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Previous data support that the inflammatory process underlying ulcerative colitis (UC) and Crohn's disease (CD) can start years before the diagnosis. The aim of this study was to determine if patients with an incidental diagnosis of UC or CD demonstrate an increase in healthcare utilization in the years preceding the symptomatic onset of the disease.We performed a multicenter, retrospective, hospital-based, case-control study. Patients with an incidental diagnosis of UC or CD during the colorectal cancer screening program at 9 hospitals were included. Cases were matched 1:3 and compared separately with two control populations: one including healthy non-IBD subjects adjusted by gender, age, and date, excluding those with visits to Gastroenterology; and a second control cohort of UC/CD patients with symptomatic onset.A total of 124 patients with preclinical inflammatory bowel disease (IBD) were included (87 UC, 30 CD, 7 IBD unclassified; median age 56 years). Patients with preclinical IBD showed an increase in the number of visits to Primary Care up to 3 and 5 years before diagnosis (aIRR 1.59, 95% CI [1.37-1.86], p = 0.001; aIRR 1.43, 95% CI [1.24-1.67], p = 0.01) and more frequent use of steroids (aOR 2.84, 95% CI [1.21-6.69], p = 0.03; aOR 2.25, 95% CI [1.06-4.79], p = 0.04) compared to matched non-IBD healthy controls, respectively. In contrast, patients with a symptomatic onset visited Primary Care less frequently, but they had an increase in the number of visits to Emergency Department, specialist care, sick-leaves, CT/ultrasound examinations, and use of antibiotics or systemic steroids.There is an increased need for medical assistance and use of systemic steroids during the presymptomatic phase of IBD. These results will help in establishing new tools for early identification of IBD in the future.

Background The immune response involved in the pathogenesis of Inflammatory Bowel Disease (IBD) may be present years before the diagnosis, but the characteristics of the disease during the preclinical period have been scarcely investigated. Aim To describe the microscopic findings of preclinical IBD and its relationship with the natural history of the disease. Methods Medical records from all patients with an incidental diagnosis of IBD during a screening colonoscopy were included in this multicentric and retrospective study. We assessed 15 histologic items in the biopsy samples at diagnosis, and the Geboes score was calculated in patients with Ulcerative Colitis (UC). The main outcome was the development of gastrointestinal symptoms during follow-up. Results We included 110 patients (79 UC, 24 Crohn's Disease (CD) and 7 with unclassified disease). In UC the most common histologic findings were acute or chronic inflammatory infiltrate and crypt epithelial polymorphs, while in CD we observed acute or chronic neutrophilic infiltrate and epithelial irregularity. Granuloma were only observed in 4% of CD patients. Crypt distortion and the infiltration of neutrophils in the epithelium were associated with a higher risk of developing symptomatic disease. Conclusions Preclinical IBD shows specific microscopic findings and they are associated with the progression to symptomatic disease.

Introduction: obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy and capsule endoscopy is the next step in these patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule panendoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk. Aim: to analyze our experience with capsule endoscopy in the bleeding setting. Methods: the first 100 panendoscopic capsule procedures performed in our center from August 2011 until December 2016 were retrospectively reviewed. Results: positive findings were observed in 61.2 % of patients; 46.26 % had a previous negative gastroscopy and the capsule detected small bowel lesions in 67.7 % and colonic findings in 80.64 %. Taking into consideration that our population were high-risk patients (mainly because of comorbidities) and that we used up to 45 ml of sodium phosphate, sodium, potassium and creatinine changes were analyzed before and after procedure. The mean “before” values were 140.68, 4.04 and 1.36, respectively. The mean “after” values were 140.28, 3.9 and 1.35 (p = n.s.). According to our findings, no other endoscopic studies would be needed in 64.5 % of patients with negative gastroscopy. According to capsule results, conventional endoscopy could have been avoided in 68.6 % of cases. Conclusion: panendoscopy with a capsule may be useful and safe in bleeding high-risk patients, by selecting those who need therapeutic endoscopy, avoiding up to 68.6 % of diagnostic endoscopies in our series.

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.

