Disease course of inflammatory bowel disease unclassified in a European population‐based inception cohort: An Epi‐IBD study

Abstract

Background and Aim A definitive diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) is not always possible, and a proportion of patients will be diagnosed as inflammatory bowel disease unclassified (IBDU). The aim of the study was to investigate the prognosis of patients initially diagnosed with IBDU and the disease course during the following 5 years. Methods The Epi‐IBD study is a prospective population‐based cohort of 1289 IBD patients diagnosed in centers across Europe. Clinical data were captured prospectively throughout the follow‐up period. Results Overall, 476 (37%) patients were initially diagnosed with CD, 701 (54%) with UC, and 112 (9%) with IBDU. During follow‐up, 28 (25%) IBDU patients were changed diagnoses to either UC (n = 20, 71%) or CD (n = 8, 29%) after a median of 6 months (interquartile range: 4–12), while 84 (7% of the total cohort) remained IBDU. A total of 17 (15%) IBDU patients were hospitalized for their IBD during follow‐up, while 8 (7%) patients underwent surgery. Most surgeries (n = 6, 75%) were performed on patients whose diagnosis was later changed to UC; three of these colectomies led to a definitive diagnosis of UC. Most patients (n = 107, 96%) received 5‐aminosalicylic acid, while 11 (10%) patients received biologicals, of whom five remained classified as IBDU. Conclusions In a population‐based inception cohort, 7% of IBD patients were not given a definitive diagnosis of IBD after 5 years of follow‐up. One in four patients with IBDU eventually was classified as CD or UC. Overall, the disease course and medication burden in IBDU patients were mild.

Quality of Care Standards in Inflammatory Bowel Diseases: a European Crohn’s and Colitis Organisation [ECCO] Position Paper

“…Up to 50% of patients experience at least one extra-intestinal manifestation of IBD 15 . Both CD and UC impair daily life and psychological well-being significantly, and both can lead to permanent disability [16][17][18][19] .…”

Perception of the COVID-19 Pandemic Among Patients With Inflammatory Bowel Disease in the Time of Telemedicine: Cross-Sectional Questionnaire Study (Preprint)

“…The survey included questions about whether patients felt more susceptible to SARS-CoV-2 infection compared to the general population, whether they preferred to avoid going to the hospital, and their thoughts about remote consultation. We recorded patients' sex, date of birth, time of IBD diagnosis, region of origin (Veneto or Campania), and type of disease (ie, Crohn disease, ulcerative colitis, and unclassified disease) [16]. We also asked for information regarding patients' ongoing therapy and comorbidities.…”

Discriminant equation using mucosally expressed cytokines and transcription factor for making definite diagnosis of inflammatory bowel disease unclassified

“…Additionally, in patients with suspected CD or IBD-U, double-balloon enteroscopy or barium examination of the small intestine was performed. Patients who did not meet all the criteria but had the features of IBD that cannot be classified as UC or CD were designated as IBD-U [1,3]. According to the Montreal classification, IBD-U is suggested for patients in whom there is clinical and endoscopic evidence for IBD affecting the colon, without small bowel involvement [4].…”

“…However, UC and CD are heterogeneous diseases, including a variety of complex phenotypes. Therefore, approximately 2-9% of the patients with IBD do not meet the diagnostic criteria of UC or CD [2,3]. These cases are classified as inflammatory bowel diseaseunclassified (IBD-U) [4].…”