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P165. Predictive factors for chronic inflammatory bowel diseases in patients presenting with new onset diarrhea

A.-M. Singeap1, A. Trifan1, I. Girleanu1, O.C. Stoica1, C. Stanciu2, 1University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Institute of Gastroenterology and Hepatology, Iasi, Romania, 2Institute of Gastroenterology and Hepatology, Gastroenterology, Iasi, Romania

Background

The diagnosis of chronic inflammatory bowel diseases (IBD) requires chronic changes over time (colonoscopic inflammatory changes lasting at least 6 months and chronic histological inflammation). The onset of IBD may mimic acute diarrhea (defined as having sudden onset and lasting less than four weeks); on the other hand, acute diarrhea may be mistaken with a new case of chronic IBD. Our aim was to find clinical or biological predictive factors for the diagnosis of chronic IBD.

Methods

A prospective study was conducted on all cases of new onset diarrhea which presented in our Gastroenterology Unit during 2012. Their initial evaluation included clinical exam, complete biological picture and colonoscopy. All cases of new onset diarrhea with uncertain etiology were followed and the final diagnosis was established at least 6 months after the onset, by repeating colonoscopy with biopsy. The final diagnosis was correlated with clinical and biological parameters evaluated at the first presentation.

Results

A total of 120 patients with new onset diarrhea presented to our unit in 2012. After the initial work-up, 82 patients had a positive diagnosis (infectious colitis, colorectal cancer, radiation colitis, ischemic colitis). The remaining 38 patients, including both patients with inflammatory changes at colonoscopy and patients with normal colonoscopy were reevaluated by colonoscopy and biopsies after 6 months. For 11 patients, results were conclusive for chronic IBD, 5 patients had collagenous or lymphocytic colitis, and 22 patients were diagnosed with acute self-limiting colitis or irritable bowel syndrome (IBS). Among the parameters we analysed, anemia and hypoalbuminemia in the onset of the symptomatology were significantly correlated with the subsequent diagnosis of chronic IBD; elevated levels of inflammatory parameters like C-reactive protein and erythrocyte sedimentation were present in similar proportions in the different types of final diagnosis except IBS; other biological parameters were not contributive; non-significant correlation was found with respect to age, weight loss and clinical history or associated symptoms.

Conclusion

Anemia and hypoalbuminemia are predictive factors for chronic inflammatory bowel diseases in patients presenting with new onset diarrhea; a more extensive initial work-up applied in these patients could bring an early diagnosis for IBD.