Sources of Bias in Common Diagnosis of Chronic Inflammatory Bowel Diseases
https://doi.org/10.22416/1382-4376-2020-30-5-26-29
Abstract
Aim. Causal analysis of a late diagnosis of chronic inflammatory bowel diseases (CIBD) in general medical practice.
Materials and methods. We continuously sampled 80 CIBD histories (44 of ulcerative colitis, UC, and 36 of Crohn’s disease, CD) to estimate the time and nature of first complaints, primary diagnosis, time lapse between the first physician visit and diagnosis and reasons for a late diagnosis.
Results. Only 63.6 % of patients with UC and 38.9 % with Crohn’s disease were correctly diagnosed during the first visit and subsequent examination. Abdominal pain in debut of CIBD was registered in 40.9 % of the UC and 75.0 % of CD patients (p < 0.01). Diarrhoea as a CIBD manifestation was significantly more common in the UC than in CD patients (88.6 and 55.5 % of cases, respectively; p < 0.01). Hematochesia was observed in 68.2 % of the UC and 22.2 % of CD cases (p < 0.01). Among the CD patients with primary symptoms, a correct follow-up diagnosis was less frequent compared to the UC patients (38.9 % of cases, p < 0.01). Only 30 patients with UC (68.2 %) and 18 patients with CD (50.0 %) had colonoscopy at a first outpatient visit. The main cause of late diagnoses in CIBD is a delayed ileocolonoscopy.
Conclusions. Ileocolonoscopy should be mandatory in all patients suspected for CIBD with clinical symptoms.
About the Authors
O. A. Svatkova
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Olga A. Svatkova - Clinical Resident, Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. A. Sheptulin
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Arkadiy A. Sheptulin — Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine
119435, Moscow, Pogodinskaya str., 1, bld. 1
References
1. Gastroenterology. National guide. Ed. V.T. Ivashkin, T.L. Lapina. Moscow: GEOTAR-Media Publishing Group; 2008 (In Russ.).
2. Adler G. Morbus Crohn — Colitis ulcerosa. Berlin: Springer Verlag. Heidelberg — New York; 1997.
3. Ivashkin V.T., Sheptulin A.A., Sklaynskaya O.A. Diarrhea syndrome. Moscow: GEOTAR-MED, 2002 (In Russ.).
4. Stange E.F., Travis S.P., Vermeire S., Beglinger C., Kupcinkas L., Geboes K., et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1–15. DOI: 10.1136/gut.2005.081950a
5. Bielefeldt K., Davis B., Binion D.G. Pain and inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(5):778–88. DOI: 10.1002/ibd.20848
6. Ivashkin V.T., Shelygin Yu.A., Abdulganiyeva D.I., Abdulkhakov R.A., Alekseyeva O.P., Achkasov S.I., et al. Guidelines of the Russian gastroenterological association and Russian Association of Coloproctology on diagnostics and treatment of ulcerative colitis in adults. Rus J Gastroenterol Hepatol Coloproctol. 2015;25(1):48–65 (In Russ.)
7. Ivashkin V.T., Shelygin Yu.A., Khalif I.L., Belousova E.A., Shifrin O.S., Abdulganieva D.I., et al. Clinical recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of Crohn’s disease. Coloproctology. 2017;2(60):7–29 (In Russ.).
8. Shergill A.K., Lightdale J.R., Bruining D.H., Acosta R.D., Chandrasekhara V., Chathadi K.V., et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc. 2015;81:1101–11.e1–e13. DOI: 10.1016/j.gie.2014.10.030
9. Spiceland C.M., Lodhia N. Endoscopy in inflammatory bowel disease: role in diagnosis, management, and treatment. World J Gastroenterol. 2018;24(35):4014–20. DOI: 10.3748/wjg.v24.i35.4014
10. Lamb C.A., Kennedy N.A., Raine T., Hendy P.A., Smith P.J., Limdi J. K., et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1–106. DOI: 10.1136/gutjnl-2019-318484
11. Mearin F., Lacy B.E., Chang L. Chey W.D., Lembo A., Simren M., Spiller R. Bowel disorders. Gasroenterology 2016. PII: S0016-5085(16)00222-5. DOI: 10.1053/j.gastro.2016.02.031
12. Ikhtaire S., Shajib M.S., Reinisch W., Khan W. Fecal calprotectin: its scope and utility in the management of inflammatory bowel disease. J Gastroenterol. 2016;51(5):434–46. DOI: 10.1007/s00535-016-1182-4
Review
For citations:
Svatkova O.A., Sheptulin A.A. Sources of Bias in Common Diagnosis of Chronic Inflammatory Bowel Diseases. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(5):26-29. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-5-26-29
Views:
1565
Email this article 
