P182 Prospective cohort to identify factors associated with a delay in diagnosis in patients with inflammatory bowel disease
G. Walker1, S. Lin*1, N. Chanchlani1, A. Thomas1,2, L. Moore2, P. Hendy2, N. Heerasing2, H. Green3, C. Bewshea1, J. Goodhand1,2, N. Kennedy1,2, T. Ahmad1,2
1University of Exeter, Exeter IBD Pharmacogenetics Research Group, Exeter, UK, 2Royal Devon and Exeter NHS Foundation Trust, Department of Gastroenterology, Exeter, UK, 3University of Exeter Medical School, Genetics of Complex Traits, Exeter, UK
International cohort studies have previously identified Crohn’s disease (CD), ileal disease, smoking, and age (<40 years old) as factors associated with a delay in diagnosis of patients with inflammatory bowel disease (IBD). Referral from primary to secondary care has been highlighted as a significant contributor to diagnostic delay. Currently, there is a paucity of data looking at the factors influencing diagnostic delay specific to a UK population, where healthcare system is free at point-of-access. Hence, we conducted a prospective observational cohort study of patients referred to secondary care between January 2014 to December 2017.
In total, 163 patients between the age of 18 and 46 years who first presented to their general practitioner (GP) with gastrointestinal symptoms from January 2014 were included in this study. Patients above the age of 46 were excluded due to the increased risk of colorectal cancer with increasing age. This was also the upper age limit recommended for faecal calprotectin use in the investigation of suspected IBD. In addition to baseline demographic data, our main outcome measure was time to overall diagnosis including time from onset of symptoms to GP presentation (patient delay), time of GP presentation to referral (primary care delay), and time of referral to diagnosis (secondary care delay).
The median time to diagnosis was 6.7 months [IQR 3.3–14.1], with no significant difference in time to diagnosis for IBD sub-types [CD, 9.8 months [IQR 5.5–18.5]; IBD-Unclassified, 7.0 months [IQR 4.5–8.5] and ulcerative colitis (UC), 5.2 months [IQR 2.9 −12.3] (
Referrals triaged urgently and by a gastroenterologist were associated with a reduction in secondary care diagnostic delay. Adopting a combination of primary care faecal calprotectin testing and secondary care straight-to-test may impact diagnostic delays.