Incidental Diagnosis of Inflammatory Bowel Disease from the British Bowel Cancer Screening Programme: Follow-Up Data from the First Reported Cohort

Purpose: There is limited data on asymptomatic individuals incidentally diagnosed to have Inflammatory Bowel Disease (IBD). The UK Bowel Cancer Screening Programme (BCSP) screens individuals aged 60-69 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. We reported at ACG 2011, the incidental diagnosis of IBD through BCSP at our centre between April 2008 and April 2011. The aim of this study was to characterize patient outcome in this cohort. Methods: We conducted an up-to-date case note and electronic patient record review of all patients diagnosed incidentally with IBD through BCSP with follow-up data as available until 30th April 2012. Clinical data including demographics, disease characteristics, previous and current therapies and outcomes were evaluated. Results: Of 121,350 patients invited, 59,056 were screened (Females 31,136), an uptake of 48.67% and FOBt positivity of 2.10%. Colonoscopy was performed in 1240 patients. Thirteen patients had an incidental diagnosis of IBD. Three of 13 cases were female, and the median age at diagnosis was 65. Five patients had Crohn's disease (CD), 6 ulcerative colitis (UC) and 2 had IBD-type unclassified (IBDU). Seven patients (53.8%) were asymptomatic at diagnosis. Mean values for blood parameters at diagnosis were Hb 13.8, Platelets 290, Albumin 40 and CRP 7.4. Twelve patients had follow-up data available, one asymptomatic patient died of an unrelated cause prior to clinic review. The mean follow-up period was 37.8 months (range 21-45 months). Three (50.0%) of the asymptomatic patients reviewed became symptomatic during the follow-up period. Progression of disease as determined by the Montreal classification occurred in 2 patients with change from colonic to ileo-colonic CD by 11 months and left-sided to extensive UC by 24 months. Treatment included steroids (7), 5-ASA (11), immunomodulators (azathioprine 4; methotrexate 1) and anti-TNF (infliximab 2). None required surgery. In those requiring escalation of therapy (33.3%) the median time to immunomodulation was 27 months (range 5-30 months). Mean CRP at diagnosis was 9.7 in those that progressed to immunomodulator and 6.2 in all other patients. Those requiring immunomodulators and/or anti-TNF (male 4) had asymptomatic extensive UC, symptomatic left-sided UC, symptomatic left-sided IBDU and symptomatic non-stricturing, non-penetrating Crohn's colitis at diagnosis. Conclusion: Incidental diagnosis of IBD is not an uncommon phenomenon and these patients may present an important model for study of early disease. A proportion of this cohort of initially asymptomatic patients appear to demonstrate disease progression with a rapid requirement of immunomodulator and/or anti-TNF therapy.

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