P793 Prevalence and phenotype of inflammatory bowel disease across primary and secondary care: Implications for colorectal cancer surveillance
Notice bibliographique
Résumé
Patients diagnosed with inflammatory bowel disease (IBD) with colonic involvement have increased risk of colorectal cancer (CRC). Colonoscopic surveillance reduces the risk of CRC-associated death through early detection; national/international guidelines recommend chromoendoscopy. We aimed to assess the burden of IBD in primary care unknown to our service and to identify patients eligible for, but not being offered, surveillance. We conducted a population-based observational study across primary and secondary care to evaluate the incidence and prevalence of IBD in our catchment area. Cases were identified from primary care using searches of practice databases and in secondary care using searches of electronic hospital records. Case inclusion required a specialist diagnosis of ulcerative colitis (UC), Crohn’s disease (CD) or IBD unclassified and confirmatory evidence (specialist correspondence, histology, endoscopic or operative findings). IBD was phenotyped according to the Montreal Classification and patients under the age of 75 years, who had been diagnosed with IBD with colonic disease involvement for more than 10 years, were deemed eligible for colonoscopic surveillance. Patients from 48/49 GP practices within our catchment area were included. We identified 2816 patients with IBD living within our catchment of which 11% (309/2816) were unknown to any local secondary care service. Overall, UC prevalence was 435/100000 people (95% confidence interval 416–456), Crohn’s disease prevalence was 231/100000 (95% CI 216–246), and IBD unclassified prevalence was 31/100000 (95% CI 26–37). Patients managed solely in primary care, compared with those in secondary care, were older (median age [IQR] 63.2 [50.7–72.3] vs 54.2 [40–68.1] years, p < 0.0001) and had longer disease duration (median [IQR] 23.3 [13.6–36.7] vs 11.6 [5.6–20.6] years, p < 0.0001). The proportion of UC out of total IBD was higher in primary care (73% [227/309] vs. 61% [1531/2507], p < 0.0001). A higher proportion of IBD patients in primary care than secondary care had undergone a colectomy (17% [54/309] vs 28% [148/2507], p < 0.0001). Overall, 16% (393/2507) patients known to secondary care and 30% (92/309) of patients unknown to any secondary care services were eligible for colonoscopic surveillance, equivalent to approximately one colonoscopy list per week. We report one of the highest prevalence rates of IBD in Western Europe (1 in 143 patients). 11% of patients living in our immediate catchment area were unknown to our service; a third of these were eligible for colonoscopic colorectal cancer surveillance. Effective colorectal cancer surveillance programmes in IBD must target primary-care populations and not just known secondary care populations.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».