Patients with suspected inflammatory bowel disease (IBD) could benefit from better testing protocols that would reduce the need and long wait for potentially unnecessary colonoscopies, according to a new study.
In an article published in First-line gastroenterologyResearchers at the University of Birmingham’s Birmingham NIHR Biomedical Research Center (BRC) tested a new protocol to improve the diagnosis of IBD by combining clinical history with multiple home stool tests.
In the two-year study involving 767 participants, patients were triaged and subjected to repeated fecal calprotectin (FCP) testing and the research team found that using serial FCP testing could accurately predict possible IBD, as well as Crohn’s disease and ulcerative colitis.
The team noted that a second FCP test was a strong indicator of a possible need for further investigations, including colonoscopy; although the researchers noted that only 20% of patients were presented with two samples before being referred to secondary care.
Dr Peter Rimmer from the University of Birmingham’s Birmingham NIHR Biomedical Research Center and corresponding author of the study said:
“Patients experiencing symptoms associated with inflammatory bowel diseases often have to wait a long time for a diagnosis, and current testing is under enormous pressure.
“Using a comprehensive 13-point symptom checker and multiple FCP tests, we have been able to much more accurately identify patients who had IBD and other diseases. Implementing this protocol could reduce the time needed to obtain a diagnosis and initiate treatment for IBD as many more screening tests can be performed through primary care. The sensitivity of multiple FCP tests can be used to detect those patients who need urgent referral to secondary care.
Dr Rachel Cooney, consultant gastroenterologist at University Hospitals Birmingham NHS Foundation Trust, researcher at NIHR Birmingham BRC and co-author of the study, added:
“In its simplest form, this study may help improve referral triage for patients with IBD. But as we plan new pathways of care, it could open up exciting new possibilities: With the increasing availability of at-home FCP tests, the results of these tests combined with simple symptom questionnaires could feed algorithms that allow patients to self-refer to secondary care services, reducing strain on primary care. This is something we will explore in a large follow-up study we are currently launching. “.