News

Successful evaluation of IBDoc® with IBD Home from Telia Company

IBDoc® is present in the market for 6 years now and its efficiency and usefulness has been described many times by different research teams all over the world (1, 2, 3). All of these papers are evaluating IBDoc® as a stand-alone product but IBDoc® has the possibility to be integrated in a 3rd party application, thanks to its Application Programming Interface (API). In disease management of Inflammatory Bowel Disease (IBD) by healthcare professionals, this API allows for comprehensive remote monitoring including biomarker measurements by using only one patient application. For instance, a unique application can be used to answer Quality of Life (QoL) questionnaires, messaging to healthcare professionals and perform fecal calprotectin tests at home. With all these features, a patient can be followed for a long period of time and without the need to come to the hospital if it is not needed. For the healthcare professionals, it means that all the results provided by this application are available in one spot. With the rise of many different electronic systems, there is a clear benefit of such an integration tool, avoiding healthcare professionals having to interact with multiple dashboards and tools.

One country has been pioneering the benefits of this solution for the patients and the healthcare professionals early on: Sweden. In this post, we are presenting two evaluations of the IBD Home solution. The evaluations are in Swedish and below is a summary of the original articles: Capio St. Goran hospital evaluation and Västra Götaland region evaluation.

Back in 2017, Telia Company, a Swedish telecommunication provider, created an integrated solution for the patients in partnership with BÜHLMANN: an application allowing them to answer quality of life questionnaires, doing fecal calprotectin tests at home using IBDoc® and an easy logistic system having IBDoc® tests available at the nearest possible pharmacy. This solution, called IBD Home, allows the results to be shared with the healthcare professional through SWIBREG, the national quality register for IBD. This national program is in use all over the country and is available to any IBD patient in Sweden.

Figure 1: Patients survey results

In 2020, the Capio St. Goran hospital wanted to implement this solution in their gastroenterology department. Within a few months, they were able to recruit about 70 patients to the program and completed an evaluation using surveys for the patients and the healthcare professionals. The response from patients was unequivocally positive. For most of them, IBD Home provides increased flexibility and security as they do not have to go to the lab and get their results immediately (Figure 1). After a few months of usage, 80% of the patients would recommend IBD Home to other patients in their situation.

In addition, the IBD nurse Birgitta Håkansson, participating in the program, stated that she felt that patients were more involved in their care (Figure 2). This resulted in improved conditions for the healthcare staff as well. Because more patients want and can take a larger own responsibility, the care staff can reduce the number phone calls and instead can focus on the patients which are actually in need for their resources.

Figure 2: Healthcare professionals survey results

Based on this outstanding evaluation, Capio St. Göran hospital is now trying to roll out the solution to all IBD patients, from the ones with subcutaneous injections to the ones on oral treatment. Their goal is to recruit an additional 100 patients within the next year.

In addition to this hospital study of the IBD Home program, there was an official evaluation done by the Västra Götaland region within the framework of restructuring the healthcare and program area in digitization. Since June 2017, the IBD Home program was offered to IBD patients and it was found that in this region, 338 patients were included. To measure the usefulness of the solution, patients were asked to take surveys at 3, 6 and 12 months. The results were excellent, and patients were satisfied with the service. It was noted that the main advantage for the patients was not to bring their stool samples to the lab, offering them more flexibility and time. Surveys were also given to the healthcare professionals at 3, 6 and 12 months and the results were positive too. The majority of them think that including patients into the program is not time consuming and is even saving time as it is allowing them to free up time to focus on patients that are actually in need of medical attention while other matters can be resolved by telephone. From a qualitative point of view, the report concludes very clearly that IBD Home creates clear patient benefits, mainly in the direction of quality of life improvements.

The other interesting part of this report is that they assessed IBD Home from a quantitative point of view, looking at patient visits and costs. It was found that, with IBD Home, the number of doctor visits fell by an average of 18 percent with a small increase of nurse visits, which indicates a redistribution from doctor visits to nurse visits. On the same note, emergency admissions decreased by 32 percent during year one and 44 percent during year two for the entire region. The reduction in the number of doctor visits could be explained by the fact that IBD Home creates opportunities for self-care as well as self-control of the patient’s disease, which leads to patients being able to earlier identify possible relapses and thereby implement preventive measures together with care. A proactive follow-up and control of any relapses also reduces the need of emergency admissions to hospitals. Based on available data, IBD Home means a saving of about SEK 400 (~40€) per year and patient. In addition, IBD Home can contribute to increased precision in drug treatment, which can result in both financial and patient-related benefits.

