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N15 Microscopic colitis in two DGH, is there a clear pathway to diagnosis or treatment

P. Avery*1, R. Campbell2

1Dorset County Hospital Foundation Trust, Gastroenterology, Dorchester, UK, 2Stepping Hill Hospital, Gastroenterology, Stockport, UK

Background

Microscopic Colitis(MC) is an inflammatory bowel disease(IBD) usually characterised by non-bloody diarrhoea and a normal or near normal macroscopic colonoscopy; biopsies are required for diagnosis [2]. Calprotectin is unhelpful as often falls below the range that flags a referral, confusion with IBS is common. MC has distinct sub conditions Lymphocytic(LC) and Collagenous colitis(CC) MC is not a new disease; An epidemiological study in Sweden between 1993 and 1998, suggested the incidence was similar to Crohn’s disease in the subsets and combined comparative to ulcerative colitis [1].In Nottingham in 2017 the numbers reflected an increase in diagnosis rates over time [3].

Methods

At two District General Hospital’s one in the south of England(SDGH) serving a population of 330,000 and one in the north west(NWDGH) with a population of 380,000. Figures were looked at for diagnosis of MC year to date these are approximate as there was coding variance in both trusts.

TrustTotal Number MCLC%CC%Male%Female%
SDGH4761.738.34.2595.75
NWDGH7668322.6397.37

Numbers by trust.

Results

Mean time from symptom onset was variable in both trusts, time from diagnosis to first treatment varied depending on the referral pathway. NWDGH reports the 2 week wait path led to a speedy diagnosis, the Nurse led referral pathway in gastro was 10 weeks and Gastroenterology longer. At the SDGH the 2 week pathway was responsible for the biggest number of diagnosis, meaning 18 patients received a diagnosis in approx. 4 weeks there is no direct to nurse referral pathway and the routine gastroenterology wait is 18 weeks. Only 4 patients at the SDGH made it on the IBD service. Most patients lack support there was wide variation in the advice given depending on follow-up. Sixteen were discharged to GP care with a letter of advice and 18 were seen in gastro clinics, the advice on treatment varied from Budesonide to Loperamide or worse nothing at all.

Conclusion

This DGH experience in the North and South of England informs that diagnosis remains troublesome, pathways and treatment is variable. The exact numbers for prevalence and incidence remain insidious due to this and the need for histological diagnosis. It could be suggested that extended waits for diagnosis leads to a burden to the individual in terms of Quality of life (QOL) and the health and social economy; this is difficult to Quantify. Addressing coding issues may help to understand the impact of MC. IBD Nurses could bridge the support gap but service review would be needed This retrospective audit was limited skimming the surface of deeper issues.

References

1. Münch A, Aust D, Bohr J, et al. Microscopic colitis: current status, present and future challenges. Statements of the European Microscopic Colitis Group, European Crohn's and Colitis Organisation (ECCO). J Crohn's Colitis 2012;6:932–45.

2. Olesen, M, Eriksson S, Bohr J, et al. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Örebro, Sweden, 1993–1998. Gut 2004;53:346–50.

3. Lewis NR, Archer T, Kaye P. PWE-061 epidemiology of microscopic colitis in nottingham: a contemporary cohort study. Gut 2017;66: A156.