Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure

Objective: To address Inflammatory Bowel Disease (IBD) patients’ attitudes, understanding and tolerance of colonoscopy and assess whether there are specific factors that influence these parameters. Design: structured questionnaire-based survey. Tolerance of various aspects of colonoscopy procedure graded on a scale 1-5, 5 representing most intolerance/burden (worries/concerns about the procedure/risks, bowel preparation, disruption to life, procedural discomfort and travel concerns). Setting: London teaching hospital - St Georges Hospital Patients: Consecutive patients with established IBD attending the specialist IBD clinic Results: 98 patients responded (46% male). Mean age was 43.2 years. 33 had Ulcerative Colitis (UC), 50 had Crohn’s Disease (CD), and 11 were unsure of diagnosis. Mean number of colonoscopies was 3.7. Females were more worried about the procedure than males (3.0 vs 2.1, p<0.05), were less tolerant of bowel preparation (3.5 vs 2.3, p<0.05), experienced more disruption to their lives (2.9 vs 1.9, p<0.05) and were more troubled by travel concerns (2.0 vs 1.4, p<0.05). Patients with the disease for ≥ 5 years experienced significantly more discomfort than patients with the disease for a shorter duration (3.2 vs 2.7 p<0.05). Patients aged ≥55 years are significantly less worried about the procedure (2.7 vs 2.0, p = <0.05) and tolerate the bowel preparation better (3.1 vs 2.4, p = <0.05). The majority of the patients felt colonoscopy was ‘bearable’ (53%) with only 13% describing it as ‘very unpleasant’. 55% would have the procedure ‘as frequently as required’ if their physician felt it appropriate. Conclusions: Our research highlights a significant difference in the perception of colonoscopy by gender and age. Overall our findings reveal a preparedness to undergo colonoscopy as required despite an increasing requirement for this test. The differences highlighted should prompt endoscopy units to accommodate and make allowances for these different perceived tolerance in routine clinical activity.