Trends in Biochemical Parameters, Healthcare Resource and Medication Use in the 5 Years Preceding IBD Diagnosis: A Health Maintenance Organization Cohort Study

Cohen, Nathaniel A.; Kliper, Efrat; Zamstein, Noa; Ziv‐Baran, Tomer; Waterman, Matti; Hodik, Gabriel; Ben‐Tov, Amir; Kariv, Revital

doi:10.1007/s10620-022-07714-2

Cited by 5 publications

(10 citation statements)

References 30 publications

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“…Further, the median age of this cohort, and thereby comorbid conditions and other variables, may limit the generalizability of these data. However, this data are consistent with other reports on increased healthcare utilization preceding IBD diagnosis 5 . Together, these studies suggest that nonspecific symptoms may be ongoing for many years before diagnosis.…”

supporting

confidence: 91%

mentioning

confidence: 95%

“…However, this data are consistent with other reports on increased healthcare utilization preceding IBD diagnosis. 5 Together, these studies suggest that nonspecific symptoms may be ongoing for many years before diagnosis. Comparatively, those with symptoms leading up to IBD diagnosis had even higher healthcare utilization, implying that gradual escalation of symptoms (and inflammation) may be the final stage leading to IBD diagnosis.…”

mentioning

confidence: 95%

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Preclinical IBD: One more piece of the puzzle

Agrawal

Torres

2023

UEG Journal

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Over the recent years, increasing evidence has strengthen the concept that inflammatory bowel disease (IBD) diagnosis is preceded by dysregulated immune pathways, altered intestinal permeability, dysbiosis, and other pathogenic mechanisms, that set the stage for disease to become clinically manifest. Understanding this preclinical period 1 can help deconvolute IBD pathogenesis, lead to prediction tools, novel therapeutic strategies, and preventive interventions. The study by Rodrigues-Lago et al provides new insights into preclinical IBD. 2 Leveraging the population-based Basque Colorectal Cancer Screening Programme (individuals aged 50-69, invited to undergo colonoscopy following a positive fecal immunochemical test), the authors originally described incidental IBD diagnosis in 0.35% of this asymptomatic cohort. 2,3 In the current study, they retrospectively explore healthcare and medication utilization in the years preceding IBD diagnosis; 124 individuals with incidental IBD diagnosed during their screening colonoscopy [current study citation] were age and gender-matched in a 1:3 ratio to 372 healthy controls (HC), and to 305 IBD patients with symptoms prior to IBD diagnosis. The primary endpoints included outpatient and emergency care visits, hospital admissions, radiological examinations, and antibiotics and corticosteroids prescriptions, 3-5 years before diagnosis (excluding the 12 months preceding diagnosis).Compared to HC, individuals with incidental IBD had higher primary and specialized care, and higher use of corticosteroids.Compared to those with incidental IBD, those with symptoms preceding IBD diagnosis had increased utilization of specialist and emergency care, radiological examinations, and antibiotics and corticosteroids prescriptions.Access to endoscopic and clinical data is a strength of this study. Indeed, while previous studies have reported on biomarkers of inflammation up to 10 years before IBD diagnosis, it remains unclear when mucosal lesions occur. 4 And while these data do notThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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supporting

confidence: 91%

mentioning

confidence: 95%

mentioning

confidence: 95%

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Preclinical IBD: One more piece of the puzzle

Agrawal

Torres

2023

UEG Journal

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“…Finally, a previous study found that in the 5-year period before diagnosis, patients with CD had higher use of antibiotics, proton pump inhibitors, and etanercept than patients with UC. The same study also found that patients with CD, but not UC, had increased use of nonsteroidal anti-inflammatory drugs, antibiotics, and steroids in the 2 years before diagnosis (18). Interestingly, in a sensitivity analysis including 66% of our study population, we found increased medication use, especially in the CD population, 15 years before a diagnosis of IBD.…”

Section: Discussionmentioning

confidence: 85%

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

et al. 2023

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Objectives There is growing interest in the pre-diagnostic phase of inflammatory bowel disease (IBD) and in the overlap of IBD with other diseases. We described and compared use of any prescription medication between individuals with and without IBD in a ten-year period preceding diagnosis. Methods Based on cross-linked nationwide registers, we identified 29,219 individuals diagnosed with IBD in Denmark between 2005 and 2018 and matched to 292,190 IBD-free individuals. The primary outcome was use of any prescription medication in years 1-10 prior to IBD diagnosis/matching date. Participants were considered as medication users if they redeemed ≥1 prescription for any medication in the WHO anatomical therapeutic classification (ATC) main or subgroups before diagnosis/matching. Results The IBD population had a universally increased use of medications compared to the matched population prior to IBD diagnosis. At ten years before diagnosis, the proportion of users was 1.1- to 1.8-fold higher in the IBD population in 12 of 14 ATC main groups of medication, p-value <0.0001. This applied across age, sex, and IBD subtypes, although most pronounced for Crohn’s disease (CD). Two years prior to diagnosis, the IBD population had a steep increase in medication use for several organ systems. When analyzing therapeutic subgroups of medication, the CD population exhibited 2.7, 2.3, 1.9, and 1.9 times more users of immunosuppressants, antianemic preparations, analgesics, and psycholeptics than the matched population ten years prior to diagnosis (p-value <0.0001). Conclusions Our findings demonstrate universally increased medication use years before IBD, especially CD, and indicates multiorgan involvement in IBD.

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“…What was the proportion of patients with ‘any fistula’ or ‘perianal CD’ in ‘Fluoroquinolone users with later IBD’ versus in ‘users of any other antibiotic with later IBD’? Given that many patients with IBD develop symptoms years before IBD diagnosis,6 is there a risk that the use of Fluoroquinolone still represents reverse causation in response to fistula from CD, even though you excluded the first year after antibiotic use?…”

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confidence: 99%

Antibiotic use and inflammatory bowel disease: number needed to harm?

Ludvigsson

2023

Gut

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Trends in Biochemical Parameters, Healthcare Resource and Medication Use in the 5 Years Preceding IBD Diagnosis: A Health Maintenance Organization Cohort Study

Cited by 5 publications

References 30 publications

Preclinical IBD: One more piece of the puzzle

Preclinical IBD: One more piece of the puzzle

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

Antibiotic use and inflammatory bowel disease: number needed to harm?

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