An exact diagnosis and subclassifications of inflammatory bowel disease (IBD) may be difficult even after clinical, radiological and histological examinations.
A correct subclassification is important for the success of both medical and surgical therapeutic strategies.
However, there is a dearth of information available on the frequency of changes in diagnosis in population-based studies.
Dr Magne Henriksen and colleagues from Norway prospectively re-evaluated the diagnosis in an unselected cohort of IBD patients.
The team of doctors assessed the patients during the first 5 years after the initial diagnosis.
Patients classified as IBD or possible IBD in the period 1990 to 1994, known as the IBSEN cohort had their diagnosis re-evaluated after 1 and 5 years.
Initially, the patients were classified as ulcerative colitis, Crohn's disease, indeterminate colitis or possible IBD.
At the 5-year visit, the doctors classified the patients as ulcerative colitis, Crohn's disease or non-IBD.
The team of doctors identified a total of 843 patients.
|Indeterminate colitis classifications were re-diagnosed as non-IBD after 5 years|
|Scandanavian Journal of Gastroenterology|
Of these, 518 had ulcerative colitis, 221 had Crohn's disease, 40 had indeterminate colitis and 64 presented with possible IBD.
Clinical information was available for 94% of the patients who survived after 5 years.
The doctors found a change in diagnosis in 9% of the patients initially classified as ulcerative colitis or Crohn's disease.
A change to non-IBD was more frequent than a change between ulcerative colitis and Crohn's disease.
A large proportion of patients initially classified as indeterminate colitis or possible IBD were diagnosed as non-IBD after 5 years.
The team noted that when IBD was confirmed in these groups, ulcerative colitis was more frequent than Crohn's disease.
The doctors observed 2 changes in diagnosis during follow-up in 3% of the patients.
The changes in diagnosis were more frequent in patients initially classified as indeterminate colitis or possible IBD.
Dr Henriksen's team concludes, “There are obvious diagnostic problems in a minority of patients with IBD.”
“A systematic follow-up is therefore important in these patients.”