S813 Cross-Sectional Imaging and Colonoscopy versus Colonoscopy Alone in the Diagnostic Yield of Active Inflammatory Bowel Disease

Abstract

Introduction: Crohn’s disease (CD) and Ulcerative Colitis (UC), the two major forms of inflammatory bowel disease (IBD), are characterized by periods of flares and remission. Identifying active inflammation during a hospital admission for patients with disease symptoms can help determine appropriate therapy. Intestinal inflammation is assessed using cross sectional imaging (XCI: magnetic resonance imaging or computed tomography scan), colonoscopy or a combination of both. The aim of this study was to assess if XCI in combination with colonoscopy versus colonoscopy alone increases diagnostic yield of inflammation in patients with IBD symptoms. Methods: Retrospective analysis of adults with an ICD-9/10 code diagnosis of IBD during hospitalization for IBD flare symptoms at a tertiary care center between January 1st 2013 to June 1st 2017. Active inflammation was defined by chronic active histologic changes seen on targeted ileal or colonic biopsies or by inflammation seen in terminal ileum or colon on XCI. Data including the patients’ XCI and colonoscopy reports were extracted from the institution’s integrated electronic data repository and electronic chart review. This study was approved by the institutional review board. For analysis of categorical variables, chi-square test was used. Results: A total of 760 unique patients were analyzed of which 519 (348 CD, 160 UC, 11 mixed) met inclusion criteria (mean age: 53.8 years, 49.7% men). Twenty two percent (118/519, 22.7%) had both imaging and colonoscopy during hospitalization while 72 (13.9%) had colonoscopy alone. Biopsies were obtained in 135/190 patients who underwent colonoscopy. Active inflammation was detected in 117/135 biopsy samples. Active inflammation was detected more frequently when both XCI and colonoscopy were used to assess disease activity than that identified only by colonoscopy (88.2% versus 83.7%; p< 0.0001). For CD, XCI and colonoscopy significantly detected more cases of active inflammation than colonoscopy alone (86.8% versus 83.3%; p< 0.0001). In UC, the addition of XCI did not increase diagnostic yield of active inflammation. Conclusion: Appropriate care of hospitalized patients with IBD relies on the identification of active inflammation. In our hospitalized cohort with CD, active inflammation was identified more often with a combination of XCI and colonoscopy. Multimodality assessment in hospitalized patients with symptoms of active disease adds important information that can improve care and ultimately, disease outcomes.