Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate

Schoepfer, Alain M.; Dehlavi, Mohamed-Ali; Fournier, Nicolas; Safroneeva, Ekaterina; Straumann, Alex; Pittet, Valérie; Peyrin-Biroulet, Laurent; Michetti, Pierre; Rogler, Gerhard; Vavricka, Stephan R.; Müller, Christoph; IBD Cohort Study Group, (Müller C) (2013). Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate. American journal of gastroenterology, 108(11), pp. 1744-1753. New York, N.Y.: Nature 10.1038/ajg.2013.248

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OBJECTIVES

The impact of diagnostic delay (a period from appearance of first symptoms to diagnosis) on the clinical course of Crohn's disease (CD) is unknown. We examined whether length of diagnostic delay affects disease outcomes.

METHODS

Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). The frequencies of occurrence of bowel stenoses, internal fistulas, perianal fistulas, and CD-related surgery (intestinal and perianal) were analyzed.

RESULTS

A total of 905 CD patients (53.4% female, median age at diagnosis 26 (20-36) years) were stratified into four groups according to the quartiles of diagnostic delay (0-3, 4-9, 10-24, and ≥25 months, respectively). Median diagnostic delay was 9 (3-24) months. The frequency of immunomodulator and/or antitumor necrosis factor drug use did not differ among the four groups. The length of diagnostic delay was positively correlated with the occurrence of bowel stenosis (odds ratio (OR) 1.76, P=0.011 for delay of ≥25 months) and intestinal surgery (OR 1.76, P=0.014 for delay of 10-24 months and OR 2.03, P=0.003 for delay of ≥25 months). Disease duration was positively associated and non-ileal disease location was negatively associated with bowel stenosis (OR 1.07, P<0.001, and OR 0.41, P=0.005, respectively) and intestinal surgery (OR 1.14, P<0.001, and OR 0.23, P<0.001, respectively).

CONCLUSIONS

The length of diagnostic delay is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery. Efforts should be undertaken to shorten the diagnostic delay.

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