Figure 3: Overall IBD patient visits in the Västra Götaland region

If you want to know more about our API program, now including HL7/FHIR communication, please contact us at support@ibdoc.net.

  1. Heida A. et al., 2017, Agreement Between Home-based Measurement of Stool Calprotectin and ELISA Results for Monitoring Inflammatory Bowel Disease Activity, Clin Gastroenterology and Hepatology.
  2. Walsh A. et al., 2018, Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis—a Prospective Analysis, Journal of Crohn’s and Colitis.
  3. Haisma et al., 2019, Head-to-head comparison of three stool calprotectin tests for home use, Plos One.

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COVID-19 impact on IBD centers: IBDoc® success story and surveys

In 2020, the COVID-19 crisis had a high impact on the daily life of people all over the world. That is particularly true for patients with a chronic disease who must go to their hospital for regular follow-up visits. Inflammatory Bowel Disease (IBD) patients are no exception here. In order to face this extraordinary situation, IBD centers had to change their organization to meet with the obligation of social distancing and lockdown in some countries.

This is especially true for one of the most impacted European country, the UK. A vast majority of IBD centers in the UK started to use home monitoring tools during the pandemic, including IBDoc®, as a mean to safely test fecal calprotectin. Our distributor in the UK, Alpha Laboratories, highlighted this switch to digital health in their latest issue of their journal called “Perspective”. In this article, they reported why and how the Mid and South Essex University Hospital Trust started to use IBDoc® routinely within less than a year. The gastroenterology department introduced IBDoc® with a small pilot in Summer 2020 to check patient acceptance and the correlation to an ELISA laboratory test. After confirmation that the tool was highly appreciated by patients and comparison studies to ELISA were completed, the team rolled out the pilot from 20 to 110 patients in a few months. As we can read from the numerous interviews in this article, from Healthcare Professionals (HCP) and patients, this implementation in Essex was a complete success: Patients are considering the test easy-to-use and feel that they are gaining control over their chronic condition. On the HCP side, nurses and doctors see that the patients are more involved in their disease management, which ultimately leads to less work and less cost to the Hospital as HCPs can focus resources on patients who have immediate need for direct contact and support.

In addition, the Hospital wanted to make sure that IBDoc® continuously meets the quality requirements for lab tests by enrolling it in a NEQAS Ring Scheme (EQA). This participation ensures that IBDoc® is constantly monitored just like a lab test.

This switch towards digital health was true for most IBD centers in the world. With the pandemic, the goal was to adapt and only accept patients for emergencies such as unavoidable endoscopies and surgery. In order to stay in contact with the rest of the patients, IBD centers enhanced their capabilities in telemedicine. Lees et al., 2020 (1) conducted a global survey to assess the shift from face-to-face meetings to telemedicine, before, during and after the pandemic. Using Google Forms, the study sent out a questionnaire via Twitter, LinkedIn and emails on April 20th 2020 for a period of 10 days. 802 answers were obtained, mostly by gastroenterologists (82,4%), IBD nurses (10,2%) and surgeons, dietitians and psychologists (7.5%) from 56 countries, mostly from the UK (90), the US (86), Italy (85) and Brazil (44).

The results from this questionnaire clearly showed that the COVID-19 crisis created a change from nearly 100% face-to-face to phone or video consultations. Interestingly enough it seems that the impact will last beyond this extraordinary period, as the IBD centers intend to keep using telemedicine tools even after the crisis will be over (Figure 1).

Figure 1: Survey answer to evaluate what tools will use the IBD centers once the COVID-19 crisis is over (746 answers; reference 2).

But for most of the centers, telemedicine so far only means consultations over the phone or by video. A vast majority of the centers do not use an app to monitor Patient Reported Outcome (PRO) and to communicate with patients. Only about 50 participants reported using such a solution for most of their patients and about 100 reported using it for some of their patients. The rest reported no use of such tools but a majority (slightly more than 500 participants) reported they wanted to assess the use of such tools.

