P143. Incidental diagnosis of inflammatory bowel disease in a British bowel cancer screening cohort
R.O. Butcher1, L.E. Loo1, A.M. Abbasi1, R. George1, R.C. Prudham1, J.K. Limdi1
1Pennine Acute Hospitals NHS Trust, Gastroenterology, Manchester, United Kingdom
Background: The UK Bowel Cancer Screening Programme (BCSP) was launched in 2006 and rolled out in successive waves now covering the entire population of England and Wales. It screens individuals aged 6069 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. Our study aimed to quantify the incidental diagnosis of Inflammatory Bowel Disease (IBD) through this programme and characterise patient outcome in this cohort.
Methods: We conducted a retrospective review of BCSP outcomes at our Centre from its launch in April 2008 until September 2011. Screening data included the number of patients invited to participate, number screened (FOBt outcome normal or abnormal) and number of colonoscopies performed. In those with newly diagnosed IBD at colonoscopy confirmed on histology, clinical data including demographics, disease characteristics, previous therapy and outcome were obtained from case note and electronic patient record review.
Results: Of 136,811 patients invited, 67,485 were screened, representing an uptake of 49.33% and FOBt positivity of 2.02%. Colonoscopy was performed in 1401 patients (female 523). Polyps were detected in 630 (41.37%), cancer in 134 (8.80%) and 469 (30.79%) had a normal examination. Thirty patients had endoscopic appearance suggestive of IBD, confirmed at histology in 15 patients. Two patients were excluded from analysis as the diagnosis of colitis preceded the screening examination on case note review. Three of 13 incidental IBD cases reviewed were female, median age at diagnosis was 65 and mean follow-up was 29.8 months. Five patients had Crohn's disease, 6 ulcerative colitis and 2 had IBD-type unclassified (IBDU). Seven patients (53.8%) were asymptomatic at diagnosis. Treatment included steroids (6), 5‑ASA (11), immunomodulators (azathioprine 4; methotrexate 1) and anti‑TNF (infliximab 2). No patient required surgery. Those requiring immunomodulators and/or infliximab were all male and had asymptomatic pan ulcerative colitis, symptomatic left sided ulcerative colitis, symptomatic left-sided IBDU colitis and symptomatic colonic, non-stricturing, non-penetrating Crohn's disease at diagnosis.
Conclusions: An incidental diagnosis of IBD is not an uncommon occurrence. With the advent of endoscopic bowel cancer screening this number is probably set to increase. This subset of patients may present an important model for study of early disease providing novel insights into disease pathogenesis and evolving treatment paradigms.