New Testing Protocol Accelerates Diagnosis Pathway for Patients with IBD

Studies have shown that delayed diagnosis of inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, can increase the risk of serious complications. For ulcerative colitis, this could include an increased risk of colectomy. With Crohn’s disease, it could mean a higher chance of intestinal structuring.

Diagnosing IBD involves reviewing symptoms, analyzing a combination of blood and fecal biomarkers, and performing a confirmatory endoscopy. Delays in obtaining an endoscopy could be a limiting factor in expediting the diagnosis.

In a study published recently in Frontline Gastroenterology, researchers from the Birmingham HIHR Biomedical Research Centre at the University of Birmingham in the U.K. analyzed a new protocol to expedite IBD diagnosis in patients referred to the Birmingham IBD inception pathway from January 2021 to August 2023. The Birmingham inception pathway is a rapid-access clinic intended to accelerate the diagnosis of patients older than 16 years with suspected IBD.

A total of 767 participants were included in the study. Each received an at-home stool sample collection kit and was asked to bring the sample to their first appointment for analysis of fecal calprotectin (FCP), a commonly used marker in IBD diagnosis. At the first appointment, a 13-point symptom history was taken. Repeated FCP tests were performed before endoscopy referral.

Peter Rimmer, Ph.D.

Lead researcher Peter Rimmer, Ph.D., and his colleagues found that the use of serial FCP tests in combination with a symptom history strongly predicted potential IBD. A second FCP test was the strongest indicator of a potential need for a colonoscopy.

Rimmer and his colleagues concluded that serial FCP testing could prevent unnecessary colonoscopies and streamline a self-referral pathway for endoscopies when necessary.

The authors wrote, “With the growing availability of home FCP testing, symptom complexes and FCP values could feed into algorithms that allow self-referral to secondary care services. The provision of simple symptom questionnaires and home delivered FCP testing could reduce strain on primary care, allow rapid identification and prioritization of those most likely to have IBD.”

The researchers plan to validate their findings in a large follow-up study.