscopies potentially avoidable and one CRC missed. Based on the maximal outcome of two FITs, sensitivity was 100%, specificity 71% (66-77%) and 68%; 95% CI 62-74 (160/237) colonoscopies potentially avoidable. Among 17% (42/242) patients with one FIT of >200 mg Hb/g faeces, 85% (11/13) had CRC. Positive predictive values of FIT varied 16.9-26.2% depending on cutoff and one or two FITs, whereas NPVs were 99% and above in all scenarios. In 60 patients reporting rectal bleeding, one FIT at cutoff 10 mg Hb/g discriminated well between CRC and other conditions (p ¼ .001). In regression models, FIT was more important than age, sex and all symptoms. Conclusion: One or two FITs in symptomatic patients referred for colonoscopy imply powerful risk stratification abilities for CRC, even among patients reporting rectal bleeding. Larger studies in various settings will clarify how to make the best use of this opportunity.

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Section: Discussionsupporting

confidence: 86%

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Tsapournas

Hellström

Cao

et al. 2020

Scandinavian Journal of Gastroenterology

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“…3 In IBD, delays in diagnosis and therapy can have serious consequences including the need for emergency surgery. 4 Patients are understandably concerned about the impact of their IBD and its treatment on their risk of severe COVID-19 disease. However, it is important that IBD patients continue to attend for inpatient, day case and outpatient hospital care for the management of active disease and complications and for therapies such as intravenous biologics.…”

Section: What This Study Addsmentioning

confidence: 99%

Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

Kennedy

Hansen

Younge

et al. 2020

Frontline Gastroenterol

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ObjectiveTo determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.MethodsInternet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020.ResultsRespondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4–7.5 and median 3, IQR 2–4) to the point of survey (median 2, IQR 1–4.8 and median 2, IQR 1–3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery.ConclusionsIBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

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“…In a recent study, the median duration from the first IBD symptoms to diagnosis was 6.2 and 2.4 months in patients with CD and UC, respectively. However, 25% of the study population had longer diagnosis time intervals of more than 21 and 6 months, respectively, from the presentation of initial symptoms [18]. The diagnostic delay was associated with increased risk of surgery related to IBD.…”

Section: Discussionmentioning

confidence: 95%

Anemia is associated with the risk of Crohn’s disease, not ulcerative colitis: A nationwide population-based cohort study

Kang

Chun

et al. 2020

PLoS ONE

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Anemia is a common manifestation of inflammatory bowel disease (IBD), but it remains unclear whether anemia is associated with the development of IBD. We assessed the risk of developing IBD in anemic patients, and stratified the results with respect to their hemoglobin concentrations. A population-based study was conducted using the National Healthcare Insurance Service database in South Korea. We included individuals over 20 years' old who participated in the national health screening program in 2009 (n = 9,962,064). Anemia was defined as a hemoglobin level less than 13 g/dL in men and less than 12 g/dL in women. We compared the rate of newly diagnosed IBD in anemic patients and non-anemic individuals. Newly diagnosed IBD was identified using both the ICD-10 medical code and specialized V codes for rare intractable diseases in South Korea. During the mean follow-up period of 7.3 years, the incidences of CD and UC in anemic patients were 2.89 and 6.88 per 100,000 person-years, respectively. The risk of CD was significantly higher in anemic patients than in non-anemic individuals [adjusted hazard ratio (aHR), 2.084; 95% confidence interval (CI), 1.769-2.455]. The risk of CD development was inversely proportional to the hemoglobin concentration. A J-curve relationship was observed between age and the risk of CD in anemic patients. The risk of CD in male anemic patients was significantly higher than that in female anemic patients (aHR, 1.432 vs. 1.240, respectively). By contrast, there was no statistically significant difference in the risk of developing UC in anemic and non-anemic individuals (aHR, 0.972; 95% CI, 0.880-1.073). This work indicates that anemia is related to the development of CD, and this risk was inversely proportional to the hemoglobin concentration.

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Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery

Cited by 90 publications

References 23 publications

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

Anemia is associated with the risk of Crohn’s disease, not ulcerative colitis: A nationwide population-based cohort study

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