EXPLORING THE RELATIONSHIP BETWEEN PATIENT SYMPTOMS AND PROVIDER GOALS FOR MUCOSAL HEALING IN IBD: INSIGHTS FROM THE IBD QORUS SURVEY DATA

Abstract

Abstract INTRODUCTION Patients with inflammatory bowel disease (IBD) often experience symptoms such as abdominal pain, diarrhea, and bloody bowel movements. While these symptoms traditionally guided treatment, their predictive value for disease progression is limited. The latest STRIDE-II guidelines recommend a comprehensive IBD management approach, with an emphasis on short-term symptom relief, intermediate-term biomarker normalization, and long-term achievement of endoscopic remission. This treat-to-target strategy necessitates collaboration between physicians and patients. Our study aims to investigate the relationship between patient-reported outcomes and physician efforts to achieve mucosal healing (MH) using IBD QORUS patient and provider survey data. METHODS This was a multi-center prospective study that used patient and provider matched survey data from the Crohn’s & Colitis Foundation IBD QORUS program. Surveys completed between June 2021-October 2022 were analyzed. Univariate and multivariate analyses were performed to determine the relationship between severity of patient reported symptoms and frequency of MH assessment with modalities including endoscopy and fecal calprotectin, as well as to determine how symptoms and MH status influence treatment. RESULTS In total 5,460 paired patient and provider surveys (Crohn’s disease (CD), n=3,276; ulcerative colitis (UC), n=2,184) were included in the analysis. Demographic information including age, sex and steroid-free MH, as well as severity of patient-reported symptoms were similar between CD and UC patients (Table 1). Abdominal pain severity reported by both IBD populations significantly impacted plans for future endoscopy (CD, p=0.000019; UC, p=0.000055) but not for fecal calprotectin testing. Reported stool frequency in both IBD populations significantly impacted future endoscopy plans (CD, p=0.000001; UC, p=0.000001) and future fecal calprotectin testing (CD, p=0.000304; UC, p=0.000001). Reported blood in stool had no effect on MH assessment in CD patients whereas it significantly affected plans for endoscopy (p=0.000001) and fecal calprotectin testing (p=0.000001) in UC patients. Provider discussions regarding MH occurred with 82.4% of CD patients and 85.3% of UC patients, and treatment plans in those without steroid free MH were influenced by severity of symptoms (p=0.000001). DISCUSSION Patient reported symptoms influenced fecal calprotectin and endoscopy plans in both IBD groups. Similarly, severity of symptoms in those without steroid-free MH significantly affected treatment management. These findings suggest that target-based treatment for IBD is feasible in the clinical setting and holds the potential to enhance patient outcomes.