For fecal calprotectin (fCAL) testing, 89% of the responders had a routine access to it prior to COVID-19 but only 54% managed to keep this access during the pandemic. The others had either a reduction in capacity (33.7%) or experienced a complete shutdown of activities (12,3%). For obvious reasons, home calprotectin tests were highlighted during this crisis as they allowed patients to stay at home while being monitored remotely. The study team surveilled the use of such tools (Figure 2). Out of 746 participants, around150 participants reported using it for their patients (2). Thereby, IBDoc® was the most used tool (53,3%) followed by CalproSmart (39,3%).

This paper highlights the need of the IBD community for digital tools. Indeed, around 420 out of 802 answers reported the wish to use those tools regularly. Of note, there is no home monitoring tool approved by FDA.

Figure 2: Survey answer to evaluate how many IBD centers are currently using a Point-Of-Care calprotectin test (746 answers; reference 2).

Following the same idea, a similar survey was performed specifically in the UK by Kennedy et al., 2020 (3). Again, the survey was trying to evaluate the challenges that IBD centers met during the pandemic and how they adapted to face them. Using Google Forms, they collected answers from the 8th to the 14th of April 2020. The study team tried to assess the staffing resources in the services, the changes that were made to answer the pandemic challenge and the long-term impact. During the week the survey was active, 147 answers were collected representing 70% of IBD services in the UK. As the UK saw high infection numbers during the 1st wave, it made sense to evaluate the specificities of this country to see if the impact on the telemedicine shift was higher than in other countries.

The answers were comparable to the global survey: most clinics switched face-to-face appointments to telephone consultations (86%) or to video consultations (11%). Of note, 6% of clinics used apps to follow their patients before the pandemic and 14% were in the set-up phase at the time of the survey. On the same subject, most clinics (94%) observed an increased activity with their IBD service line which made them adapt to the increasing demand by allocating resources.

Regarding fCAL testing, one out of four clinics reported a complete stop of the activity and one out of three reported a reduced activity (Figure 3). However, 5% (6/120) of the services reported an implementation of a point-of-care tool such as IBDoc® and 2% (3/120) reported a scale-up of this service. The survey was done approximatively one month after the lockdown in the UK, so the numbers represent a trend towards the increased use of telemedicine.

Figure 3: Map of the IBD centers in the UK with their access to a fecal calprotectin test.

  1. Innovation in Inflammatory Bowel Disease Care During the COVID-19 Pandemic: Results of a Global Telemedicine Survey by the International Organization for the Study of Inflammatory Bowel Disease; Charlie W. Lees, Miguel Regueiro, Uma Mahadevan; Gatroenterology, 2020.
  2. IO IBD Taskforce Telemedicine COVID-19 and IBD; Charlie W. Lees, Sara Lewin, Alissa Hart, Miguel Regueiro, Uma Mahadevan; 2020; https://ioibd.org/wp-content/uploads/2020/05/IOIBD-Taskforce-Telemedicine-COVID-19-and-IBD-guidelines-1.pdf
  3. Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic; Nicholas A Kennedy, Richard Hansen, Lisa Younge, Joel Mawdsley, R Mark Beattie, Shahida Din, Christopher A Lamb, Philip J Smith, Christian Selinger, Jimmy Limdi, Tariq H Iqbal, Alan Lobo, Rachel Cooney, Oliver Brain, Daniel R Gaya, Charles Murray, Richard Pollok, Alexandra Kent, Tim Raine, Neeraj Bhala, James O Lindsay, Peter M Irving, Charlie W Lees, Shaji Sebastian; Frontline Gastroenterology, 2020.

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The role of IBDoc® in virtual clinics

In 2016, the Nancy University Hospital has set-up a virtual clinic for Inflammatory Bowel Disease (IBD) patients. The main goal of this eHealth solution is to provide a communication channel between patients and the healthcare professionals and to decide on patient management changes. In 2018, the IBD unit decided to add the possibility to perform a fecal calprotectin test at home, using IBDoc®. In order to check the patient acceptance for such a tool, the hospital decided to organize a study designed to confirm the usability and usefulness of IBDoc® (1). 30 enrolled patients were asked to perform one home test and to fill out a questionnaire based on multiple-choice questions.

