Intest Res.  2016 Jul;14(3):258-263. 10.5217/ir.2016.14.3.258.

Change in the diagnosis of inflammatory bowel disease: a hospital-based cohort study from Korea

• Lee HS
• Choe J
• Lee HJ
• Hwang SW
• Park SH
• Yang DH
• Kim KJ
• Ye BD
• Byeon JS
• Myung SJ
• Yoon YS
• Yu CS
• Kim JH
• Yang SK

• KMID: 2354968
• DOI: http://doi.org/10.5217/ir.2016.14.3.258

Abstract

BACKGROUND/AIMS
Accurately diagnosing inflammatory bowel disease (IBD) remains a challenge, but is crucial for providing proper management for affected patients. The aim of the present study was to evaluate the frequency of change in diagnosis in Korean patients who were referred to our institution with a diagnosis of IBD.
METHODS
We enrolled 1,444 patients diagnosed with ulcerative colitis (UC) and 1,452 diagnosed with Crohn's disease (CD), who had been referred to the Asan Medical Center between January 2010 and December 2014. These patients were assessed and subsequently classified as having UC, CD, indeterminate colitis, possible IBD, or non-IBD.
RESULTS
During a median follow-up of 15.9 months, 400 of the 2,896 patients (13.8%) analyzed in this study experienced a change in diagnosis. A change in diagnosis from UC to CD, or vice-versa, was made in 24 of 1,444 patients (1.7%) and 23 of 1,452 patients (1.6%), respectively. A change to a non-IBD diagnosis was the most common modification; 7.5% (108 of 1444) and 12.7% (184 of 1452) of the patients with a referral diagnosis of UC and CD, respectively, were reclassified as having non-IBD. Among the 292 patients who were ultimately determined not to have IBD, 135 (55 UC and 80 CD cases) had received IBD-related medication.
CONCLUSIONS
There are diagnostic uncertainties and difficulties in relation to IBD. Therefore, precise assessment and systematic follow-up are essential in the management of this condition.

Keyword

Crohn disease; Ulcerative colitis; Diagnosis; Inflammatory bowel diseases

MeSH Terms

Chungcheongnam-do
Cohort Studies*
Colitis
Colitis, Ulcerative
Crohn Disease
Diagnosis*
Follow-Up Studies
Humans
Inflammatory Bowel Diseases*
Korea*
Referral and Consultation

Figure

• 

  Fig. 1 Final diagnosis according to the initial diagnosis. Patients who were referred with the diagnosis of UC or CD were subsequently classified as having UC, CD, indeterminate colitis (IC), possible IBD, or non-IBD.

Reference

1. Moum B, Ekbom A, Vatn MH, et al. Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway. Gut. 1997; 40:328–332. PMID: 9135520.

2. Silverberg MS, Daly MJ, Moskovitz DN, et al. Diagnostic misclassification reduces the ability to detect linkage in inflammatory bowel disease genetic studies. Gut. 2001; 49:773–776. PMID: 11709510.

3. Henriksen M, Jahnsen J, Lygren I, et al. Change of diagnosis during the first five years after onset of inflammatory bowel disease: results of a prospective follow-up study (the IBSEN Study). Scand J Gastroenterol. 2006; 41:1037–1043. PMID: 16938716.

4. Yantiss RK, Odze RD. Pitfalls in the interpretation of nonneoplastic mucosal biopsies in inflammatory bowel disease. Am J Gastroenterol. 2007; 102:890–904. PMID: 17324129.

5. Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology. 2007; 133:1670–1689. PMID: 17983810.

6. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 1991; 325:928–937. PMID: 1881418.

7. Matsui T, Yao T, Sakurai T, et al. Clinical features and pattern of indeterminate colitis: Crohn's disease with ulcerative colitis-like clinical presentation. J Gastroenterol. 2003; 38:647–655. PMID: 12898357.

8. Geboes K, Colombel JF, Greenstein A, et al. Indeterminate colitis: a review of the concept –what's in a name? Inflamm Bowel Dis. 2008; 14:850–857. PMID: 18213696.

9. Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007; 5:1430–1438. PMID: 18054751.

10. Solberg IC, Lygren I, Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009; 44:431–440. PMID: 19101844.

11. Yang SK, Hong WS, Min YI, et al. Incidence and prevalence of ulcerative colitis in the Songpa-Kangdong District, Seoul, Korea, 1986-1997. J Gastroenterol Hepatol. 2000; 15:1037–1042. PMID: 11059934.

