P072 The pathway IBD care in Rio de Janeiro from a tertiary referral center point of view Gomes Rafaela Roberta1, Nolasco Matheus Victor1, Azevedo Junior Carlos Edmilson1, Costa Marcia2, Zaltman Cyrla3 1 Division of Gastroenterology, Department of In

P072  The pathway IBD care in Rio de Janeiro from a tertiary referral center point of view

 

Gomes Rafaela Roberta1, Nolasco Matheus Victor1, Azevedo Junior Carlos Edmilson1, Costa Marcia2, Zaltman Cyrla3
1 Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 2 Fluminense Federal University, Niteroi, Brazil, 3 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

BACKGROUND: It’s well-established that both Crohn's disease and ulcerative colitis are a public health challenge worldwide¹. The complexity of the diagnosis and the lack of familiarity of primary care practitioners with the different IBD phenotypes can cause a delay in IBD recognition, referral to an IBD unit, and consequently treatment. The aim of this study is to evaluate patient care pathway since first symptoms until attendance in a tertiary IBD outpatient unit.

METHODS: Retrospective cohort study involving outpatients from a reference IBD unit from a University Federal Hospital in Rio de Janeiro (HUCFF-UFRJ), from 2015 to 2018. The data collected through structured interviews and medical record review were: sex; age at diagnosis; family history; initial and definitive diagnosis; the interval time between symptoms onset and definitive diagnosis; disease type and phenotype; extra-intestinal manifestations (EIM), number of medical appointments until definitive diagnosis; type of health system unit where the diagnosis occurred; and first treatment. Statistics were performed using SPSSv21 software.

RESULTS: 188 patients were included, 99 (52.6%) with CD and 89 (47.3%) with UC, the majority female (56,4%) with a predominant age group of 17 to 40 years in both diseases (72.7% CD; 52.8% RCU). Family IBD history was more frequent in CD (21.2% vs. 12.1%) (p = 0.08). Predominant initial treatment in the UC was with aminosalicylates (39.3%), whereas in CD, the use of symptomatic treatments (24.2%) prevailed. In both diseases, the presumptive IBD diagnosis was made in the private health system (40.4% CD; 46.1% UC), but the definitive diagnosis occurred mainly at the university public hospital (CD= 60.6% vs 21.2%; UC= 50.6% vs 31.5% UC, respectively), not occurring in basic care units. The earlier diagnosis (less than a year) was more significantly obtained in UC (50.6 %) in comparison to CD patients (28.3%) (p=0.001). The first symptoms in CD were in decrescent order: abdominal pain (78.8%), diarrhea (70.7%), and weight loss (63.6%); and in UC: rectal bleeding (80.9%), diarrhea (76.4%), and abdominal pain (53.9%). EIM was present in 43.7% UC and 34.4% CD, with a higher frequency of rheumatological manifestations in both diseases (DC 23.2%; UC 21.3%).

CONCLUSION(S): Despite the predominance of classic initial symptoms, the diagnosis of IBD was complex and mostly made in reference centers with a significative delay, mainly in CD patients. The introduction of treatment during the therapeutic window of opportunity in early disease modify progressive course of disease, delaying or preventing complications and patient’s quality of life. However, the local expertise, availability of minimal testing resources and an IBD care pathway with standardize referral patterns are necessary to provide an earlier diagnosis and treatment.