The IBDoc® home test was widely accepted by patients and identified as simple to use by most users (19/20).  In addition, all patients except 1 reported that they would like to continue with IBDoc® in the future and that they recommend home testing to other patients. The study team noted an improvement of the patient management over their own disease with this tool. Indeed, they reported that 66% of enrolled patients successfully performed the home test whereas the adherence rate to an ELISA test is 35%.  You can find the detailed results of this study in the quoted paper below.

In the past few years, eHealth has grown exponentially, and especially for chronic diseases remote monitoring leads this development. In the IBD field clinics are moving towards electronic Patient Reported Outcome (ePRO) to follow their patient wellbeing from afar. Fecal calprotectin testing at home is the perfect addition to PROs in order to make sure that the patients’ symptoms are not caused by an underlying inflammation. With the COVID-19 crisis, the need for remote monitoring tools has been highlighted to keep patients out of the hospital for as long as possible (2). Tools such as IBDoc® can help towards this goal as it can help predict an upcoming flare, therefore identifying patients that actually need to go to the hospital.

Before settling on IBDoc®, the study team reviewed the other home tests in the market. Based on the comparison study performed by Haisma et al., 2019 (3), they chose IBDoc® as it had shown the superiority of IBDoc® compared to other home testing tools. The study team conducted a method comparison between the 3 available tests, using 40 stool samples. Agreement to ELISA, usability and Reading Error Rate were the study outcomes, that highlighted the IBDoc® advantage versus the other tested tools.

Concordance to ELISA for the 3 home tests were 82%, 79% and 73%, respectively for IBDoc®, QuantOnCal® and CalproSmart®. Error rates were significantly higher for CalproSmart® and QuantOnCal® compared to IBDoc®, 5,8%, 4,8% and 1,9%, respectively. Very low error rates result in IBDoc® performing with the highest usability score compared to the 2 other home tests.

As highlighted in the D’Amico paper, even if the concordance to ELISA remains the most important factor to choose a test, the usability is very important, especially for the patients acceptance and ease of use. If the test is too difficult to use or suffers from technical problems or errors, patients are discouraged to engage and trust in home testing. It is therefore important that manufacturers also focus on the user-friendliness of their devices, and IBDoc® is in line with these expectations.

Fig.5: Reading error rate per home test for different smartphone types

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IBDoc® in Clinical Practice

Fecal calprotectin is an ideal non-invasive marker to monitor inflammation in the gut for patients suffering from IBD. Since IBD is a chronic condition, remote disease monitoring offers patients to facilitate their disease management and working lives since less hospital visits are needed. Further, hospital visits always bear the risk of potential infections, not only COVID-19, so reducing numbers of hospital visits is a benefit for chronic disease patients. But not only patients can benefit from remote disease monitoring, but also clinics can free up consultant time for patients who are really in need of clinical visits.

IBDoc®, a smartphone based application for fecal calprotectin testing, offers the perfect solution for IBD patients to monitor their disease at home. At ECCO 2020 in Barcelona we had the chance to talk with Kathleen Sugrue from Mercy University Hospital in Cork, Ireland and Pearly Avery from Dorset County Hospital in the UK about the use of IBDoc® in clinical practice.

IBDoc® calprotectin in clinical practice- teaser

ECCO 2020 interview with Kathleen Sugrue about the daily use of IBDoc® at the Mercy University Hospital

ECCO 2020 interview with Pearl Avery about the daily use of IBDoc® at the Dorset County Hospital

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IBDoc® News from ECCO 2020

At ECCO 2020, IBDoc® was again under the spotlight as 2 very interesting posters were presented. After 5 years of market presence, long term data about the impact of IBDoc® usage in clinical routine are beginning to emerge. Improving quality of life of IBD patients is extremely important, developing tools to allow patients to have a higher sense of control over their disease is now a must, especially for chronic diseases. Kathleen Sugrue assessed this in her poster at ECCO 2020.

