The management and treatment of Inflammatory Bowel Disease (IBD) can be varied and complex. While the advancement of medicine has created a multitude of different classes of drugs, it also calls for greater surveillance and monitoring. Treatment of IBD with biologic medicines requires tuberculosis screening prior to the initiation of therapy. For the gastroenterologist it requires multiple steps of screening, interpretation of data, and clear documentation prior to evaluating patients as possible candidates for these therapies. The complexity of patients' co-morbidities requires the aid of primary care and other specialties to ensure that all medical needs are met in a timely and safe manner.Methods:
The study utilized an electronic medical record system at an urban-based academic medical center to assess the rate of screening for tuberculosis (TB) prior to initiating treatment of IBD with biologic therapy such as tumor necrosis factor (TNF) inhibitors. The research protocol allowed the investigators to conduct a 6-month retrospective analysis on IBD patients who presented to clinic for established follow up care. The study analyzed the rate of TB screening in patients with a diagnosis of Crohn's or Ulcerative Colitis who were either on continuing biologic therapy or initiating treatment due to ongoing symptoms and/or worsening severity. Statistical analysis utilizing a one-tailed Fisher's Exact Test with a P-value set less than 0.05 was used to interpret the results of our study.Results:
A total of 275 patients were evaluated during this 6-month period. Of the 163 patients with a diagnosis of Crohn's disease 77 (47%) were screened for TB. In comparison, only 37 (33%) out of a total of 112 patients with a diagnosis of Ulcerative Colitis were screened. The 2 tailed study highlighted a P-value of 0.02 associated with the statistically significant data outlined in this study.Conclusions:
The analysis identified a difference in the rates of screening between Crohn's and Ulcerative Colitis patients in terms of TB screening. There may be a multitude of reasons to explain the difference in screening rates between these 2 groups of IBD patients. One, it may be linked to the severity of disease as UC patients have more visible signs and symptoms and as a result may be treated in a timely manner and not have to escalate treatment to biologic therapies as often as Crohn's patients. More importantly, the difference highlights a discrepancy in the care provided to UC patients. The lack of homogeneity that one would expect in this study depicts a much larger issue with lack of a comprehensive medical system to keep track of and monitor patients' care beyond the Gastroenterologist's office. The lack of a safety net for such complex patients once again highlights the demands placed on all physicians to ensure patient safety and monitoring of all co-morbidities.