PWE-017 From diarrhoea to diagnosis: an analysis of faecal calprotectin use in an IBD referral pathway

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Abstract

Introduction

The volume of referrals to gastroenterology from primary care is steadily increasing. In order to prioritise appointments for suspected inflammatory bowel disease (IBD), a pathway for primary care assessment and referral of patients to a specialist IBD clinic was introduced in Telford and Wrekin in 2015, based on NICE guidelines. This took symptoms, baseline bloods and faecal calprotectin (FC) result into account. We reviewed the efficacy and outcome of referrals following implementation of the pathway.

Methods

A retrospective analysis of all patients in Telford and Wrekin who had a FC requested between September 2015 and September 2016. Electronic data were collected contemporaneously by the pathology laboratory on patients’ age, gender and FC result. Further retrospective analysis of the cohort assessed whether a referral was made, the outcome of the referral, including endoscopy findings if performed, and diagnosis. The cohort was divided into three groups based on the FC result: negative, indeterminate and positive. The number of referrals that followed the IBD pathway was recorded for each group.

Results

506 patients had FC requested over 12 months. Ages ranged from 1 to 88 years and 63% were female. 244 were referred to secondary care. The likelihood of being referred correlated with the absolute FC value (table 1).

Conclusion

FC remains a sensitive marker of IBD in the symptomatic population. Whilst GP’s are being guided by FC result when making referrals, there remains a significant number of patients who are being referred with IBS. In over a fifth of referrals the FC is obsolete as the patient requires a two week wait colorectal cancer appointment. This has financial implications as each FC assay costs £35. Thus there is still progress to be made regarding implementation of the IBD pathway.

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