Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. Data are available upon reasonable request.

中文翻译：

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优化疑似 IBD 紧急转诊的分类：伯明翰 IBD 启动研究的结果


目的 炎症性肠病 (IBD) 的诊断延迟会导致不良后果。我们报告了一个定制的诊断途径，以评估如何最好地将临床病史和粪便钙卫蛋白 (FCP) 结合起来，以实现早期诊断和有效的资源利用。方法 对在紧急“两周等待”标准之外转诊的疑似 IBD 患者实施快速就诊途径。根据症状和 FCP 对患者进行分类。诊断前采集 13 点症状史并前瞻性收集临床指标，包括重复 FCP。结果 在 767 名患者中（2021 年 1 月至 2023 年 8 月），423 名患者被诊断患有 IBD（208 名克罗恩病（CD），215 名溃疡性结肠炎（UC））。 CD 中最常见的症状是腹痛 (84%)、稀便 (84%) 和疲劳 (79%)，而 UC 中最常见的症状是直肠周围出血 (94%)、尿急 (82%) 和稀便 (81%)。最强的 IBD 预测因子是粪便中混有血液（CD OR 4.38；95%CI 2.40–7.98，UC OR 33.68；15.47–73.33）和体重减轻（CD OR 3.39；2.14–5.38，UC OR 2.33；1.37–4.00）。重复 FCP 测试显示非 IBD 患者较基线有所减少。 >100 μg/g（曲线下面积 (AUC) 0.800）和 >200 μg/g（AUC 0.834）这两种测量值共同预测 IBD。然而，无论第一个结果如何，单独考虑第二个值 ≥220 μg/g 更为准确（约登指数 0.735，AUC 0.923）。使用 FCP 进行症状建模，AUC 增加至 0.947。结论 连续 FCP 测量可避免不必要的结肠镜检查。两个 >200μg/g 的 FCP 可以让患者直接进行结肠镜检查，两个 >100μg/g 的 FCP 可以提示临床审查。第二个结果≥220 μg/g 比双结果阈值更准确。将家庭 FCP 测试与关键症状结合起来可能构成有效自我转诊途径的基础。数据可根据合理要求提供。