Accuracy of Revised Ibd-Refer Criteria for Evaluation of Patients with Suspected Inflammatory Bowel Disease in Low Resource Setting: A Diagnostic Prospective Cohort Study
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Date
2024-05
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Addis Ababa University
Abstract
Background: Diagnosis of inflammatory bowel disease (IBD) often faces significant delays. Early recognition tools offer the best chance for timely treatment and positive outcomes.
Objective: To prospectively validate the original IBD REFER criteria and Assess the diagnostic accuracy of revised IBD-REFER criteria for clinical use in screening at-risk patients and determine the diagnostic delay in three Ethiopian gastroenterology centers in 2024.
Method: A multi-center prospective diagnostic cohort study of 272 undiagnosed GI clinic patients was employed. A modified Delphi method with three steps was used to establish consensus among 10 expert gastroenterologists. Both revised and original IBD-REFER criteria were scored for each patient. Data was presented as means [± standard deviation], or medians (interquartile range [IQR]). A point estimate (e.g., odds ratio, sensitivity, specificity) was accompanied by 95% confidence intervals [CI]. All comparisons were made with two-sided significance levels of p < 0.05 and analyzed with SPSS V20.0.
Result: This study involved 272 participants from three medical centers in Addis Ababa, Ethiopia. Gastrointestinal symptoms were prevalent, with 23.6% experiencing watery diarrhea for at least one month and 11.8% having recurrent diarrhea for at least two weeks. Elevated ESR or CRP was noted in 34.7% of participants, and 28.0% experienced involuntary weight loss. The original IBD REFER criteria showed a sensitivity of 97.8% and specificity of 58.4%, while the revised criteria had the same sensitivity but a slightly lower specificity of 52.7%. The positive predictive value (PPV) and negative predictive value (NPV) for the original IBD REFER criteria were 31.9% and 99.2%, respectively, while the revised criteria had a PPV of 29.1% and an NPV of 99.2%. The area under the ROC curve (AUC) for the original IBD REFER criteria was 0.65, compared to 0.64 for the revised criteria. Multivariable logistic regression identified watery diarrhea lasting for at least one month (AOR: 14.8 (95%CI: 4.1, 54.3)), recurrent bloody diarrhea for at least two weeks (AOR: 88.6 (95% CI: 15.7, 499.9)) Eelevated ESR or CRP, weight loss, and a history of unexplained bowel obstruction to be associated with IBD diagnosis. The mean time to diagnosis for IBD was 26.6 months, with a range of 2 to 186 months, longer for Crohn’s disease (27.2 months) compared to ulcerative colitis (25.6 months).
Conclusion: The study highlights the significant challenges in diagnosing IBD in low-resource settings like Ethiopia, emphasizing the need for improved diagnostic pathways and early referral systems. Future research should focus on refining diagnostic criteria to enhance specificity and exploring the integration of advanced diagnostic tools. Addressing these challenges can lead to earlier diagnosis, better patient outcomes, and reduced disease-related complications in resourceV limited settings.
Keywords-Inflammatory bowel disease, IBD REFER Criteria, diagnostic delay, screening criteria, Ethiopia
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Inflammatory bowel disease IBD REFER Criteria diagnostic delay screening criteria Ethiopia, , , ,