P3645 - Clinical Decision Making in Mimickers of IBD: Practice Management From IBD Live

Hannah W. Fiske, MD¹, Christopher Ward, MD², Samir A. Shah, MD, FACG³, David Binion, MD, FACG⁴, Steven Wexner, MD, PhD⁵, Francis A. Farraye, MD, MSc, MACG⁶, Alka Goyal, MBBS, MD⁷, Jeffrey M. Dueker, MD, MPH⁴, John S. Hanson, MD⁸, Raymond K.. Cross, MD, MS, FACG⁹, Corey A. Siegel, MD, MS¹⁰, Badr Al-Bawardy, MD¹¹, Edward Barnes, MD, MPH, FACG¹², Myron Brand, MD, FACG¹³, Joanna MP. Melia, MD¹⁴, Kofi Clarke, MD¹⁵, Philip M. Ginsburg, MD, FACG¹⁶, Hans Herfarth, MD, PhD¹², Erin Forster, MD, MPH¹⁷, Mike Engels, MD¹⁸, Taha Qazi, MD¹⁹, Matthew Bohm, DO²⁰, Ben Cohen, MD, MAS²¹, Aamir Dam, MD²², Sean Fine, MD, MS²³, Jill Gaidos, MD, FACG²⁴, Stefan Holubar, MD²¹, Tracy L. Hull, MD²⁵, Colleen R.. Kelly, MD²⁶, L. Campbell Levy, MD²⁷, Jessica Philpott, MD, PhD²⁸, Miguel Regueiro, MD^29
1Brown University/Rhode Island Hospital, Providence, RI; ²Lahey Clinic, Lahey, MA; ³Gastroenterology Associates, Inc., Providence, RI; ⁴UPMC, Pittsburgh, PA; ⁵Cleveland Clinic Florida, Weston, FL; ⁶Mayo Clinic, Jacksonville, FL; ⁷Stanford University, Palo Alto, CA; ⁸Atrium Health, Charlotte, NC; ⁹University of Maryland School of Medicine, Baltimore, MD; ¹⁰Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; ¹¹King Faisal Specialist Hospital and Research Center, Riyadh, Ar Riyad, Saudi Arabia; ¹²University of North Carolina at Chapel Hill, Chapel Hill, NC; ¹³Yale University, Guilford, CT; ¹⁴Johns Hopkins University School of Medicine, Baltimore, MD; ¹⁵Penn State Health, Hershey, PA; ¹⁶Yale University School of Medicine, Hamden, CT; ¹⁷Medical University of South Carolina, Charleston, SC; ¹⁸Lehigh Valley Hospital, Allentown, PA; ¹⁹Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ²⁰Indiana University Hospital, Indianapolis, IN; ²¹Cleveland Clinic, Cleveland, OH; ²²Moffitt Cancer Center, Tampa, FL; ²³Warren Alpert Medical School of Brown University, Providence, RI; ²⁴Yale University, New Haven, CT; ²⁵Cleveland Clinic, Chagrin Falls, OH; ²⁶Alpert School of Medicine of Brown University, Providence, RI; ²⁷Dartmouth Hitchcock Medical Center, Lebanon, NH; ²⁸Cleveland Clinic Foundation, Cleveland, OH; ²⁹Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Since 2009, a group of inflammatory bowel disease (IBD) specialists have been utilizing “IBD Live,” a weekly live video conference with a global audience of 150-200 participants, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed as IBD, a substantial number were mimics for which IBD was not the ultimate diagnosis. We have prospectively categorized all IBD Live cases and identified “IBD mimics” with consequent clinical management implications.

Methods: Cases have been recorded and archived since May 2018. 371 total cases from May 2018 through February 2023 were reviewed spanning 186 hours. IBD mimics were defined as those cases with features of IBD that ultimately resulted in a non-IBD diagnosis. IBD mimics were analysed and categorized by original suspected diagnosis, diagnostic workup, and the evaluation that led to the correct diagnosis.

Results: 306 of the 371 cases discussed were IBD including 193 Crohn’s disease (CD), 107 ulcerative colitis (UC) and 6 IBD-unclassified (IBD-U). 65 (17.5%) cases (Table 1) were mimics with a presumed initial diagnosis of IBD.

The evaluations that ultimately resulted in the correct diagnosis included: additional endoscopic biopsies (n=13, 21%), surgical exploration/pathology (n=10, 16.5%), biopsies from outside the GI tract (n=10, 16.5%), genetic and other laboratory testing (n=8, 13%), deeper analysis of patient history, including medication review, family, social, and sexual history (n=8, 13%), imaging (n=5, 8%), balloon enteroscopy (n=5, 8%), and capsule endoscopy (n=2, 3%).

We further delineated the diagnostic testing into three categories that ultimately yielded a correct diagnosis: 1) procurement of additional tissue for evaluation, 2) different radiographic or endoscopic evaluation from the original work-up, especially inspection of the small bowel, and 3) more thorough history-taking.

Discussion: In a 5-year period at IBD Live, 17.5% of cases were found to be IBD mimics, many of which originally received advanced therapies for presumed CD or UC. The diverse presentation of IBD cases and the complexity of both assessment and diagnosis necessitates significant consideration of IBD mimics at all times. The substantial differences and often conflicting treatment approaches to IBD versus IBD mimics will directly impact the quality and cost of patient care.


Disclosures:


Hannah W. Fiske, MD¹, Christopher Ward, MD², Samir A. Shah, MD, FACG³, David Binion, MD, FACG⁴, Steven Wexner, MD, PhD⁵, Francis A. Farraye, MD, MSc, MACG⁶, Alka Goyal, MBBS, MD⁷, Jeffrey M. Dueker, MD, MPH⁴, John S. Hanson, MD⁸, Raymond K.. Cross, MD, MS, FACG⁹, Corey A. Siegel, MD, MS¹⁰, Badr Al-Bawardy, MD¹¹, Edward Barnes, MD, MPH, FACG¹², Myron Brand, MD, FACG¹³, Joanna MP. Melia, MD¹⁴, Kofi Clarke, MD¹⁵, Philip M. Ginsburg, MD, FACG¹⁶, Hans Herfarth, MD, PhD¹², Erin Forster, MD, MPH¹⁷, Mike Engels, MD¹⁸, Taha Qazi, MD¹⁹, Matthew Bohm, DO²⁰, Ben Cohen, MD, MAS²¹, Aamir Dam, MD²², Sean Fine, MD, MS²³, Jill Gaidos, MD, FACG²⁴, Stefan Holubar, MD²¹, Tracy L. Hull, MD²⁵, Colleen R.. Kelly, MD²⁶, L. Campbell Levy, MD²⁷, Jessica Philpott, MD, PhD²⁸, Miguel Regueiro, MD²⁹. P3645 - Clinical Decision Making in Mimickers of IBD: Practice Management From IBD Live, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.