Introduction We participated in the UK National Audit of inflammatory bowel disease service provision (Royal College of physicians, 2014). This recommends that >90% of inflammatory bowel disease (IBD) patients with diarrhoea, have a stool sample sent for culture and Clostridium difficile (CDT) testing on admission. ECCO guidelines recommend stool testing in both outpatient and inpatient disease flares. To date a national audit reviewing stool testing of patients contacting IBD Helplines for advice with diarrhoea has not been performed; therefore we reviewed the results from our clinical practice of both inpatients and out-patients.
Method We searched the IBD telephone helpline electronic records from September 2011 to October 2014 to identify patients presenting with diarrhoea. Electronic records were reviewed to determine if stool samples for standard stool culture and CDT were requested before escalating therapy, and the results of that testing. By searching hospital admission data we identified all patients admitted for >24 h with a diagnosis of Crohn–s disease or ulcerative colitis with symptoms of loose stool and increased frequency during the same time period and reviewed the same data.
Results 357 patients contacted the IBD Helpline complaining of diarrhoea. 357 (100%) were sent stool pots for standard stool culture and CDT by post. Results were reviewed before deciding on further management. 300 (84%) patients completed the tests. Of these 15 (5%) were positive. 8 showed CDT, 6 Campylobacter and 1 Blastocystis hominis. 179 (99 male) IBD patients were admitted during the same 3 year period with symptoms of a flare. 122 patients had diarrhoea on admission. 96 (79%) underwent stool testing. 2 (2%) were positive for infection: 1 for campylobacter, 1 for CDT.
Conclusion These results demonstrate that enteric infection is a relatively common cause of disease flares and underlines the importance of screening for this. Unfortunately frequency of stool testing in our inpatient population falls below recommended standards. In contrast testing undertaken by our nurse-led IBD helpline met the standard.
Disclosure of interest H. Johnson: None Declared, K. Wade Conflict with: sponsorship from Abbvie, S. Weaver Conflict with: Advisory board for MSD and Abbvie, S. McLaughlin Conflict with: Sponsorship from Abbvie and Ferring to attend international meetings.