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P482 Different characteristics of inflammatory bowel disease patients between tertiary referral centres and secondary hospitals

K. H. Song*1, Y. J. Lee2, K. O. Kim3, H. S. Lee4, E. S. Kim2, J. I. Koo1, J. S. Jeong1, W. S. Seo1

1Goo Hospital, General Surgery, Daegu, South Korea, 2Keimyung University School of Medicine, Internal Medicine, Daegu, South Korea, 3Yeungnam University College of Medicine, Internal Medicine, Daegu, South Korea, 4Kyungpook National University School of Medicine, Department of Internal Medicine, Daegu, South Korea

Background

Because most studies on inflammatory bowel disease (IBD) have been conducted in tertiary referral hospitals, little has been known for the features of inflammatory bowel disease (IBD) patients in primary or secondary hospitals. This study aimed to compare demographic and clinical characteristics of IBD patients in secondary hospitals with those in tertiary referral centres.

Methods

Data of patients who were diagnosed of IBD and followed-up for at least 3 months in a secondary hospital and 3 tertiary referral centres were retrospectively reviewed.

Results

Overall, 178 Crohn’s disease (secondary 76 and tertiary 102) and 269 ulcerative colitis (UC) patients (secondary 170 and tertiary 99) were included in the study. Period from initial symptom to diagnosis in IBD patients was significantly shorter in secondary than that in tertiary group (median day, CD, 28 vs 150, p < 0.001; UC, 30 vs 61, p = 0.001). As initial symptoms of CD, patients from secondary hospital were more likely to show perianal symptoms like perianal fistula or abscess (56.6% vs 34.3%, p = 0.003), whereas those from referral centres had more often luminal symptoms such as abdominal pain (54.9% vs 17.1%, p < 0.001), diarrhoea (44.1% vs 18.4%, p < 0.001), and body weight loss (9.8% vs 1.3%, p = 0.025). Complicated behaviours such as stricturing and penetrating were significantly more observed in tertiary centres, whereas perianal disease was more common in the secondary hospital. Ileal location was more frequently observed in tertiary group. For UC, patients from secondary hospital had more limited extent of the disease (proctitis 58.8% vs 21.2%, p < 0.001). Cumulative rate of azathioprine use in the secondary hospital was significantly lower than that in tertiary referral centres in both CD and UC patients after control of disease behaviour, location, and extent.

Conclusion

Clinical characteristics of IBD patients from the secondary hospital are substantially different from those from tertiary referral centres.