Figure 1 Actions of patients having moderate or high IBDoc® results

At Mercy University Hospital, the goal of the study was to assess the impact of IBDoc® in clinical practice. Since 2014, 733 patients were enrolled in the IBDoc® program. The clinic now has sufficient experience with this tool to allow an evaluation. The patients were allowed to stay at home and came to the hospital for further evaluation only if the IBDoc® result was elevated (>100µg/g). Over the last 6 months, a total of 240 tests were performed by patients. Of those, 40% were normal, 40% were moderate and 20% were high. Only the patients with a moderate or a high result were scheduled for an appointment at the hospital within a week. Of the moderate, 20% had a change of therapy and of the high results, all patients were booked for an urgent colonoscopy and all were found to have an active disease.

This study has several outcomes. First of all, the IBDoc® set-up allows to free-up time both on the patient side, who is no longer coming to the hospital, and on the hospital side, where the care givers could now focus more on patients with active diseases. The patients are only coming to the clinic when it is needed, enhancing the patients quality of life. Next, we can see that IBDoc® has a 100% correlation with endoscopy, which makes it an excellent tool for patient monitoring and allows the fast track system in clinical practice.

On the same topic, an internal audit was conducted at Dorset County Hospital to evaluate the efficiency of IBDoc®, which is used there since 2016. Pearl Avery presented the audit findings in her ECCO 2020 poster to better assess the benefit for patients and hospitals. The study is a retrospective evaluation of the most recent results generated with IBDoc®. Correlation between fecal calprotectin and endoscopy or patient disease state was then evaluated.

Over the last 6 months, 134 patients were registered to use IBDoc®. Of those, 111 patients generated a result. Based on this result, 31 patients were scheduled for a colonoscopy and an 84% correlation between fecal calprotectin and colonoscopy was found. It is important to note that, for high results generated with IBDoc®, correlation goes up to 100%. In patients having normal colonoscopy result but a high calprotectin value, other reasons for the high calprotectin was found, such as C.difficile infections and others. Of the 80 patients with no colonoscopy, disease status was assessed and 39 patients were deemed well, 19 needed a tighter monitoring and 23 needed a change of therapy. These outcomes correlate very well with IBDoc® thresholds: Normal (<150), Moderate (150-400) and High (>400).

Table.1 Correlation of IBDoc® results and colonoscopy outcome

As for the first poster, the aim was here to demonstrate the good correlation between IBDoc® and endoscopy. This allows to better identify the patients in need for further evaluation and those who don’t, increasing time management for both the clinic and the patient.

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Fecal calprotectin- a small protein of high importance

Worldwide more than 6.8 million people live with Inflammatory Bowel Disease (IBD) which is characterized by chronic inflammation of the gastrointestinal tract. The highest numbers of IBD patients are observed in North America and Europe with an estimated 2.2 million affected persons in North America and an estimated 0.3% of the European population suffering from IBD (1, 5, 9, 11). In Europe, epidemiological studies suggest both a north-west gradient with more IBD patients in the north and a west-east gradient with more patients in the west. Thereby both, the incidence and prevalence are still increasing (1, 9. 13).

Crohn`s disease (CD) and ulcerative colitis (UC) are the two major forms of IBD, both characterized by inflammation of intestinal mucosa and a chronic, relapsing disease course. Thereby periods with high disease activity and acute symptoms alternate with phases of remission, with slight or no symptoms (14, 15). Ulcerative colitis normally starts with mucosal inflammation at the rectum which extends continuously upwards through the colon. Thereby only the inner lining of the colon is inflamed. In contrast, in Crohn`s disease the inflammation can affect entire intestinal layers and inflammations can occur anywhere in the gastrointestinal tract, from mouth to anus. Thereby inflammation is typically segmental, meaning that several patches of inflammation are interspersed between healthy portions of the gut. The exact cause of IBD remains unknown, although it is suggested that several aspects such as genetic and environmental factors may play a role (13, 14, 15).

What is calprotectin?

Calprotectin is a cytosolic protein particularly present in neutrophil granulocytes. These are specialized cells of leucocytes belonging to the non-specific immune response in the human body and play a major role in inflammatory reactions. Depending on the localization of the inflammation, calprotectin can be found in different body fluids and in serum. When there is an inflammation in the gastrointestinal tract, neutrophil granulocytes migrate from the circulation to the intestinal mucosa. They accumulate at the site of inflammation and calprotectin is released into the intestinal lumen. While feces migrate towards the anus, it gets into contact with calprotectin. This can be measured in secreted stool using different tests (6, 10, 16).

