Subclinical bowel inflammation increases healthcare resources utilization and steroid use before diagnosis of inflammatory bowel disease

Abstract

Background: Previous data support that the inflammatory process underlying ulcerative colitis (UC) and Crohn's disease (CD) can start years before the diagnosis. The aim of this study was to determine if patients with an incidental diagnosis of UC or CD demonstrate an increase in healthcare utilization in the years preceding the symptomatic onset of the disease. Methods: We performed a multicenter, retrospective, hospital-based, case-control study. Patients with an incidental diagnosis of UC or CD during the colorectal cancer screening program at 9 hospitals were included. Cases were matched 1:3 and compared separately with two control populations: one including healthy non-IBD José Luis Cabriada and Manuel Barreiro-de Acosta authors share last authorship.

Transmural cross-sectional findings and bowel damage assessment in preclinical Crohn’s disease: a case-control study

“…Recent data have shown that this pre-disease phase is also associated with a range of altered circulating markers (anti-microbial antibodies [ 25 ], anti-GM-CSF [ 26 ], anti-integrin αvβ6 [ 27 ]), serum protein signatures [ 28 – 30 ], fecal markers [ 31 ], increased intestinal permeability [ 32 ], proteinuria [ 33 ], and dysregulated cellular pathways [ 28 ]. In addition, subclinical disease leads to increased healthcare resource utilization and costs, especially related to Primary Care, with more prescriptions of steroids during this period [ 11 , 34 , 35 ]. Hence, it is now clear that the subclinical inflammatory process prior to disease onset has an impact on different aspects, and it is now better characterized.…”

“…The Basque colorectal cancer screening program invites all persons between 50 and 69 years to perform a fecal immunochemical test, followed by a complete colonoscopy in those with a positive result (cut-off 20 µg Hb/g). In this study, we included all patients with a combination of clinical, endoscopic, and histologic data, requiring the presence of chronic infiltrate and absence of any enteropathogen or alternative diagnosis, all of them suggesting a diagnosis of CD [ 18 , 19 ] and following the same criteria as in our previous reports [ 8 , 9 , 11 ]. The screening program refers all subjects with abnormal findings suggestive of inflammatory bowel disease to the Gastroenterology clinic, where alternative diagnosis is systematically ruled out.…”

“…The detection of mucosal abnormalities in otherwise healthy subjects, particularly in the context of colorectal cancer screening programs, has also unveiled a new subgroup of patients where subclinical lesions could be better characterized [ 8 – 10 ]. The prevalence of these findings within population-based screening programs is approximately 0.35% [ 8 ], and up to 58% will develop symptomatic disease after a median of 7 years [ 11 ].…”

Environmental Exposure to Trace Elements and Heavy Metals Preceding the Clinical Onset of Inflammatory Bowel Disease

“…In this study, we included all patients with a combination of clinical, endoscopic, and histologic data, requiring the presence of chronic infiltrate and absence of any enteropathogen or alternative diagnosis, all of them suggesting a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) and following the same criteria as in previous reports from this cohort. 6 , 7 A sample containing 0.25 grams from the scalp were collected from each individual with a recent (<2 months) diagnosis of preclinical IBD. Patients receiving regular non-steroidal anti-inflammatory drugs were excluded.…”

Letter: fulminant onset complicated inflammatory bowel disease (IBD) – a unique subtype? Authors' reply

“…Previous studies have reported a small proportion of individuals who undergo routine bowel cancer screening colonoscopy with little or no symptomatology and are incidentally diagnosed with IBD. 5 This suggests the converse may also be true, where a subgroup of patients with an indolent disease phenotype present after having experienced a longer duration of mild symptoms.…”