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Originalité :
Intermédiaire
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Pas encore
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Nom du veilleur :
Docteur Stéphane NAHON
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Clinical Gastroenterology and Hepatology
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2018/09
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2018 Sep;16(9):1459-1466.
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doi: 10.1016/j.cgh.2017.11.006.
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Characteristics and Progression of Preclinical Inflammatory Bowel Disease.
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Rodríguez-Lago I, Merino O, Azagra I, Maiz A, Zapata E, Higuera R, Montalvo I, Fernández-Calderón M, Arreba P, Carrascosa J, Iriarte A, Portillo I, Aguirre U, Barreiro-de Acosta M, Muñoz-Navas M, Cabriada JL
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https://www.ncbi.nlm.nih.gov/pubmed/29133254
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Abstract
BACKGROUND & AIMS:
Inflammatory bowel disease (IBD) is a chronic disease usually diagnosed after the appearance of gastrointestinal symptoms. Little is known about IBD progression during its early and even preclinical phases. We aimed to determine the number of new incidental diagnoses of IBD in an older population, and evaluate disease progression from its early stages.
METHODS:
We performed a retrospective analysis of 31,005 colonoscopies performed during colorectal cancer screening of patients with positive results from fecal immunochemical tests, at 11 centers in the Basque Country (Spain) from 2009 through 2014. We collected clinical and laboratory data from all asymptomatic individuals suspected to have IBD during screening colonoscopies, with histologic confirmation.
RESULTS:
Colonoscopy screening led to 79 new diagnoses of ulcerative colitis, 24 of Crohn's disease, and 7 of unclassified colitis (average patient age, 57 y; interquartile range, 52-62 y; 57% male). Eleven patients had symptoms before colonoscopy and were excluded from the analysis. Among those patients who were asymptomatic at diagnosis, 36% developed symptoms after a follow-up period of 25 months (interquartile range, 10.5-42 mo), mostly rectal bleeding and diarrhea. Treatment was prescribed for 81 patients (88%), and 2 cases required surgery.
CONCLUSIONS:
We analyzed data from a large cohort of patients with IBD diagnosed at early or even preclinical stages, from an older population. New incidental diagnoses of IBD were made in 0.35% of individuals undergoing a population-based screening colonoscopy-most were classified as ulcerative colitis. Approximately one third of patients developed symptoms during the follow-up period.
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Quelles sont les caractéristiques des formes pré-cliniques de la RCH et de la maladie de Crohn ?
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À partir d’une base de 31000 coloscopies réalisées pour un test immunologique positif, les auteurs ont identifié 79 RCH, 24 Crohn, et 7 colites inclassées asymptomatiques. Après un recul de 25 mois, 36% ont développé une forme symptomatique (rectorragies ou diarrhée). Un traitement a été proposé chez 88% des patients.
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Dans ce travail, les formes pré-cliniques concernent principalement la RCH car il n’y a pas eu d’exploration du grêle par IRM. L’intérêt d’un diagnostic pré-clinique de la RCH est plutôt limité car dans la plupart des études le délai entre les premiers symptômes et le diagnostic se situe autour de 3 mois. L’enjeu d’un dépistage pré-clinique de la maladie de Crohn serait plus intéressant car la destruction intestinale se fait souvent à bas bruit.
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