Inflammatory alterations in the intestine, as they occur in Crohn`s disease and ulcerative colitis, lead to elevated calprotectin concentrations in stool. Thereby the severity of intestinal inflammation correlates well with the concentration of calprotectin in feces. Thus, fecal calprotectin is an ideal non-invasive biomarker to identify intestinal inflammation throughout the gastrointestinal tract. It has the ability to distinguish organic disease like IBD from non-organic disorders such as Irritable Bowel Syndrome (IBS) in patients suffering from gastrointestinal symptoms like diarrhea or chronic abdominal pain. For the initial diagnosis of IBD a combination of clinical, biochemical, stool, endoscopic and histological investigations is needed (2, 6, 8, 10, 16).

For what else can we use calprotectin?

After initial diagnosis of Crohn`s disease or ulcerative colitis the intestinal inflammation is treated using different medications. Since fecal calprotectin reflects the inflammatory status of the disease, it decreases as soon as the intestinal inflammation gets better. It was shown that fecal calprotectin not only correlates well with endoscopic disease activity, but also with mucosal healing (2, 4, 6, 8, 12). Thus, measuring calprotectin levels in stool is a good tool to monitor disease activity and assess the treatment success in IBD patients. Therefore, the number of invasive colonoscopies, which are time consuming and uncomfortable for patients, can be reduced for disease monitoring 16.

Most IBD patients experience periods of remission alternating with flares of variable severity. The aim is to maintain clinical remission, since a failure to control inflammation is associated with impaired quality of life as well as worse long-term outcomes. Several studies showed that an increase of fecal calprotectin in patients in clinical remission was associated with an increased risk of relapse. Thereby, it can increase months before a relapse, when patients still experience physical well-being and feel healthy (2, 6, 7, 8, 16).

How is calprotectin measured?

Today, most of the patients collect a sample of stool into a stool collection tube and bring it personally or send it to their gastroenterologists, to the hospital or directly to the labs. Patients receive the results from their healthcare professionals within a few days. The stool sample is stable for up to several days at room temperature. Nowadays, there are specialised stool sampling devices which already dissolve the stool into a buffer, making it more stable and ready to measure the sample in the lab right away without the need to extract the stool manually. Another possibility is to use smartphone based calprotectin home tests which allow patients to measure their fecal calprotectin at their homes. Patients can see their test results directly on their smartphone using an app and healthcare professionals are informed automatically about the performed test. This solution offers a fast, flexible and independent measurement of the inflammatory marker for patients at home without the need for hospital visits. In these days, where patients should rather stay at home because of the current COVID-19 pandemic, such solutions can be very helpful (3, 7, 16).

References

  1. Burisch, J. et al., 2013, The burden of inflammatory bowel disease in Europe, Journal of Crohn`s and Colitis
  2. Burri, E. et al., 2012, Fecal calprotectin-a useful tool in the management of inflammatory bowel disease, Swiss Medical Weekly
  3. COVID-19 ECCO Taskforce, published March 20, 2020
  4. Hart, L. et al., 2020, Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis, Journal of Crohn‘s and Colitis
  5. Jairath, V. et al., 2020, Global burden of inflammatory bowel disease, Lancet Gastroenterology & Hepatology
  6. Kostas, A. et al., 2017, Fecal calprotectin measurement is a marker of short-term clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease, World Journal of Gastroenetrology
  7. Louis Edouard, 2015, Fecal calprotectin: towards a standardized use for inflammatory bowel disease management in routine practice, Journal of Crohn’s and Colitis
  8. Maaser, C. et al., 2019, ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications, Journal of Crohn‘s and Colitis
  9. Mak, W. Y. et al., 2019, The epidemiology of inflammatory bowel disease : East meets west, Journal of Gastroenterology and Hepatology
  10. Manz, M. et al., 2012, Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study, BMC Gastroenterology
  11. Ng, S. C., et al., 2017, Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century : a systematic review of population-based studies, Lancet
  12. Penna, F.G.C. et al., 2020,Faecal calprotectin is the biomarker that best distinguishes remission from different degrees of endoscopic activity in Crohn’s disease, BMC Gastroenterology
  13. Rogler, G.et al., 2018, New insights into the pathophysiology of inflammatory bowel disease: microbiota, epigenetics and common signalling pathways, Swiss Medical Weekly
  14. Torres, J. et al., 2017, Crohn`s disease, Lancet
  15. Ungaro, R. et al., 2017, Ulcerative colitis, Lancet
  16. Walsham and Sherwood, 2016, Fecal calprotectin in inflammatory bowel disease, Clinical and Experimental Gastroenterology

