• Crohn’s disease
• perianal fistula
• prolonged time to diagnosis

• Humans
• Crohn Disease/complications
• Crohn Disease/diagnosis
• Rectal Fistula/etiology
• Rectal Fistula/diagnosis
• Male
• Female
• Adult
• Retrospective Studies
• Delayed Diagnosis/statistics & numerical data
• Time Factors
• Middle Aged

• CD
• Crohn’s disease
• IBD
• UC
• emergency admissions
• inflammatory bowel disease
• inflammatory bowel disease–related surgery
• time to diagnosis
• ulcerative colitis

• Humans
• Female
• Male
• Retrospective Studies
• Adult
• Middle Aged
• Primary Health Care/statistics & numerical data
• Delayed Diagnosis/statistics & numerical data
• Crohn Disease/diagnosis
• Crohn Disease/surgery
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/surgery
• Colitis, Ulcerative/epidemiology
• Emergency Service, Hospital/statistics & numerical data
• Hospitalization/statistics & numerical data
• Inflammatory Bowel Diseases/diagnosis
• Time Factors
• Adolescent
• Risk Factors
• Young Adult
• Aged

• Crohn's disease
• Diagnostic delays
• Disease characteristics
• Early intervention
• Fecal calprotectin
• Gastrointestinal symptoms
• Healthcare disparities
• Healthcare system factors
• Inflammatory biomarkers
• Inflammatory bowel disease
• Irritable bowel syndrome (IBS)
• Medical history
• Patient outcomes
• Sociodemographic factors
• Ulcerative colitis (UC)

• Crohn Disease/diagnosis
• Humans
• Delayed Diagnosis

• Crohn’s disease
• Diagnostic delay
• Diagnostic time
• Germany
• Ulcerative colitis

• Humans
• Delayed Diagnosis/statistics & numerical data
• Female
• Male
• Adult
• Prospective Studies
• Middle Aged
• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Risk Factors
• Surveys and Questionnaires/statistics & numerical data
• Time Factors
• Young Adult
• Germany/epidemiology
• Referral and Consultation/statistics & numerical data
• Aged
• Diarrhea/diagnosis
• Diarrhea/etiology
• Diarrhea/epidemiology
• Adolescent

• China
• diagnostic delay
• inflammatory bowel disease

• study was supported by grants from National High-Level Hospital Clinical Research Funding
• The Capital Health Research and Development of Special Foundation
• the National Key Clinical Specialty Construction Project
• the National Natural Science Foundation of China
• the CAMS Innovation Fund for Medical Sciences

• Inflammatory bowel disease
• genomics
• machine learning

• Adult
• Humans
• Child
• Bayes Theorem
• Exome Sequencing
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/genetics
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/genetics
• Crohn Disease/diagnosis
• Crohn Disease/genetics
• Supervised Machine Learning

• Institute for Life Sciences, University of Southampton
• National Institute for Health Research
• Southampton Biomedical Research Centre
• Department of Health and Social Care
• NIHR302478 NIHR advanced Fellowship

• Humans
• Crohn Disease/diagnosis
• Crohn Disease/drug therapy
• Crohn Disease/epidemiology
• Missed Diagnosis
• Tertiary Healthcare
• Retrospective Studies
• Biological Products/therapeutic use
• Drug Utilization

• Crohn’s disease
• calprotectin
• diagnostic delay
• inflammatory bowel disease
• red flags
• ulcerative colitis

• Crohn's disease
• Diagnosis delay
• Meta-analysis
• Risk factors
• Systematic review

• Crohn’s disease
• epidemiology
• perianal disease

• Takeda Development Center Americas, Inc.
• National Taiwan University Hospital Research

• Crohn's disease
• prevalence
• prognosis
• systematic review
• upper gastrointestinal tract

• Crohn’s disease
• clinical outcomes
• delayed diagnosis
• inflammatory bowel disease
• phenotype
• surgery
• time to diagnosis
• ulcerative colitis

• Humans
• Colectomy
• Colitis, Ulcerative/diagnosis
• Crohn Disease/diagnosis
• Delayed Diagnosis
• Inflammatory Bowel Diseases/diagnosis

• Crohn’s disease
• Diagnostic delay
• Inflammatory bowel disease
• Ulcerative colitis

• Asia Pacific region
• Nudix Hydrolase 15
• Pediatric inflammatory bowel disease
• gastrointestinal infections
• resource limited

• Epidemiology
• Inflammatory bowel diseases
• Korea
• Pathophysiology

• Chronic Disease
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/therapy
• Crohn Disease/diagnosis
• Crohn Disease/epidemiology
• Crohn Disease/therapy
• Humans
• Incidence
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/epidemiology
• Inflammatory Bowel Diseases/therapy
• Republic of Korea/epidemiology

• cohort studies
• gastrointestinal microbiome
• inflammatory bowel disease
• schizophrenia

Longer diagnostic delay (DD) in Crohn's disease (CD) is associated with complications and related surgeries. However, the impact of DD on medical cost after CD diagnosis remains uncertain.

