Characteristics and Progression of Preclinical Inflammatory Bowel Disease

Published:November 10, 2017DOI:

      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.


      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.


      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.


      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.


      Abbreviations used in this paper:

      CD (Crohn’s disease), CRP (C-reactive protein), FIT (fecal immunochemical test), IBD (inflammatory bowel disease), IBDU (inflammatory bowel disease unclassified), IQR (interquartile range), UC (ulcerative colitis), UCEIS (Ulcerative Colitis Endoscopic Index of Severity)
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        • Abraham C.
        • Cho J.H.
        Inflammatory bowel disease.
        N Engl J Med. 2009; 361: 2066-2078
        • Nahon S.
        • Lahmek P.
        • Lesgourgues B.
        • et al.
        Diagnostic delay in a French cohort of Crohn's disease patients.
        J Crohns Colitis. 2014; 8: 964-969
        • Peyrin-Biroulet L.
        • Loftus Jr., E.V.
        • Colombel J.F.
        • et al.
        Early Crohn disease: a proposed definition for use in disease-modification trials.
        Gut. 2010; 59: 141-147
        • Danese S.
        • Fiorino G.
        • Peyrin-Biroulet L.
        Early intervention in Crohn’s disease: towards disease modification trials.
        Gut. 2017; 66: 2179-2187
        • Butcher R.O.
        • Mehta S.J.
        • Ahmad O.F.
        • et al.
        Mo1302 incidental diagnosis of inflammatory bowel disease in a British Bowel Cancer Screening Cohort: a multi-centre study.
        Gastroenterology. 2013; 144 (S-630–S-631)
        • Johnston R.D.
        • Logan R.F.
        How often is IBD diagnosed incidentally at screening colonoscopy done for colorectal cancer surveillance or other reasons?.
        Inflamm Bowel Dis. 2008; 14: S170-S171
        • Kamel E.M.
        • Thumshirn M.
        • Truninger K.
        • et al.
        Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results.
        J Nucl Med. 2004; 45: 1804-1810
        • Park S.K.
        • Ye B.D.
        • Yang S.K.
        • et al.
        Clinical features and course of ulcerative colitis diagnosed in asymptomatic subjects.
        J Crohns Colitis. 2014; 8: 1254-1260
        • Mayberry J.F.
        • Ballantyne K.C.
        • Hardcastle J.D.
        • et al.
        Epidemiological study of asymptomatic inflammatory bowel disease: the identification of cases during a screening programme for colorectal cancer.
        Gut. 1989; 30: 481-483
        • Howarth G.F.
        • Robinson M.H.E.
        • Jenkins D.
        • et al.
        High prevalence of undetected inflammatory bowel disease (IBD): data from the Nottingham faecal occult blood (FOB) screening trial.
        Am J Gastroenterol. 2002; 97: 690-694
        • Annese V.
        • Daperno M.
        • Rutter M.D.
        • et al.
        European evidence based consensus for endoscopy in inflammatory bowel disease.
        J Crohns Colitis. 2013; 7: 982-1018
        • Magro F.
        • Langner C.
        • Driessen A.
        • et al.
        European consensus on the histopathology of inflammatory bowel disease.
        J Crohns Colitis. 2013; 7: 827-851
        • Travis S.P.
        • Schnell D.
        • Krzeski P.
        • et al.
        Reliability and initial validation of the ulcerative colitis endoscopic index of severity.
        Gastroenterology. 2013; 145: 987-995
        • Vind I.
        • Riis L.
        • Jess T.
        • et al.
        Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database.
        Am J Gastroenterol. 2006; 101: 1274-1282
        • Molodecky N.A.
        • Soon I.S.
        • Rabi D.M.
        • et al.
        Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review.
        Gastroenterology. 2012; 142 (quiz e30): 46-54.e42
        • Burisch J.
        • Jess T.
        • Martinato M.
        • et al.
        The burden of inflammatory bowel disease in Europe.
        J Crohns Colitis. 2013; 7: 322-337
        • Chouraki V.
        • Savoye G.
        • Dauchet L.
        • et al.
        The changing pattern of Crohn's disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007).
        Aliment Pharmacol Ther. 2011; 33: 1133-1142
        • Charpentier C.
        • Salleron J.
        • Savoye G.
        • et al.
        Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study.
        Gut. 2014; 63: 423-432
        • Arin Letamendia A.
        • Borda Celaya F.
        • Burusco Paternain M.J.
        • et al.
        Altas tasas de incidencia de enfermedad inflamatoria intestinal en Navarra. Resultados de un estudio prospectivo y poblacional.
        Gastroenterol Hepatol. 2008; 31: 111-116
        • Vernier-Massouille G.
        • Balde M.
        • Salleron J.
        • et al.
        Natural history of pediatric Crohn's disease: a population-based cohort study.
        Gastroenterology. 2008; 135: 1106-1113
        • Torres J.
        • Colombel J.-F.
        • Riddle M.S.
        Evidence for life before inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2016; 14: 825-828
        • Finckh A.
        • Deane K.D.
        Prevention of rheumatic diseases: strategies, caveats, and future directions.
        Rheum Dis Clin North Am. 2014; 40: 771-785
        • Lochhead P.
        • Khalili H.
        • Ananthakrishnan A.N.
        • et al.
        Association between circulating levels of C-reactive protein and interleukin-6 and risk of inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2016; 14: 818-824 e6
        • Kokkonen H.
        • Soderstrom I.
        • Rocklov J.
        • et al.
        Up-regulation of cytokines and chemokines predates the onset of rheumatoid arthritis.
        Arthritis Rheum. 2010; 62: 383-391
        • Choung R.S.
        • Princen F.
        • Stockfisch T.P.
        • et al.
        Serologic microbial associated markers can predict Crohn's disease behaviour years before disease diagnosis.
        Aliment Pharmacol Ther. 2016; 43: 1300-1310
        • van Schaik F.D.
        • Oldenburg B.
        • Hart A.R.
        • et al.
        Serological markers predict inflammatory bowel disease years before the diagnosis.
        Gut. 2013; 62: 683-688
        • Israeli E.
        • Grotto I.
        • Gilburd B.
        • et al.
        Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease.
        Gut. 2005; 54: 1232-1236
        • Sakata T.
        • Niwa Y.
        • Goto H.
        • et al.
        Asymptomatic inflammatory bowel disease with special reference to ulcerative colitis in apparently healthy persons.
        Am J Gastroenterol. 2001; 96: 735-739
        • Torres J.
        • Burisch J.
        • Riddle M.
        • et al.
        Preclinical disease and preventive strategies in IBD: perspectives, challenges and opportunities.
        Gut. 2016; 65: 1061-1069