Understanding the Link Between Patient Symptoms and Provider Goals for Mucosal Healing in IBD: Insights from the IBD
Angela Troia1, Sarah Harvey2, Angela Wu3
1Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Building 2, Washington, DC, 20007, USA. Angela.Troia@medstar.net.
Background:
Although symptom severity has traditionally guided treatment decisions in inflammatory bowel disease (IBD), symptoms do not reliably reflect the degree of underlying intestinal inflammation. Mucosal healing has emerged as a critical treatment goal, owing to its strong association with improved long-term outcomes. Despite this paradigm shift, it is unclear how symptom severity influences clinicians' decisions to assess for or pursue mucosal healing in routine practice.
Methods:
We analyzed 5460 matched patient and provider surveys collected from June 2021 to October 2022 through the Crohn's and Colitis Foundation's national quality improvement program, IBD Qorus. Patient-reported symptoms, including stool frequency, rectal bleeding, abdominal pain and general sense of wellbeing, were evaluated in relation to provider-reported plans for endoscopy, fecal calprotectin testing, and treatment changes.
Results:
Among patients reporting clinical remission, providers still planned endoscopy or stool biomarker testing within one year in over 60% of cases. Increased symptom severity-especially greater stool frequency, rectal bleeding, and worse general wellbeing-was significantly associated with earlier testing and treatment changes. Abdominal pain was not associated with these decisions. Providers expressed uncertainty regarding the timing of stool biomarker testing, particularly in patients with Crohn's disease. Higher composite symptom scores were consistently associated with an increased likelihood of both testing and treatment adjustment.
Conclusion:
Provider decisions to assess or treat for mucosal healing are associated with, but not fully driven by, symptom severity.
More Related Videos
07:05Important Endpoints and Proliferative Markers to Assess Small Intestinal Injury and Adaptation using a Mouse Model of Chemotherapy-Induced Mucositis
Published on: May 12, 2019
08:52Performing Colonoscopic-Guided Pinch Biopsies in Mice and Evaluating Subsequent Tissue Changes
Published on: February 5, 2021
Related Concept Videos
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Irritable Bowel Syndrome III: Medical and Nursing Management
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:28Peptic Ulcer Disease II: Pathophysiology
Damaging agents such as Helicobacter pylori, gastric acid, pepsin, and nonsteroidal anti-inflammatory drugs (NSAIDs) can weaken the mucosal defense, allowing hydrogen ions to infiltrate back and harm epithelial cells.