This was a claims‐based cohort study. Our analysis used data from 2005 to 2018 from the Japanese Claims Database. We enrolled a total of 528 newly diagnosed CD patients (76.9% male) aged 31.5 ± 13.6 years. High medical cost was defined as the highest quartile of the average monthly medical cost. DD was defined as the interval between the first visit to a gastroenterologist and diagnosis with CD. In the multivariable logistic regression analysis, patients were stratified by the use of anti‐tumor necrosis factor alpha (anti‐TNFα) agents to exclude their influence on the observed effects. This study was approved by the ethics review board of the Juntendo University Faculty of Medicine (No. 2019178).

The multivariable‐adjusted odds ratios and 95% confidence intervals of high medical cost were 1.41 (0.81–2.43) and 0.91 (0.57–1.46), respectively, for a DD of >12 months and 1 to ≤12 months compared to <1 month. In patients receiving anti‐TNFα agents, the multivariable‐adjusted odds ratios for high medical cost were 2.63 (1.34–5.16) and 1.35 (0.79–2.28) for a DD of >12 months and 1 to ≤12 months, respectively, compared to <1 month. In patients without anti‐TNFα, multivariable logistic regression analyses were not presented because of a small number of patients categorized into the high medical cost group.

A delayed diagnosis of CD may incur high medical cost in patients who develop aggressive disease that requires treatment with anti‐TNFα agents.

• Crohn's disease
• anti‐tumor necrosis factor alpha
• diagnostic delay
• medical cost

We aimed to investigate the differences in direct healthcare costs between patients with and without inflammatory bowel disease (IBD) and changes in direct healthcare costs before and after IBD diagnosis.

This population-based study identified 34,167 patients with IBD (11,014 patients with Crohn’s disease and 23,153 patients with ulcerative colitis) and 102,501 age-and sex-matched subjects without IBD (the control group) from the National Health Insurance database using the International Classification of Disease, 10th revision codes and the rare intractable disease registration program codes. The mean healthcare costs per patient were analyzed for 3 years before and after IBD diagnosis, with follow-up data available until 2015.

Total direct healthcare costs increased and peaked at $2,396 during the first year after IBD diagnosis, but subsequently dropped sharply to $1,478 during the second year after diagnosis. Total healthcare costs were higher for the IBD patients than for the control group, even in the third year before the diagnosis ($497 vs $402, p<0.001). The costs for biologics for the treatment of IBD increased steeply over time, rising from $720.8 in the first year after diagnosis to $1,249.6 in the third year after diagnosis (p<0.001).

IBD patients incurred the highest direct healthcare costs during the first year after diagnosis. IBD patients had higher costs than the control group even before diagnosis. The cost of biologics increased steeply over time, and it can be assumed that biologics could be the main driver of costs during the early period after IBD diagnosis.

• Biologic product
• Cost and cost analysis
• Inflammatory bowel disease

• Crohn’s disease
• IBD
• Income
• earnings
• inflammatory bowel disease
• ulcerative colitis

• Inflammatory bowel disease [IBD]
• fistula
• stricture

Inflammatory bowel disease is a chronic and progressive disorder of the gastrointestinal tract. A relevant proportion of patients develop complicated lesions, defined as strictures, fistulas and/or abscesses already at diagnosis, and this proportion increases over time. The preclinical phase defines the period of time from the appearance of the first immune disturbances until the development of overt disease, and it may be present months to years before the diagnosis. Multiple biomarkers (e.g., C-reactive protein, interleukin-6, fecal calprotectin) and cellular mechanisms (e.g., complement cascade, lysosomes, innate immunity, and glycosaminoglycan metabolism) are already altered during this period. Research in this area allows the description of the initial immune disturbances that may identify potential targets and lead to the development of new drug therapies. During this period, different interventions in high-risk individuals, including drugs or environmental factors, will open the possibility of innovative strategies focused on the reduction of complications, or even prevention trials for inflammatory bowel disease. Here, we review the most relevant findings regarding the characteristics, prevalence and biomarkers associated with preclinical disease, along with their possible use in our future clinical practice.

• Crohn’s disease
• early stage
• preclinical
• ulcerative colitis

• Crohn's disease
• children
• diagnostic delay
• inflammatory bowel disease
• time to diagnosis
• ulcerative colitis

• Colitis ulcerosa
• Crohn's disease
• Diagnostic delay
• Enfermedad de Crohn
• Enfermedad inflamatoria intestinal
• Inflammatory bowel disease
• Retraso diagnóstico
• Ulcerative colitis

• Crohn’s disease
• bowel damage
• natural history

• Crohn’s disease
• IBD
• comorbidity
• diagnostic delay
• disability pension
• sick leave

