P220. Incidental diagnosis of inflammatory bowel disease in a British bowel cancer screening cohort: a multi-centre study
R.O. Butcher1, S.J. Mehta2, O.F. Ahmad2, C.A. Boyd1, R. Anand2, J. Stein2, A.M. Abbasi1, R. George1, R.C. Prudham1, R. Vega2, S. McCartney2, S.L. Bloom2, J.K. Limdi1, 1Pennine Acute Hospitals NHS Trust, Gastroenterology, Manchester, United Kingdom, 2University College London Hospital, Gastroenterology, London, United Kingdom
The UK Bowel Cancer Screening Programme (BCSP) was launched in 2006 to cover the entire population of England and Wales. It screens individuals aged 60–69 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. We aimed to quantify the incidental diagnosis of Inflammatory Bowel Disease (IBD) and patient outcome in this cohort.
A retrospective review of BCSP outcomes was conducted from launch in February 2007 to August 2012. Screening data included patients invited, number screened (FOBt “normal” or “abnormal”) and colonoscopies performed. In those diagnosed with IBD at colonoscopy confirmed on histology, clinical data (demographics, disease characteristics, treatment and outcome) were obtained from case note and electronic record review.
Of 477,553 patients invited, 219,705 were screened, representing an uptake of 46.01% and FOBt positivity of 2.35%. Colonoscopy was performed in 5350 patients (female 2287). Polyps were detected in 2344 (39.86%), cancer in 339 (5.77%) and 1383 (23.52%) had a normal examination. Endoscopic appearance suggestive of IBD in 112 patients was confirmed at histology in 66. Eleven patients were excluded as the diagnosis of IBD preceded screening. Twenty-one of 55 incidental cases were female. Median age at diagnosis was 64. Sixteen patients had Crohn's disease (CD), 33 ulcerative colitis (UC) and 6 had IBD-type unclassified (IBDU). Follow-up data was available in 42 patients (mean follow-up 23.9 months). Twenty patients (47.6%) were asymptomatic at diagnosis. Seven (35.0%) of the asymptomatic patients became symptomatic during the follow-up period. Treatment included steroids (11), 5-ASA (34), immunomodulators (azathioprine 6; methotrexate 1) and anti-TNF (infliximab 2; adalimumab 1). None required surgery. In those requiring escalation of therapy (14.3%) the median time to immunomodulation was 21 months (range 5–30 months). Those requiring immunomodulators and/or anti-TNF therapy (male 4; female 2) had asymptomatic extensive UC, symptomatic left-sided UC, symptomatic left-sided IBDU, symptomatic Crohn's colitis and symptomatic stricturing terminal ileal CD (2) at diagnosis.
An incidental diagnosis of IBD is not uncommon. With the advent of bowel cancer screening this number is set to increase. A proportion of these patients demonstrate rapid disease progression. Such patients may present an important model for study of early disease with novel insights and evolving treatment paradigms.