S1520 How Do IBD Patients Present? A Tertiary Care Center Study of Pre-Diagnostic Patient Journeys

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 International Classification of Diseases codes up to 5 years before the earliest IBD-related International Classification of Diseases codes were extracted from our clinical data warehouse. K50–K52 (International Classification of Diseases-10) and 555–558 (International Classification of Diseases-9) International Classification of Diseases codes were excluded to avoid including signals directly related to the diagnosis of IBD. The first onset of each clinical department visit or International Classification of Diseases 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/International Classification of Diseases 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. 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 International Classification of Diseases codes (21–25% each) up to 6 months before diagnosis, and leg pain was an early signal up to one year before diagnosis. International Classification of Diseases codes related to the gastrointestinal system, except abdominal pain, did not appear until 6 months before diagnosis (diarrhea). Common chronic diseases, such as hyperlipidemia and hypertension, remained frequent up to 3 months pre-diagnosis. Conclusion: 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 gastroenterology 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.