Regional Practice Patterns for Newly Diagnosed Inflammatory Bowel Disease in Baton Rouge

Abstract

Listen

Translate article

Introduction: Due to the ambiguity in clinical presentation of inflammatory bowel disease (IBD), there can be significant delays in diagnosis. Previous studies found that diagnostic delays are associated with an increased risk of bowel stenosis and Crohn's disease (CD)-related intestinal surgeries. With earlier diagnosis and treatment, it may be possible to modify the natural history of the disease and prevent complications. Although treatment strategies can be argued, there is proof that early therapy reduces steroid use, improves maintenance of remission, and may decrease hospitalizations.Figure. IBD: Treatment Patterns.Table. 5: ASA Compound Use by Crohn's Disease LocationMethods: A retrospective chart review of all newly diagnosed patients with IBD at a private practice in Baton Rouge since 2013 was conducted. Patients diagnosed elsewhere were excluded. We collected basic demographic data, symptoms at onset, complications, time to diagnosis, disease characteristics, and initial treatment strategies. Results: Of 55 patients diagnosed with IBD, 32 had CD and 23 had ulcerative colitis (UC). Initial treatment therapies of 32 CD patients included 16 with steroids, 12 with mesalamine compounds, 6 with immunomodulators, 12 with biologic therapies, and 2 with other therapies. Average time to diagnosis was 194.7 and there were 10 hospitalizations, 5 ED visits, and 5 surgeries. Mesalamine use in CD was seen in 2 patients with L1 disease location, 4 with L2 disease location, 6 with L3 disease location, and 1 with L1 + L4 concurrent disease location. In the UC population, average time from symptom onset to diagnosis was 451.22. There were 4 hospitalizations, 4 ED visits, and 0 surgeries. Conclusion: Our cohort, though small, is indicative of the variance in practice patterns for the treatment of IBD. Although clinical trials have not consistently shown mesalamine to be effective in the treatment of Crohn's disease, it appears to be routinely used within the cohort. We speculate our results are reflective of IBD practice patterns across private clinics in the country. We did not find a correlation between diagnostic delay and complications. However our small sample size may have exaggerated the variation in times to diagnosis/treatment. We recognize the limitations in our study, most notably, small sample size and lack of diversity. For this reason, we have expanded our IRB to include the LSU public clinics in Baton Rouge. Additionally, we speculate a shortened time frame limited the risk of complications in the mesalamine cohort.