Telephone straight-to-test strategy improves early diagnosis of IBD

SAN DIEGO — The telephone straight-to-test approach shortened the length of time from primary care referral to diagnosis of inflammatory bowel disease, according to a study presented at Digestive Disease Week.

“An early diagnosis [of IBD] has a positive impact on the disease,” Hein Myat Thu Htet, MD, gastroenterology trainee at Whipps Cross Hospital, Barts Health NHS Trust, in England, said during his presentation. “Early diagnosis enables us to arrange for early intervention to reduce bowel damage and prevent the risk of progression and complications, such as strictures.”

However, “the average time to reach a diagnosis is about 9 months in Crohn’s disease and about 4 months in ulcerative colitis,” he added.

Htet and colleagues conducted a study to determine if the telephone straight-to-test method can help diminish the time it takes to diagnose IBD. The telephone straight-to-test approach involved the examination of referrals of primary care patients with lower gastrointestinal complications; routine referrals were defined as an 18-week wait and urgent referrals were considered a 2-week wait. The examinations were prioritized by data provided on referral letters and through patient history reported during evaluations over the telephone. Endoscopic evaluations were accelerated if patients had traits characteristic of IBD, including family history, elevated fecal calprotectin and weight loss.

Over the 4-year study duration, 1,757 patients were referred by primary care physicians for assessment. A total of 78 patients (4.4%) had positive results on sigmoidoscopy or colonoscopy, including inflammation or ulcers believed to be IBD-related. A diagnosis of IBD was confirmed in 47 of those patients; 24 (51%) presenting as UC, 12 (25.5%) as Crohn’s disease and 11 (23.5%) as indeterminate colitis. The other patients were diagnosed with drug-induced, infective, bowel preparation-related or diverticular-related colitis.

Overall, the average duration from referral to diagnosis was 37 days. The mean time to diagnosis was 32.4 days in patients with Crohn’s disease and 41.5 days in those with UC. Patients with an urgent referral had a significantly shorter time to diagnosis than those with a routine referral (25.2 days vs. 45.7 days; P = .004).

“Our telephone straight-to-test pathway shows a very significant improvement in diagnosing IBD for those patients who present with lower GI symptoms, especially to primary care physicians,” Htet concluded. “Early diagnosis is key in having a positive outcome.” – by Alaina Tedesco

Reference:

Htet HMT, et al. Abstract 112. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Htet reports no relevant financial disclosures. Please see the abstract for all other author’s relevant financial disclosures.