P148 Subclinical inflammatory bowel disease precedes the diagnosis and leads to an increase on healthcare resources utilization: multicentric case-control study in the Basque Country
Rodríguez-Lago, I.(1);Aguirre, U.(2);Ramírez de la Piscina, P.(3);Muñagorri, A.(4);Zapata, E.(5);Higuera, R.(6);Montalvo, I.(7);Iriarte, A.(8);Fernández-Calderón, M.(9);Arreba, P.(10);Carrascosa, J.(11);Cabriada, J.L.(1);Barreiro-de Acosta, M.(12);
(1)Hospital Universitario de Galdakao, Gastroenterology, Galdakao, Spain;(2)Hospital Universitario de Galdakao. Research Network on Chronic Disease REDISSEC, Research Unit, Galdakao, Spain;(3)Hospital Universitario Araba, Gastroenterology, Vitoria, Spain;(4)Hospital Universitario Donostia, Gastroenterology, Donostia, Spain;(5)Hospital de Mendaro, Gastroenterology, Mendaro, Spain;(6)Hospital San Eloy, Gastroenterology, Barakaldo, Spain;(7)Onkologikoa, Gastroenterology, Donostia, Spain;(8)Hospital de Bidasoa, Gastroenterology, Hondarribia, Spain;(9)Hospital de Mondragón, Gastroenterology, Mondragón, Spain;(10)Hospital Universitario de Basurto, Gastroenterology, Bilbao, Spain;(11)Hospital de Zumárraga, Gastroenterology, Zumárraga, Spain;(12)Hospital Clínico Universitario de Santiago, Gastroenterology, Santiago de Compostela, Spain;
Background
The inflammatory process associated to ulcerative colitis (UC) and Crohn’s disease (CD) starts before the onset of symptoms and the diagnosis, but this period has not yet been well defined. Our aim was to determine if patients with an incidental diagnosis of UC or CD have an increase in healthcare utilization in the years preceding the symptomatic onset of the disease.
Methods
All asymptomatic patients with a diagnosis of UC or CD during the colorectal cancer screening program between October 2010-January 2021 were included in this multicentric retrospective case-control study. Cases were matched 1:3 with controls adjusted by sex, age and date, excluding subjects with any visit to Gastroenterology. The main outcomes were the number of outpatient or Emergency Rooms visits, admissions, radiological examinations (US, CT, MRI), sick-leaves, and drug prescriptions (antibiotics, systemic steroids) up to 5 years before the diagnosis. Descriptive statistics were used, with chi-square tests and a multivariable hurdle or negative binomial regression model, adjusted by smoking habits and Charlson index.
Results
A total of 124 patients were included (87 UC, 30 CD, 7 IBD-U; median 56 years (IQR, 53-62); 56% male), compared with 372 controls. Baseline characteristics including comorbidities were balanced between both cohorts. Patients demonstrated an increase in the number of visits to Primary Care physician during both 3 and 5 years before the diagnosis, but there were no differences in the remaining outcomes including hospital admissions, Emergency Room or outpatients visits, and sick-leaves (Figure 1 and 2). Systemic steroids were more frequently prescribed to patients in the preceding 3 to 5 years before diagnosis. Patients underwent US and/or CT scan less frequently in the preceding 5-year period.
Conclusion
Patients with IBD show an increased need of medical assistance in the years prior to the diagnosis, even during the presymptomatic phase of the disease. Tools focused on early identification of IBD may start on Primary Care facilities, but certain factors as steroids may alter the development of symptoms and the full spectrum of the disease.