Docs Misclassify IBD in Survey

Published: Oct 30, 2014

By Nancy Walsh, Senior Staff Writer, MedPage Today

PHILADELPHIA -- The severity of inflammatory bowel disease is significantly underestimated by gastroenterologists, results of a survey indicated.

A total of 55% and 67% of physicians who participated in a web-based survey rated cases of Crohn's disease and ulcerative colitis as being mild when they were actually moderate, according to Tauseef Ali, MD, of the University of Oklahoma, and colleagues.

Similarly, for case studies that represented severe disease, 76% and 81% of the physicians gave ratings of either moderate or mild for Crohn's disease and ulcerative colitis, respectively, Ali and colleagues reported in a poster session at the annual meeting of the American College of Gastroenterology here.

"The implication of these findings is that clinicians may not be choosing therapies that have been approved and are indicated for moderate to severe disease, such as a tumor necrosis factor inhibitor, which could have an impact on disease outcome and prevent complications," Ali told MedPage Today.

In clinical trials, the severity of Crohn's disease and ulcerative colitis are assessed according to the Harvey Bradshaw index and the Mayo score, respectively.

The Bradshaw index rates the degree of overall well-being, abdominal pain, number of soft or liquid stools, complications such as fissures and fistulas, and the presence of an abdominal mass, providing a numerical score in which remission is less than 5 and severe disease is above 16.

The Mayo scoring system rates stool frequency, rectal bleeding, endoscopy findings, and physician's global assessment, giving scores from zero to 12, with higher scores representing worse disease.

The survey consisted of multiple choice questions about six cases, three for Crohn's and three for ulcerative colitis, which together represented mild, moderate, and severe cases of the two diseases.

Each case included information about patient age, primary complaint, number of liquid stools and the presence of blood, physical examination and endoscopy findings, extra-intestinal symptoms, and co-morbidities.

A total of 200 gastroenterologists participated, all of whom had been in practice for at least a year in an academic or community setting.

Only for the mild cases did a majority of the survey participants answer correctly, at 75% and 79%, respectively, for Crohn's disease and ulcerative colitis.

"We need to develop a tool that could combine clinical symptoms, biochemical findings, radiologic data, and endoscopy results, along with disease phenotype, to better assess and monitor disease activity and response to treatment. This could help us standardize clinical data and improve communication among physicians," Ali said in an interview.