P0384Early referral from secondary to tertiary care may improve therapeutic management of IBD: a population-based study

Background Diagnostic delay and late referral to specialist centres negatively impact on the prognosis of inflammatory bowel disease (IBD)[1]. The IMPACT survey[2] showed that 25% of patients had to wait up to 5 years to obtain a final diagnosis of IBD, despite being seen by a doctor or having one or more visits to the emergency department. Some studies identify late referral from general practitioners to IBD units as a risk factor for worse prognosis, but no studies have investigated the impact of late referral from non-IBD specialist gastroenterology units (secondary care level) to IBD specialist units on IBD management. Methods Consecutive patients with suspected or established IBD diagnosis seen at 16 secondary care level gastroenterology units were referred to 3 specialist IBD centres in two healthcare districts (ASL) in Rome, Italy (total population 1,881,515 subjects). A web platform (NET-MICI, KLink, Florence, Italy) was used to book a visit in the specialist centre at the first availability in identified slots. The primary outcome was to evaluate the number of patients correctly referred. Secondary outcomes were to assess the number of patients needing therapeutic change, advanced therapy, or surgery. Descriptive analysis is presented. Results From April 2024 to October 2025, 91 patients were referred, 28 with suspected IBD (31%), 63 (69%) with established diagnosis of IBD (23 Crohn’s disease, CD, 40 ulcerative colitis, UC). Diagnosis of non-IBD colitis was made in 6/28 patients (21%, 2 infectious colitis, 1 colitis associated to diverticula, 3 unclassified chronic colitis), whilst in the remaining 22 patients (79%) IBD diagnosis was excluded. Characteristics of the 63 referred IBD patients are shown in Figure 1. Median time diagnosis-to-referral was 17 months (0–462), median time from symptoms to diagnosis was 4.5 months (0–120), median number of cycles of systemic corticosteroids per year prior to referral was 1.0 (0.8–2.0). Among the IBD population, 56 patients (88%) were found to be undertreated: 47 patients (74%) needed therapy escalation, 8 (16.7%) started advanced therapy, 1 (2%) underwent surgery. No significant differences were found between CD and UC patients. Conclusion Collaboration between secondary and tertiary level units identified 88% undertreated IBD patients. Timely referral may improve therapeutic management of IBD. References: 1. Cantoro et al. The Earlier You Find, the Better You Treat: Red Flags for Early Diagnosis of Inflammatory Bowel Disease Diagnostics 2023;13(20), 3183 2. Ghosh et al. Impact of inflammatory bowel disease on quality of life: Results of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) patient survey J Crohns Colitis 2007;1(1):10-20 Conflict of interest: Monterubbianesi, Rita: none Pica, Roberta: None Pagnini, Cristiano: None Ruffo, Alessandra: None Camastra, Caterina Maria: None Di Paolo, Maria Carla: None Angelucci, Erika: None Falasco, Giuliano: None Cocco, Andrea: None Cantoro, Laura: None Cassieri, Claudio: None Cosintino, Rocco: None De Nitto, Daniela: None Graziani, Maria Giovanna: None Faggiani, Roberto: None Dr. Fiorino, Gionata: No conflict of interest