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Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study

Blackwell, J; Saxena, S; Jayasooriya, N; Bottle, A; Petersen, I; Hotopf, M; Alexakis, C; Pollok, RCG; POP-IBD study group (2021) Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study. Journal of Crohns & Colitis, 15 (2). pp. 203-211. ISSN 1873-9946 https://doi.org/10.1093/ecco-jcc/jjaa146
SGUL Authors: Pollok, Richard Charles G

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Abstract

Background and Aims Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD). Aims To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s Disease (CD) and ulcerative colitis (UC). Methods Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016. Results We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98). Conclusions There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Crohn's and Colitis following peer review. The version of record J Blackwell, S Saxena, N Jayasooriya, A Bottle, I Petersen, M Hotopf, C Alexakis, R C Pollok, POP-IBD study group, Prevalence and Duration of Gastrointestinal Symptoms Before Diagnosis of Inflammatory Bowel Disease and Predictors of Timely Specialist Review: A Population-Based Study, Journal of Crohn's and Colitis, Volume 15, Issue 2, February 2021, Pages 203–211 is available online at: https://doi.org/10.1093/ecco-jcc/jjaa146
Keywords: Gastroenterology & Hepatology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Journal of Crohns & Colitis
ISSN: 1873-9946
Dates:
DateEvent
February 2021Published
15 July 2020Published Online
24 June 2020Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
SP2018/3Crohn's and Colitis UKhttp://dx.doi.org/10.13039/501100003522
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100004440
URI: https://openaccess.sgul.ac.uk/id/eprint/112110
Publisher's version: https://doi.org/10.1093/ecco-jcc/jjaa146

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