Background The diagnosis of ulcerative colitis (UC) is usually established after the development of symptoms, but preclinical disease may be present even years before the final diagnosis. Around 25% of UC patients may show a proximal extension of the disease. The primary aim of the study was to define the main characteristics and the risk of progression of preclinical UC. Methods We performed a multicentric, retrospective study of all patients included in the colorectal cancer screening programme in 11 centres between 2009–2014. All subjects were initially assessed with a faecal occult blood test (OC-Sensor, Eiken Chemical Co., Tokyo, Japan) and, if this test was positive (cut-off 20 μg Hgb/g), a colonoscopy was performed. All patients were asymptomatic and had an incidental diagnosis of UC confirmed by histology during a screening colonoscopy. The main outcomes were the risk of developing symptomatic disease and proximal disease extension. A chi-square test was performed in order to assess the risk factors of proximal extension and symptomatic disease. Results During this period we performed 31 005 colonoscopies after 498 227 FIT. We included 79 patients with a new diagnosis of UC (age 58 years [IQR, 52–63], 37% non-smokers]). At baseline, disease extension was E1 in 32%, E2 in 33% and E3 in 35%. After a median follow-up of 29 months (IQR, 17–41), 76% received some treatment, and no patient showed proximal disease extension. In 45% (33% E3 and 12% E2) we observed a reduction of the disease extension. Among those subjects who were asymptomatic at diagnosis, 32% developed symptomatic disease after a median of 7.5 months (IQR, 1–14). Disease extent at diagnosis did not influence the risk of symptomatic disease during follow-up (p = 0.85). Those patients with left-sided or extensive UC were more frequently treated with mesalazine, systemic steroids or thiopurines, compared with those with proctitis (p = 0.001, 0.023 and 0.047, respectively). Conclusion Approximately one-third of patients with preclinical UC develop symptomatic disease, but there is no risk of proximal disease extension after 2 years of follow-up.

Background The diagnosis of inflammatory bowel disease (IBD) is usually established after the development of symptoms, but preclinical disease may be present years before the final diagnosis. Recently, histology has become one of the main outcomes of IBD treatment. The primary aim of our study was to define the main histological findings of preclinical IBD and its association with the natural history of the disease. Methods This multicentric, retrospective study included all patients who participated in the colorectal cancer screening programme in 11 centres between 2009–2014. All patients were firstly assessed by a faecal immunochemical test (OC-Sensor, Eiken Chemical Co., Tokyo, Japan) and, if this test was positive (cut-off 20 μg Hgb/g), a colonoscopy was performed. All patients had an incidental diagnosis of IBD confirmed by histology, according to current ECCO criteria, during a screening colonoscopy. Three histologic findings were evaluated at diagnosis: presence of granuloma, crypt abscesses and/or eosinophilic infiltrate. The main outcomes were the development of symptoms and the risk of proximal disease extension. The frequency of each finding was described separately by IBD subtype and the chi-square test was used to describe possible association with the main outcomes. Results During this period we performed 31,005 colonoscopies after 498,227 FIT. Finally, 110 patients were included with an incidental diagnosis of ulcerative colitis (UC, 79 cases), Crohn’s disease (CD, 24 cases) or IBD-Unclassified (IBD-U, 7 cases). Crypt abscesses were present in 56%, 33% and 57% of UC, CD and IBD-U patients, respectively (Figure 1). An eosinophilic infiltrate was observed in 27%, 25% and 57% of patients, respectively. Granuloma were only observed in 4% of CD patients. There were no statistically significant differences in these findings according to IBD subtype (p = 0.14, 0.22 and 0.17 for crypt abscesses, eosinophilic infiltrate and granuloma, respectively). After a median follow-up of 25 months (IQR, 11–42), 36% of patients developed symptomatic disease. Neither of the histological findings were associated with a higher risk of developing symptomatic disease (p = 0.29, 0.78 and 0.3, respectively). No patient showed proximal extension of UC. Conclusion Preclinical IBD is frequently associated with the presence of crypt abscesses, especially in UC. Granuloma is probably a late finding in CD. Around one third of patients show a eosinophilic infiltrate in the early phases of the disease.

Introduction: insufflation with carbon dioxide (CO 2) during endoscopies compared to air is associated with a decrease in abdom inal discomfort after the examination, because CO 2 is readily absorbed through the small intestine and eliminated by the lungs. Aim: the objective of this randomized clinical trial was to assess the effect of CO 2 insufflation on pain and abdominal distension after an ileo-colonoscopy (I) and after an ileo-colonoscopy plus gastroscopy (I+G). Material and methods: we included a total of 309 patients in the study and all endoscopies were performed under sedation with propofol. Two hundred fourteen patients underwent an I (132 with CO 2 / 82 with air) and 95 underwent an I+G (53 with CO 2 / 42 with air). Abdominal pain was studied at 10, 30 and 120 minutes of exploration and abdominal perimeter difference before and after the procedure. Results: both in group I and in group I+G, the use of CO 2 trans lated into an average of abdominal pain significantly lower (p < 0.05). Similarly, a smaller increase in waist circumference was found among group I and group I+G, in patients where CO 2 was used (p < 0.05). Conclusion: the insufflation of CO 2 instead of air during the performance of endoscopy significantly reduces the discomfort and abdominal pain after an ileo-colonoscopy and after a gastroscopy + ileo-colonoscopy.