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IBD and COVID-19

Because of the current situation with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the COVID-19 disease it is important to keep IBD patients out of clinics whenever possible. Nevertheless, tight monitoring of inflammation level in the gut is needed to deal with these chronic conditions. Calprotectin has proven to be an ideal non-invasive biomarker to monitor inflammatory bowel diseases. IBDoc®, a smartphone based application for fecal calprotectin testing at home, offers the perfect solution to to keep patients out of clinics while still being able to monitor their disease. Click on the link below to read an overview on the benefits of calprotectin home testing.

Start using IBDoc® today

To help you get started quickly, we have a wide selection of information material, including online resources for remote training, to support Healthcare Professionals and patients when they start using IBDoc®. Several quick and easy IBDoc® portal tutorial videos exist to help Healthcare Professionals with the first steps of creating an account and setting up new users.

We renewed our information brochure for patients where they can find all necessary informations for the smartphone based fecal calprotectin home testing application. This should help the Healthcare Professionals to present IBDoc® to their patients.

Patient home test IBDoc® to prevent hospital visits

After 5 years of market presence long term data become available showing the ease of use of this smartphone-based application and the benefits for patients and clinics. Two excellent posters were presented by K.Sugrue and P. Avery at ECCO 2020 about how IBDoc® can impact patient`s disease management and how the home test can optimize the time management in clinics.

Stay safe and healthy!!!

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Fecal Calprotectin Home Testing in 2020

The use of fecal calprotectin (fCAL) in clinical routine is demonstrated beyond doubt. We now have extensive knowledge of its efficacy for IBD/IBS differentiation and IBD monitoring, as it has been shown to be an excellent surrogate biomarker for inflammatory status of the gut that correlates well with endoscopic activities (1). The key benefit of measuring fCAL is in avoiding unnecessary endoscopies to patients, which are uncomfortable, painful, time consuming and costly (2).

In 2015, IBDoc® the first home test kit for fCAL obtained the CE marking and took monitoring of IBD patients to a new level. IBDoc® was proven to be as efficient as a lab test (3, 4, 5) and very well accepted by patients in several countries 6, 7, 8. In addition to avoid unnecessary procedures, home testing can avoid hospital visits altogether for the patients. This not only saves time for both, the patients and the healthcare professionals, but also reduces costs. Over the years data on routine usage of IBDoc® has become more and more available. Two posters were recently published at ECCO 2020 and both came to the same conclusion: home testing is perfect to discriminate patients who need immediate care from those who do not (9, 10). As technology continues to improve, patients are now monitored from afar in virtual clinics until they need a physical appointment.

2020 just barely started when a novel event also brought focus on home testing. As the new coronavirus (SARS-CoV-2) continues to spread at an increasing speed, hospitals and whole countries are shutting down to avoid contaminations in an attempt to decrease the numbers of infected people suffering from COVID-19 (11). Early data showed that many of the initially infected people were hospital staff or hospitalized patients (12). Because of this and general social distancing measures, IBD patients are asked to stay at home but it is still recommended that the fCAL monitoring is continued. The European Crohn’s and Colitis Organisation (ECCO) gathered a group of gastroenterologists to address the questions about this global pandemic and to give guidance on how to proceed in this particular situation (13). Additionally, data on IBD patients that have contracted COVID-19 is continually added to the SECURE-IBD registry. The main goal is to prevent patients from going to the hospital, and as a result the priority for the physicians is to set-up virtual clinics to follow their patients from distance. This means frequent phone calls to assess the clinical symptoms, to reduce endoscopic procedures for patients with moderate-to-severe symptoms and to perform fCAL home testing to determine the inflammatory status of the gut. This approach has been assessed and proven to be as efficient as a standard clinical care with hospital appointments (14). The benefits of remote monitoring in the care of patients with chronic diseases for the health care system are obvious and gradually on the way to becoming the new standard of care. The current situation highlights one of the benefits and might help to accelerate the shift to more remote monitoring. Even outside of a pandemic shut-down situation it is a good idea to reduce hospital visits due to potential infection risks. Chronic disease patients are also not always fully mobile and it is not always easy to take time of work to organize hospital travel.