12. Yang SK, Yun S, Kim JH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study. Inflamm Bowel Dis. 2008; 14:542–549. PMID: 17941073.

13. Park SH, Yang SK, Park SK, et al. Long-term prognosis of crohn's disease and its temporal change between 1981 and 2012: a hospital-based cohort study from Korea. Inflamm Bowel Dis. 2014; 20:488–494. PMID: 24412992.

14. Lee HS, Park SH, Yang SK, et al. Long-term prognosis of ulcerative colitis and its temporal change between 1977 and 2013: a hospital-based cohort study from Korea. J Crohns Colitis. 2015; 9:147–155. PMID: 25518059.

15. Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989; 170:2–6. PMID: 2617184.

16. Park SH, Kim YM, Yang SK, et al. Clinical features and natural history of ulcerative colitis in Korea. Inflamm Bowel Dis. 2007; 13:278–283. PMID: 17206722.

17. Ye BD, Yang SK, Cho YK, et al. Clinical features and long-term prognosis of Crohn's disease in Korea. Scand J Gastroenterol. 2010; 45:1178–1185. PMID: 20560811.

18. Choi CH, Jung SA, Lee BI, et al. Diagnostic guideline of ulcerative colitis. Korean J Gastroenterol. 2009; 53:145–160. PMID: 19835217.

19. Ye BD, Jang BI, Jeen YT, et al. Diagnostic guideline of Crohn's disease. Korean J Gastroenterol. 2009; 53:161–176. PMID: 19835218.

20. Louis E. When it is not inflammatory bowel disease: differential diagnosis. Curr Opin Gastroenterol. 2015; 31:283–289. PMID: 26039719.

21. Schumacher G, Sandstedt B, Kollberg B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Clinical findings and early diagnosis. Scand J Gastroenterol. 1994; 29:265–274. PMID: 8209188.

22. Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy. 2006; 38:592–597. PMID: 16673312.

23. Ye BD, Yang SK, Kim D, et al. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis. 2012; 16:799–804. PMID: 22508109.

24. Ko JK, Lee HL, Kim JO, et al. Visceral fat as a useful parameter in the differential diagnosis of Crohn's disease and intestinal tuberculosis. Intest Res. 2014; 12:42–47. PMID: 25349562.

25. Weng MT, Wei SC, Lin CC, et al. Seminar report from the 2014 Taiwan Society of Inflammatory Bowel Disease (TSIBD) spring forum (May 24th, 2014): Crohn's disease versus intestinal tuberculosis infection. Intest Res. 2015; 13:6–10. PMID: 25691838.

26. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol. 2002; 97:1446–1451. PMID: 12094863.

27. Epstein D, Watermeyer G, Kirsch R. Review article: the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther. 2007; 25:1373–1388. PMID: 17539977.

28. Almadi MA, Ghosh S, Aljebreen AM. Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge. Am J Gastroenterol. 2009; 104:1003–1012. PMID: 19240705.

29. Makharia GK, Srivastava S, Das P, et al. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol. 2010; 105:642–651. PMID: 20087333.

30. Thia KT, Loftus EV, Jr . , Sandborn WJ, Yang SK. An update on the epidemiology of inflammatory bowel disease in Asia. Am J Gastroenterol. 2008; 103:3167–3182. PMID: 19086963.

31. Loke YK. Use of databases for clinical research. Arch Dis Child. 2014; 99:587–589. PMID: 24489362.

32. Molodecky NA, Panaccione R, Ghosh S, Barkema HW, Kaplan GG;. Challenges associated with identifying the environmental determinants of the inflammatory bowel diseases. Inflamm Bowel Dis. 2011; 17:1792–1799. PMID: 21744435.

33. Kaplan GG. Pitfalls and perils of using administrative databases to evaluate the incidence of inflammatory bowel disease overtime. Inflamm Bowel Dis. 2014; 20:1777–1779. PMID: 25159456.

34. Ngeow J, Eng C. New genetic and genomic approaches after the genome-wide association study era–Back to the future. Gastroenterology. 2015; 149:1138–1141. PMID: 26073374.

35. Lee KM, Kim YS, Seo GS, Kim TO, Yang SK. IBD Study Group of the Korean Association for the Study of Intestinal Diseases. Use of thiopurines in inflammatory bowel disease: a consensus statement by the Korean Association for the Study of Intestinal Diseases (KASID). Intest Res. 2015; 13:193–207. PMID: 26130993.