Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing in incidence in many countries of the world, especially in countries were infectious colitis are still prevalent. One challenge of research combining IBD patients from different international centers is the possibility that practice variation may affect the diagnosis and treatment decisions at each country. We aim to examine the variation in the diagnosis of IBD using survey-administered clinical vignettes to validate international cooperation in research. Participating organizations included the Crohn’s & Colitis Foundation, the Asian Organization for Crohn’s & Colitis (AOCC), the Asian Pacific Association of Gastroenterology (APAGE), the Crohn’s & Colitis Foundation of India, the European Crohn’s and Colitis Organisation (ECCO), and the Lebanese Society of Gastroenterology (LSGE). Gastroenterologist and IBD specialist survey respondents were presented 3 clinical vignettes. First the entire H&P and laboratory values were given and participants selected an initial diagnosis. Then the colonoscopy stills and pathology report were given for a final diagnosis. The diagnoses listed in multiple choice format were CD, UC, IBD-U, TB, CMV, C. difficile, parasitic, lymphocytic, collagenous, NSAID-induced or other colitis. In this exploratory analysis, we used the Cochran-Mantel-Haenszel statistic to look at the consensus in final diagnosis of IBD colitis (CD, UC or IBD-U) or infectious colitis (TB, CMV, C. difficile or parasitic etiologies) or other forms of colitis (lymphocytic, collagenous, NSAIDs-induced or other etiologies) between Asia, Europe and North America. We also looked at the change of diagnosis once colonoscopic and pathologic data were presented. We analyzed 269 participants. 61.5% were from Asia, 15.2% were from Europe and 23.4% were from North America. 78.8% were GI attendings and 10.8% were fellows in training. 41.3% completed specialized IBD training. 21.2% had an IBD-heavy patient cohort (>50% of all patients seen). 77.3% completed their medical education, training and practice in the same country. The general median year in practice was 6, ranging between -1 (still in training) to 61 years. Table 1 shows that there was consensus among the different causes of colitis in 9 out of 10 cases. Said case was diagnosed as IBD by 62.5% of European, while participants from Asia and North American diagnosed the case as infectious colitis (62.5% and 81.8% respectively). Otherwise, there was consensus in the same diagnosis type after reviewing colonoscopic and pathologic data in all ten cases. The study showed nominal variation in diagnosis of IBD around the world. There is no need to account for such variation when conducting international clinical trials.
Read full abstract