Iago Rodríguez-Lago1, Olga Merino2, Irene Azagra3, Ainara Maiz4, Eva Zapata5, Rebeca Higuera6, Isabel Montalvo7, María Fernández-Calderón8, Paz Arreba9, Juan Carrascosa10, Ainara Iriarte11, Isabel Portillo12, Urko Aguirre13, Manuel Barreiro-de Acosta14, Miguel Muñoz-Navas15, José Luis Cabriada16. 1. Gastroenterology Department, Hospital de Galdakao, Galdakao, Vizcaya, Spain. Electronic address: iago.r.lago@gmail.com. 2. Gastroenterology Department, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain. 3. Gastroenterology Department, Hospital Universitario de Álava, Álava, Spain. 4. Gastroenterology Department, Hospital Donostia, Donosti, Guipúzcoa, Spain. 5. Gastroenterology Department, Hospital de Mendaro, Guipúzcoa, Spain. 6. Gastroenterology Department, Hospital de San Eloy, Baracaldo, Vizcaya, Spain. 7. Gastroenterology Department, Hospital Onkologikoa, Donosti, Guipúzcoa, Spain. 8. Gastroenterology Department, Hospital de Mondragón, Mondragón, Guipúzcoa, Spain. 9. Gastroenterology Department, Hospital de Basurto, Bilbao, Vizcaya, Spain. 10. Gastroenterology Department, Hospital de Zumárraga, Zumárraga, Guipúzcoa, Spain. 11. Gastroenterology Department, Hospital de Bidasoa, Hondarribia, Guipúzcoa, Spain. 12. Colorectal Cancer Screening Programme, The Basque Health Service, Spain. 13. Research Unit, Health Services Research on Chronic Patients Network, Hospital de Galdakao, Galdakao, Vizcaya, Spain. 14. Gastroenterology Department, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain. 15. Gastroenterology Department, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 16. Gastroenterology Department, Hospital de Galdakao, Galdakao, Vizcaya, Spain.
Abstract
BACKGROUND & AIMS: Inflammatory bowel disease (IBD) is a chronic disease usually diagnosed after the appearance of gastrointestinal symptoms. Little is known about IBD progression during its early and even preclinical phases. We aimed to determine the number of new incidental diagnoses of IBD in an older population, and evaluate disease progression from its early stages. METHODS: We performed a retrospective analysis of 31,005 colonoscopies performed during colorectal cancer screening of patients with positive results from fecal immunochemical tests, at 11 centers in the Basque Country (Spain) from 2009 through 2014. We collected clinical and laboratory data from all asymptomatic individuals suspected to have IBD during screening colonoscopies, with histologic confirmation. RESULTS: Colonoscopy screening led to 79 new diagnoses of ulcerative colitis, 24 of Crohn's disease, and 7 of unclassified colitis (average patient age, 57 y; interquartile range, 52-62 y; 57% male). Eleven patients had symptoms before colonoscopy and were excluded from the analysis. Among those patients who were asymptomatic at diagnosis, 36% developed symptoms after a follow-up period of 25 months (interquartile range, 10.5-42 mo), mostly rectal bleeding and diarrhea. Treatment was prescribed for 81 patients (88%), and 2 cases required surgery. CONCLUSIONS: We analyzed data from a large cohort of patients with IBD diagnosed at early or even preclinical stages, from an older population. New incidental diagnoses of IBD were made in 0.35% of individuals undergoing a population-based screening colonoscopy-most were classified as ulcerative colitis. Approximately one third of patients developed symptoms during the follow-up period.
BACKGROUND & AIMS:Inflammatory bowel disease (IBD) is a chronic disease usually diagnosed after the appearance of gastrointestinal symptoms. Little is known about IBD progression during its early and even preclinical phases. We aimed to determine the number of new incidental diagnoses of IBD in an older population, and evaluate disease progression from its early stages. METHODS: We performed a retrospective analysis of 31,005 colonoscopies performed during colorectal cancer screening of patients with positive results from fecal immunochemical tests, at 11 centers in the Basque Country (Spain) from 2009 through 2014. We collected clinical and laboratory data from all asymptomatic individuals suspected to have IBD during screening colonoscopies, with histologic confirmation. RESULTS: Colonoscopy screening led to 79 new diagnoses of ulcerative colitis, 24 of Crohn's disease, and 7 of unclassified colitis (average patient age, 57 y; interquartile range, 52-62 y; 57% male). Eleven patients had symptoms before colonoscopy and were excluded from the analysis. Among those patients who were asymptomatic at diagnosis, 36% developed symptoms after a follow-up period of 25 months (interquartile range, 10.5-42 mo), mostly rectal bleeding and diarrhea. Treatment was prescribed for 81 patients (88%), and 2 cases required surgery. CONCLUSIONS: We analyzed data from a large cohort of patients with IBD diagnosed at early or even preclinical stages, from an older population. New incidental diagnoses of IBD were made in 0.35% of individuals undergoing a population-based screening colonoscopy-most were classified as ulcerative colitis. Approximately one third of patients developed symptoms during the follow-up period.