Consultation patterns before Inflammatory Bowel Disease diagnosis associated with worse outcomes

A new study  from our Child Population Health theme has found worse outcomes to occur amongst patients diagnosed with inflammatory bowel disease who visited their primary care practice frequently in the years before diagnosis.

Inflammatory bowel disease is a term used to describe two main conditions, ulcerative colitis and crohn’s disease. The condition causes inflammation in the gut, and can result in symptoms such as diarrhoea, abdominal pain and rectal bleeding; it affects over 500,000 people in the UK.

In this new study, published in the British Medical Journal Open Gastroenterology, researchers at St George's University of London, Imperial College London, University College London and King’s College London, studied the records of over two-thousand  people in England with ulcerative colitis and crohn’s disease between 1998-2016.

The results revealed, amongst patients who experienced gastrointestinal symptoms before they were diagnosed, frequent primary care consultation was associated with worse inflammatory bowel disease outcomes. Notably there was an increased risk of surgery, and, with respect to ulcerative colitis, an increased risk of becoming dependent on steroid medication. 

Infographic showing associations between prior healthcare use, time to diagnosis and clinical outcomes in IBD.

The intensity of primary care consultations was highest in the year before diagnosis, and in this year was associated with worse clinical outcomes in both crohn’s and ulcerative colitis. The study also found, individuals who required hospitalisation for gastrointestinal symptoms before diagnosis were at increased risk of hospital admissions related to inflammatory bowel disease and intestinal surgery following their diagnosis.

The findings also revealed that a longer time to diagnosis was associated with an increased risk of Crohn’s disease-related hospitalisation. Paradoxically, a longer time to diagnosis was associated with a milder disease course in ulcerative colitis. The authors suggest that this may be because more aggressive disease types present rapidly over a short period of time with higher frequency and intensity of consultation and urgent hospital attendance in the period before diagnosis. 

This study highlights the need for accelerated diagnostic approaches for patients who return repeatedly with unresolved in  gastrointestinal symptoms. Electronic records contain valuable information about patterns of healthcare use that could potentially be utilised to direct timely referrals and identify of aggressive forms of IBD.

Child Population Health theme logo