Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn's Disease.

Schoepfer, Alain; Santos, Jessica; Fournier, Nicolas; Schibli, Susanne; Spalinger, Johannes; Vavricka, Stephan; Safroneeva, Ekaterina; Aslan, Nurullah; Rogler, Gerhard; Braegger, Christian; Nydegger, Andreas (2019). Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn's Disease. Journal of Crohn's & Colitis, 13(10), pp. 1334-1342. Elsevier 10.1093/ecco-jcc/jjz065

[img] Text
Schoepfer JCrohnsColitis 2019_epub.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (696kB) | Request a copy

BACKGROUND AND AIMS Length of diagnostic delay is associated with bowel strictures and intestinal surgery in adult patients with Crohn's disease [CD]. Here we assessed whether diagnostic delay similarly impacts on the natural history of paediatric CD patients. METHODS Data from the Swiss IBD Cohort Study were analysed. Frequency of CD-related complications [bowel stenosis, perianal fistula, internal fistula, any fistula, resection surgery, fistula/abscess surgery, any complication] at diagnosis and in the long term [up to 30 years after CD diagnosis] was compared between paediatric patients [diagnosed <18 years] and adult patients [diagnosed ≥18 years] using multivariate Cox proportional hazard regression modelling. RESULTS From 2006 to 2016, 387 paediatric and 1163 adult CD patients were included. Median [interquartile range: IQR] diagnostic delay was 3 [1-9] for the paediatric and 6 [1-24] months for the adult group, respectively. Adult onset CD patients presented at diagnosis more frequently with bowel stenosis [p <0.001] and bowel surgery [p <0.001] compared with paediatric CD patients. In the long term, length of diagnostic delay was significantly associated with bowel stenosis [p = 0.001], internal fistula [p = 0.038], and any complication [p = 0.024] in the adult onset CD population. No significant association between length of diagnostic delay and CD-related outcomes in the long term was observed in the paediatric population. CONCLUSIONS Adult CD patients have longer diagnostic delay compared with paediatric CD patients and present at diagnosis more often with bowel stenosis and surgery. Length of diagnostic delay was found to be predictive for CD-related complications only in the adult but not in the paediatric CD population.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Spalinger, Johannes and Safroneeva, Ekaterina

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1873-9946

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

24 Apr 2019 08:36

Last Modified:

05 Nov 2019 14:57

Publisher DOI:

10.1093/ecco-jcc/jjz065

PubMed ID:

31002741

Uncontrolled Keywords:

Crohn’s disease bowel damage natural history

BORIS DOI:

10.7892/boris.130276

URI:

https://boris.unibe.ch/id/eprint/130276

Actions (login required)

Edit item Edit item
Provide Feedback