Questionnaire May Help PCPs Refer Patients for IBD Screening

A simple 8-item questionnaire may help primary care physicians PCPs) assess if patients with gastrointestinal complaints have irritable bowel disease (IBD), according to a new study.

Diagnosis of IBD is often associated with diagnostic delay. Diagnosis with fecal calprotectin is helpful to screen patients, but its use in primary care is not common.

“Since most patients present to their general practitioner with unspecific abdominal complaints first, improving diagnostic procedures for diagnosing IBD patients in primary care is one of the most important starting points to reduce diagnostic delay,” Corinne Chmiel, PD, Dr. med, of Institute of Primary Care, Universitäts Spital Zürich, Switzerland, and colleagues in Journal of Evaluation in Clinical Practice.

This study tested use of the CalproQuest, a questionnaire designed to increase pretest probability for a positive calprotectin test. The questionnaire consists of four major and four minor questions specific to IBD.

Questions to Help Physicians Diagnose IBD

Major questions are:

  • Does the patient suffer from abdominal pain at least 3 times a week for at least 4 weeks?
  • Does the patient suffer from diarrhea (more than three bowel movements daily) for 7 consecutive days?
  • Does the patient have diarrhea at night‐ time/does the patient awake from sleep because of abdominal pain or diarrhea?
  • Does the patient report bloody stool?

Minor questions are:

  • Does the patient report mucus in stool for more than 4 weeks?
  • Does the patient report unwanted weight loss (5% of normal body weight over 6 months)?
  • Does the patient present with fever or report fever over the last 4 weeks (temperature > 38°C)?
  • Does the patient report fatigue over the last 4 weeks?

The test is considered positive if two major or one major and two minor criteria are positive.

This study of its feasibility included 95 patients who had complained of unspecific gastrointestinal complaints for at least 2 weeks. Of the 95 patients, 54.7% were positive according to the CalproQuest questionnaire: 41.1% met two major criteria and 13.7% met one major and two minor criteria.

“The CalproQuest is a feasible instrument for the assessment of IBD in primary care,” the researchers concluded. “Further prospective studies concerning the validity and cost effectiveness of a combined use with the calprotectin test in this setting are necessary.”

Chmiel C, Vavricka SR, Hasler S, et al. Feasibility of an 8-item questionnaire for early diagnosis of inflammatory bowel disease in primary care. J Eval Clin Pract. 2019;25:155-162. Doi:10.1111/jep.13046. Epub 2018 Oct 15.