Virginia Tech Carilion School of Medicine Roanoke, VA
Introduction: Inflammatory bowel disease (IBD) is complex, easily misdiagnosed and mismanaged. Multidisciplinary care improves patient outcomes. Yet, few hospitals have a multidisciplinary team approach to IBD care that consistently includes a gastrointestinal expert pathologist. This study aims to quantify the impact an expert pathologist has on a multidisciplinary team in the care of difficult IBD patients.
Methods: A retrospective chart analysis was performed on patients (N = 283) discussed at the semi-monthly multidisciplinary IBD conference at Carilion Clinic, from June 1, 2013 through December 31, 2019. Each patient was presented between one and six times at the conference. Data collected: diagnosis before and after conference, reason for change in diagnosis, endoscopy findings, medications, surgeries, and if clinical remission was achieved within 6 months after conference.
Results: Significantly, after the first conference, 42% of patients presented had a change in diagnosis: 84% due to expert pathologist interpretation, 12% due to radiology, and 4% due to other reasons. The majority of diagnostic changes after the second (73%), third (67%), and fourth (100%) conferences were also attributed to pathology (Table 1). Crohn disease was the most common new diagnosis after conference, and indeterminate colitis was the most commonly changed diagnosis. For patients whose diagnoses changed to ulcerative colitis after conference, most had moderate active colitis (54%), whereas for those who changed to Crohn disease, the severity of colitis was distributed similarly between none (22%), mild (26%), moderate (28%), and severe (24%). Approximately 24% to 35% of patients had a change in IBD medication after the first, second, and third conferences, among which ~34% to 40% had a change in diagnosis. Following the conference, ~17% to 20% of patients underwent surgical intervention, among which ~12% to 27% had a change in diagnosis. A majority of these patients achieved clinical remission within 6 months of the conference.
Discussion: The majority of diagnostic changes made at the multidisciplinary IBD conference were due to histopathologic re-interpretation. A change in diagnosis at times led to significant modifications in disease management through surgery or medication changes. Multidisciplinary care teams are essential to the best management of difficult IBD patients. An expert gastrointestinal pathologist is a critical team member to the discussion of nuances of each patient’s case.