  1. Rosenfeld, G. et al. FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease. World J. Gastroenterol. 22, 8211–8218 (2016). http://dx.doi.org/10.3748/wjg.v22.i36.8211
  2. Yang, Z., Clark, N. & Park, K. T. Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease in adults and children. Gastroenterol. Hepatol. 12, 253–62.e2 (2014). http://dx.doi.org/10.1016/j.cgh.2013.06.028
  3. Ungar B. et. al., 2017, Home smart-phone based measurement of fecal calprotectin by IBD patients: correlation with laboratory assay and applicability as patient-friendly monitoring too, ECCO 2017 Poster.
  4. Hejl J. et al., 2017, Point of care testing of fecal calprotectin as a substitute for routine laboratory analysis, Practical Laboratory Medicine.
  5. Heida A. et al., 2017, Agreement Between Home-based Measurement of Stool Calprotectin and ELISA Results for Monitoring Inflammatory Bowel Disease Activity, Clin Gastroenterology and Hepatology.
  6. Bello C. et al., 2017, Usability of a home-based test for the measurement of fecal calprotectin in asymptomatic IBD patients, Digestive and Liver Disease, 2017.
  7. Wei S. et al., 2018, Experience of patients with inflammatory bowel disease in using a home fecal calprotectin test as an objective reported outcome for self-monitoring, Intestinal Research.
  8. Moore AC. et al., 2018, IBDoc® Canadian User Performance Evaluation, Inflammatory Bowel Diseases.
  9. Avery P. et al., 2020, IBDoc® Faecal calprotectin self-test retrospective audit in a District General Hospital (DGH), ECCO 2020 Poster.
  10. Sugrue K. et al., 2020, An evaluation of the impact of IBDoc® in clinical practice 5 years after introduction, ECCO 2020 Poster.
  11. Huang C. et al., 2020, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, The Lancet.
  12. Wang D. et al., 2020, Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China, JAMA
  13. COVID-19 ECCO Taskforce, published March 20, 2020
  14. McCombie et al., 2019, A Noninferiority Randomized Clinical Trial of the Use of the Smartphone-Based Health Applications IBDsmart and IBDoc in the Care of Inflammatory Bowel Disease Patients, Inflammatory Bowel Disease, 2019

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IBDoc® in French TV

Allô docteurs is a French medical TV show, covering new topics every day to help patients dealing with their disease. On the 3rd of February 2020, the show was  about “living with IBD”.

A 3 minute story was presented on how healthcare professionals and patients are using IBDoc®, the fecal calprotectin home test, to improve their control over the disease.

On the healthcare professional side, IBDoc® is used to monitor fecal calprotectin closely. If the result is high, the patient is followed-up and measures are taken as soon as possible to prevent a relapse.

On the patient side, IBDoc® is deemed helpful to improve the quality of life. Indeed, patients are no longer needed to go to the hospital as long as their fecal calprotectin levels are normal. IBDoc® allows them to be more autonomous and saves them time.

 

 

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IBDoc® Update

New IBDoc® Tutorial Videos

We created six new IBDoc® Portal Tutorial Videos. They help Healthcare Professionals that start using IBDoc® with the first steps of creating an account and setting up new users.

Updated IBDoc® Flyer

This flyer can be used to easily demonstrate the efficiency and practicality of IBDoc®.  It was updated to better reflect the current status of IBDoc®: we now support a total of 60 validated smartphones.

Updated IBDoc® Smartphone List

During Summer 2019, we received approval from our notified body TÜV Süd to add 8 new smartphone models to be used with IBDoc®, bringing us to a total of 60 validated smartphones. We now support the latest iPhones with the Xs series and we continue to expand the Huawei coverage, responding to an increasing demand for this brand.

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