P253 Incidental diagnosis of inflammatory bowel disease in a British bowel cancer-screening cohort: 6-year clinical outcome follow-up of the first reported cohort
J. Scott*1, U. Nosegbe2, R. Butcher2, A. Abbassi2, R. Prudham2, R. George2, J. Limdi2
1Penine Acute Hospitals NHS Trust, Gastroenterology, Manchester, United Kingdom, 2Pennine Acute Hospitals NHS Trust, Department of Gastroenterology, Manchester, United Kingdom
The UK Bowel Cancer Screening programme (BCSP) was launched in 2006 in England and Wales. At launch it screened all individuals aged 60–69 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. We reported at ECCO 2012 the first ever experience of incidental diagnosis of IBD through screening. We present a 6-year follow-up of these patients.
We conducted a retrospective case notes and electronic record review of clinical outcomes until September 30, 2015, for patients diagnosed with inflammatory bowel disease (IBD) from the BCSP from April 2008 until September 2011. We reviewed their symptoms at diagnosis, their treatment course and compared stage of disease at initial presentation to that at last follow-up.
Between April 2008 and September 2011, 136 811 patients were invited to the BCSP and 67 485 were screened with a 49.33% uptake and FOBt positivity of 2.02%. Colonoscopy was performed in 1 401 patients, and 13 patients (3 female) were diagnosed with IBD. Of these, 6 patients had ulcerative colitis (UC), 5 had Crohn’s disease (CD), and 2 had IBD unclassified (IBDU). One IBDU patient was subsequently reclassified as UC during follow-up. At diagnosis, 7 (53.8%) patients were asymptomatic. An asymptomatic patient died of an unrelated cause, with follow-up data available for 12 patients. Median follow-up time was 72.5 months (range 39–82 months). Disease characteristics and outcomes are summarised below (Table 1). Disease distribution progressed in 2 patients and 6 (100%) of the asymptomatic patients developed symptoms at some stage during follow-up.
Table 1 Summary of disease characteristics and outcomes
Treatment included steroids (10), 5-ASA (12), immunomodulator (azathioprine ; methotrexate ) and Anti-TNF (infliximab ; adalimumab ). Median time to immunomodulator was 29.5 months and to anti-TNF, 28.0 months. Mean CRP at diagnosis for those who progressed to immunomodulator was 10.4 compared with 5.5 in those that did not and 15.5 in those that required biologics. A patient with symptomatic IBDU underwent subtotal colectomy 54 months after diagnosis but died 7 days post-operatively. Another patient died at 39 months from an unrelated cause.
Incidental diagnosis of IBD is a common phenomenon, presenting an important model for study of early disease. A proportion of these initially asymptomatic patients appear to demonstrate disease progression with a rapid requirement of immunomodulator and/or anti-TNF therapy.