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Observational Study
. 2025 Feb 1;16(2):e00740.
doi: 10.14309/ctg.0000000000000740.

Asymptomatic Inflammatory Bowel Disease Diagnosed During Colorectal Cancer Population Screening in Catalonia: Characteristics and Natural History

Eduard Brunet-Mas  1   2   3 , Anna Selva  4   5   6 , Francesc Bas-Cutrina  7 , Anna Brujats  8   9 , Berta Caballol  10 , Rebeca Font  11   12 , Bàrbara Gómez  13 , Carlos Gonzalez-Muñosa  9 , David Busquets  14 , David Monfort  15 , Diana Patrícia Vera  16 , Elisabet Maristany  17 , Gemma Cirera  18 , Gisela Torres  19 , Jesús Castro-Poceiro  20 , Joel Lopez  21 , Laura Gonzalez-Gonzalez  22 , Lucia Màrquez-Mosquera  23 , Marta Gallach  24 , Maria Esteve  3   25 , Gemma Tremosa  26 , Sandra Torra  27 , Virginia Robles-Alonso  28 , Pilar Garcia-Iglesias  29 , Iago Rodríguez-Lago  30 , Xavier Calvet  1   2   3   31
Affiliations
Observational Study

Asymptomatic Inflammatory Bowel Disease Diagnosed During Colorectal Cancer Population Screening in Catalonia: Characteristics and Natural History

Eduard Brunet-Mas et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Inflammatory bowel disease (IBD) is usually diagnosed when symptomatic. Prognosis and evolution of preclinical IBD is largely unknown. However, colorectal cancer screening programs (CRCSP) detect a subset of patients with IBD with no symptoms. The aim of this study was to describe the natural history of asymptomatic IBD diagnosed through CRCSP.

Methods: An observational, longitudinal, and retrospective study was performed at 22 centers in Catalonia between January 2010 and December 2019 including patients with asymptomatic IBD detected in the CRCSP. Demographic data and IBD characteristics, evolution, and treatment were recorded. Descriptive statistics and Kaplan-Meier analysis were used for the analysis. Data were given separately for IBD, Crohn's disease (CD), ulcerative colitis (UC), and IBD unclassified (IBDU).

Results: One hundred eighty-eight patients were included: 103 UC (54.8%), 60 CD (31.9%), and 25 IBDU (13.3%). Sixty-six (35.1%) were women, and the average age was 59.9 ± 5.9 years. Sixty-four patients (34.0%) developed symptoms after a median follow-up of 35.6 months. Diarrhea was the most frequent symptom for CD and IBDU (25.4% and 11.5%, respectively) and blood in stools for UC (21.4%). The median time to first symptom was 11.6 months. Treatment was prescribed in 135 patients (72.2%); mesalazine was the most prescribed drug (123 patients; 65.4%). Thirteen patients (6.9%) required biological treatment. None underwent surgery.

Discussion: Around one-third of asymptomatic patients with IBD developed symptoms after a medium follow-up of 3 years. Only 6.9% required biological treatment, and none required surgery. Overall, prognosis of asymptomatic IBD seems better.

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Conflict of interest statement

Guarantor of the article: Xavier Calvet, MD, PhD.

Specific author contributions: E.B.M. designed the study, analyzed data, and wrote the manuscript. E.B.M., A.S., F.B.-C., A.B., B.C., B.G., C.G., D.B., D.M., D.P.V., E.M., G.C., G.T., J.C.-P., J.L., L.G.-G., L.M.-M., M.G., M.E., G.T., S.T., V.R., P.G.-I. provided data. All authors critically reviewed the text and provided important intellectual content; all approve the submitted version.

Financial support: This study received a 6,000€ grant for initiation to research from the Societat Catalana de Digestologia.

Potential competing interests: Eduard Brunet-Mas has served as a speaker and consultant for Janssen, Chiesi, Kern, and Takeda. David Busquets has served as a speaker for Janssen, Takeda, Pfizer, AbbVie, and MSD. Jesús Castro-Poceiro has served as a speaker or received research funding from AbbVie, Dr. Falk Pharma, Galapagos, and Pfizer. Maria Esteve has received support for conference attendance and research support from AbbVie, Biogen, Faes Farma, Ferring, Janssen, MSD, Pfizer, Takeda, and Tillotts. Virginia Robles-Alonso has received a grant from Takeda. Pilar Garcia-Iglesias has served as a speaker for Abbott. Iago Rodríguez-Lago has received financial support for traveling and educational activities from, or has served as an advisory board member for, AbbVie, Adacyte, Celltrion, Chiesi, Danone, Ferring, Faes-Farma, Janssen, Galapagos, MSD, Pfizer, Roche, Takeda, and Tillotts Pharma. Financial support for research: Tillotts Pharma. IRL-L is supported by a research grant from Gobierno Vasco-Eusko Jaurlaritza (Grant No 2020111061) and by a research grant from Biobizkaia Bizkaia HRI (Grant No BCB/I/LIB/22/008). Xavier Calvet has received grants for research from Abbott, MSD, and Vifor and fees for advisory board services form Abbott, MSD, Takeda, and Vifor. He has also given lectures for Abbott, MSD, Takeda, Shire, and Allergan. Anna Selva, Francesc Bas-Cutrina, Anna Brujats, Berta Caballol, Rebeca Font, Bàrbara Gómez, Carlos Gonzalez-Muñoza, David Monfort, Diana Patrícia Vera, Elisabet Maristany, Gemma Cirera, Gisela Torres, Joel Lopez, Laura Gonzalez-Gonzalez, Lucia Màrquez-Mosquera, Marta Gallach, Gemma Tremosa, and Sandra Torra have no conflicts of interest to report. No artificial intelligence was used in this work.

Figures

Figure 1.
Figure 1.
Flowchart of the study. CD, Crohn's disease; CRCSP, colorectal cancer screening programs; ECCO, European Crohn's and Colitis Organization; IBD, inflammatory bowel disease; IBDU, IBD unclassified; iFOBT, immunological fecal occult blood test; NSAID, nonsteroidal anti-inflammatory drugs; UC, ulcerative colitis.
Figure 2.
Figure 2.
Time to first symptom for CD, UC, and IBDU. CD, Crohn's disease; IBD, inflammatory bowel disease; IBDU, IBD unclassified; UC, ulcerative colitis.
See this image and copyright information in PMC

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