P1081 - How Do IBD Patients Present? A Tertiary Care Center Study of Pre-Diagnostic Patient Journeys

Mao-Yuan Chen, MD, Aryan Ayati, MD, MPH, Goktug Onal, , Anshu Mukherjee, , Vivek Rudrapatna, MD, PhD
University of California San Francisco, San Francisco, CA

Introduction: Early and effective treatment of inflammatory bowel disease (IBD) is associated with patient outcomes, which highlights the importance of prompt and accurate diagnosis. Understanding the pre-diagnostic patient journey to identify signals can strengthen clinical awareness. We sought to identify the most common provider types and abnormalities preceding the diagnosis of IBD in newly diagnosed patients.

Methods: We included 406 adults newly diagnosed IBD at a tertiary center from 2012 onward. In-person visits and ICD codes up to 5 years before the earliest IBD-related ICD codes were extracted from our clinical data warehouse. K50–K52 (ICD-10) and 555–558 (ICD-9) ICD codes were excluded to avoid including signals directly related to the diagnosis of IBD. The first onset of each clinical department visit or ICD code was coded as the event date for each patient. The cumulative trajectories were examined at predefined time points counting backwards from diagnosis. Patients having the first record of visit/ICD code were classified as “in-system” for the respective analysis.

Results: Prior to the date of diagnosis, 68% of the in-system patients had visited gastroenterology (Figure 1). Around 30% of the in-system patients had visited general internists or dermatologists up to one year before diagnosis. A steady 20% visited primary care-related specialties throughout the whole trajectory. Hip pain and abdominal pain were consistently the most common ICD codes (21–25% each) up to 6 months before diagnosis, and leg pain was an early signal up to one year before diagnosis (Figure 2). ICD codes related to the gastrointestinal system, except abdominal pain, did not appear until six months before diagnosis (diarrhea). Common chronic diseases, such as hyperlipidemia and hypertension, remained frequent up to 3 months pre-diagnosis.

Discussion: In addition to general internists, dermatologists and obstetricians/gynecologists see many patients who may already harbor early signs or symptoms of IBD. These findings suggest a role for electronic health record-embedded algorithms to screen and flag patients from these clinics who could benefit from early GI referral. We also find that musculoskeletal complaints are common precursor symptoms of IBD, possibly more common than traditional IBD symptoms or lab test abnormalities. Future work is needed to validate these findings and to understand their pathophysiological significance.


Figure: Figure 1. Accumulated Trajectory of Visits up to Each Time Point since 5 Years before Diagnosis for Patients Newly Diagnosed with IBD. The cells were sorted based on decreasing cumulative frequencies at each time point. The numbers in parentheses indicate (the cumulative number of patients, the percentage of patients relative to the number of in-system patients). Since a patient can have multiple visits in the trajectory, the relative frequencies do not add up to 100%.


Figure: Figure 2. Accumulated Trajectory of Level-3 ICD Codes up to Each Time Point since 5 Years before Diagnosis for Patients Newly Diagnosed with IBD. The cells were sorted based on decreasing cumulative frequencies at each time point. The numbers in parentheses indicate (the cumulative number of patients, the percentage of patients relative to the number of in-system patients). Since a patient can have multiple ICD codes in the trajectory, the relative frequencies do not add up to 100%.

Disclosures:
Mao-Yuan Chen indicated no relevant financial relationships.
Aryan Ayati indicated no relevant financial relationships.
Goktug Onal indicated no relevant financial relationships.
Anshu Mukherjee indicated no relevant financial relationships.
Vivek Rudrapatna: Acucare – Advisory Committee/Board Member. Blueprint Medicines – Grant/Research Support. Data Unite – Advisory Committee/Board Member. Genentech – Grant/Research Support. Ironwood – Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events. Merck – Grant/Research Support. Microsoft – Grant/Research Support. Mitsubishi Tanabe – Grant/Research Support. Natera – Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events. Stryker – Grant/Research Support. Takeda – Grant/Research Support. ZebraMD – Advisory Committee/Board Member.

Mao-Yuan Chen, MD, Aryan Ayati, MD, MPH, Goktug Onal, , Anshu Mukherjee, , Vivek Rudrapatna, MD, PhD. P1081 - How Do IBD Patients Present? A Tertiary Care Center Study of Pre-Diagnostic Patient Journeys, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.