P079 Men, Medications, Insurance, and Age at Diagnosis are associated with Inconsistent Adherence to Surveillance Colonoscopies in IBD

Atienza Matthew1, Hennessey Megan1, Rao Sanjana1, Houle Matthew1, Dharia Ishaan1, Hayrapetian Laurie1, Zepp Molly1, Borum Marie1
1 George Washington University School of Medicine, Washington, United States

BACKGROUND: Inflammatory Bowel Disease (IBD) is a chronic, inflammatory disorder of the gastrointestinal tract that increases the risk of colorectal cancer. Patients diagnosed with IBD are, therefore, recommended to have surveillance colonoscopies to enable early detection of colorectal malignancy. Patients with ulcerative colitis (UC) and Crohn’s colitis are advised to have surveillance colonoscopies every 1-3 years beginning 8 years after diagnosis. It has been reported that IBD patients may not consistently undergo recommended surveillance. This study evaluated patient factors that may affect adherence to colonoscopy surveillance in inflammatory bowel disease.

METHODS: A retrospective chart review of all IBD patients managed at an academic gastroenterology practice for the past 3 years was performed. All patients with a diagnosis of UC or Crohn’s colitis for ≥8 years were included. There were no exclusion factors. Patient gender, race, IBD subtype, current age, age at diagnosis, medication regimen, insurance status (private; public: Medicaid and Medicare) and the date of the most recent colonoscopy were obtained. Patients were deemed compliant with surveillance colonoscopy guidelines if they had a colonoscopy 8 years after initial diagnosis or within 3 years of the previous one. A confidential database was created using Microsoft Excel. Statistical analysis was performed using Fisher’s exact test with significance set at p<0.05. The study was IRB approved.

RESULTS: 171 patients were evaluated. 131 (76.6%) had a diagnosis of UC, 38 (22.2%) had Crohn’s colitis, and 2 (1.2%) had indeterminate colitis. 103 (60.2%) were female and 68 (39.8%) were male. The mean age was 47.8 years (range: 22- 83). 94 (55.0%) were White, 48 (28.1%) African American, 6 (3.5%) Asian, 1 (0.6%) Hawaiian/Pacific Islander, and 22 (12.9%) declined identification. 106 patients (62.0%) had surveillance colonoscopies within the recommended timeframe, and 65 patients (38.0%) were not compliant with recommendations. There was no significant difference in the rate at which surveillance colonoscopies were performed based upon patient’s current age (67.3% ≤50 years vs 54.3% >50 years, p=0.109), race (56.4% White vs 70.8% African American, p=0.1046; 56.4% White vs 66.7% Asian, p=0.6971; other racial group comparisons p=1.000) or disease subtype (65.6% UC vs 50% CD, p=0.0899). There was a significant difference in the rate at which colonoscopies were performed based upon gender (p=0.0103), age at diagnosis (67.6% ≤30 years vs 51.7% >30 years; p=0.0483), medication regimen (54% biologic / immunologic vs 71% other medications; p=0.023) and insurance status (66.2% private vs 47.5% public; p=0.0412).

CONCLUSION(S): Surveillance colonoscopies to decrease colon cancer risk are an important aspect of IBD care. This study, consistent with other reports, revealed that IBD patients have suboptimal compliance with colon cancer surveillance. Overall, only 62% of patients had their colonoscopies at the recommended time. Men and individuals diagnosed > 30, on biologic / immunologic therapy or on public insurance were less often adherent to colonoscopy guidelines. While this study is limited due to small size and retrospective design, it can serve as a foundation for further research. It is crucial that factors effecting adherence to colon cancer surveillance are identified.