PTU-038 New diagnosis of inflammatory bowel disease in the over 60s: an unintended consequence of the Bowel Cancer Screening Programme?

Abstract

<h3>Introduction</h3> The Bowel Cancer Screening Programme (BCSP) was introduced in England in 2006, with the expectation that screening would be available throughout England for the 60–69 years of age cohort by the end of 2009. Our own Trust began screening in May 2009. Although the programme aims is to detect individuals with polyps or tumours, patients with other causes of internal bleeding may be identified. <h3>Methods</h3> The results of all 253 patients (pts) attending for screening colonoscopy in the 6-month period May – October 2009 were assessed. The Hospital notes and pathology records were reviewed for all reports mentioning a diagnosis of inflammatory bowel disease (IBD). Pts identified with IBD were asked about pre screening colonoscopy bowel symptoms. Patients whose records indicated a known diagnosis of IBD were removed from the study. <h3>Results</h3> 15/253 pts (5.9%) were reported to have endoscopic features of inflammatory bowel disease. 5 pts were removed from the analysis on account of : prior diagnosis of Crohn9s (1), normal histology despite endoscopic evidence stating inflammation / ulceration (2) and 2 pts with ileal ulceration known to have been on anti-inflammatory drugs or aspirin. 10 pts (6M:4F, 4%) of the screening cohort were identified with a new diagnosis of Crohn9s (ileal (5) or aphthous ulceration of the colon, 2) or ulcerative colitis (3, left sided). Recommendations for Gastroenterology referral were made to the GP. One patient was started on mesalazine on the day of the procedure together with same day review by the IBD Nurse specialist. Most (9/10) of the cohort had experienced a change in bowel habit or rectal bleeding, but had not reported their symptoms to the GP. <h3>Conclusion</h3> 4% of our patient cohort attending for bowel cancer screening colonoscopy were given a new diagnosis of inflammatory bowel disease. The majority described pre-existing symptoms but had not sought medical advice, with the arrival of the faecal occult blood testing kit prompting them to participate in the programme. An unintended benefit of the BCSP has been to identify IBD in a 4% cohort of individuals attending for screening colonoscopy.