Upper gastrointestinal tract predominant Crohn's Disease (CD) remains an elusive clinical entity, manifesting limited or vague symptomatology, eluding clinical suspicion, and delaying subsequent diagnostic evaluation. As a result, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard IBD evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be grossly normal in patients without long standing-disease. We describe an 18-year-old male who presented with only unexplained, persistent iron-deficiency anemia. Extensive outpatient testing including multiple endoscopic evaluations with standard biopsies was unfruitful. Ultimately, a positive fecal calprotectin prompted enteroscopy with endoscopic mucosal resection (EMR) in an effort to obtain a larger, deeper tissue specimen. Grossly cobblestoned mucosa along with histopathology revealing focal crypt abscesses, chronic inflammation in the lamina propria, and superficial foveolar epithelial regenerative changes were consistent with CD. This patient's case illustrates the need for a high degree of suspicion for CD in patients with unexplained or persistent iron deficiency anemias. Persistent investigation yielded an elevation in fecal calprotectin suggesting underlying gastrointestinal inflammation and prompted advanced endoscopic evaluation with EMR. Waxing and waning tissue findings are characteristic of CD and pose a unique challenge in patients with upper gastrointestinal predominant pathology. As such, diligent workup including laboratory evaluation, imaging, and serial endoscopy is critical to establish pathology and dictate subsequent management in IBD, especially upper gastrointestinal tract predominant CD.

• Crohn’s disease
• diagnostics
• direct costs
• disease-modifying therapy
• early diagnosis
• fibromyalgia syndrome
• inflammation
• irritable bowel syndrome
• multiple sclerosis
• ulcerative colitis

• R44AI124766, R44AI129147 National Institutes of Health

Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.

To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.

Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest follow-up] at each diagnostic interval.

The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75^th percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916).

A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.

• Ulcerative colitis
• Diagnostic delay
• Anti-tumor necrosis factor alpha
• Smoking

• Adult
• Age Factors
• Anti-Inflammatory Agents/therapeutic use
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/epidemiology
• Colitis, Ulcerative/pathology
• Colitis, Ulcerative/therapy
• Delayed Diagnosis/statistics & numerical data
• Diagnostic Errors/statistics & numerical data
• Female
• Hemorrhoids/diagnosis
• Hospitalization/statistics & numerical data
• Humans
• Incidence
• Male
• Middle Aged
• Republic of Korea/epidemiology
• Retrospective Studies
• Risk Factors
• Symptom Flare Up
• Time Factors
• Tumor Necrosis Factor-alpha/antagonists & inhibitors

• Age at diagnosis
• Crohn’s disease
• Educational level
• Surgery
• Ulcerative colitis

The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population.

The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses.

The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses.

Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.

• Anal fistula
• Crohn disease
• Prognosis

The patient-physician relationship has a pivotal impact on the inflammatory bowel disease (IBD) outcomes. However, there are many challenges in the patient-physician relationship; lag time in diagnosis which results in frustration and an anchoring bias against the treating gastroenterologist, the widespread availability of medical information on the internet has resulted in patients having their own ideas of treatment, which may be incongruent from the treating physicians’ goals resulting in patient physician discordance. Because IBD is an incurable disease, the goal of treatment is to sustain remission. To achieve this, patients may have to go through several lines of treatment. The period of receiving stepping up, top down or even accelerated stepping up medications may result in a lot of frustration and anxiety for the patient and may compromise the patient-physician relationship. IBD patients are also prone to psychological distress that further compromises the patient-physician relationship. Despite numerous published data regarding the medical and surgical treatment options available for IBD, there is a lack of data regarding methods to improve the therapeutic patient-physician relationship. In this review article, we aim to encapsulate the challenges faced in the patient-physician relationship and ways to overcome in for an improved outcome in IBD.

• Communication barriers
• Patient reported outcome measures
• Patient-physician relations

We aimed to evaluate the clinical characteristics and prognosis of Crohn’s disease (CD) in patients who showed proximal small bowel involvement using a nationwide Korean CD cohort.

We reviewed the data from a cohort of patients diagnosed with CD. The clinical outcomes of patients were evaluated according to the presence of proximal small bowel involvement.

Among 1,329 patients with CD for whom complete disease location data were available, 222 patients (16.7%) showed involvement of the proximal small bowel. Compared to patients without proximal small bowel involvement, those with small bowel involvement were more likely to display stricturing behavior (19.8% vs 12.7%, p=0.020). The surgery-free survival of patients who showed proximal small bowel involvement was inferior to that of patients without proximal small bowel involvement (10-year surgery-free survival: 58.4% vs 67.7%, respectively, p<0.001). Additionally, upper gastrointestinal involvement was more common in patients with proximal small bowel involvement than in those without involvement (odds ratio, 1.643; 95% confidence interval, 1.008 to 2.677).

Proximal small bowel involvement is a poor prognostic factor for the surgery-free survival of Korean patients with CD. Proximal small bowel involvement should be evaluated in patients with CD for predicting long-term clinical outcomes.

• Crohn disease
• General surgery
• Jejunum
• Prognosis
• Proximal small bowel

• gastroenterology
• general paediatrics
• growth

To investigate the factors affecting diagnostic delay and outcomes of diagnostic delay in inflammatory bowel disease (IBD)

We retrospectively studied 165 patients with Crohn’s disease (CD) and 130 patients with ulcerative colitis (UC) who were diagnosed and had follow up durations > 6 mo at Korea University Ansan Hospital from January 2000 to December 2015. A diagnostic delay was defined as the time interval between the first symptom onset and IBD diagnosis in which the 76^th to 100^th percentiles of patients were diagnosed.

The median diagnostic time interval was 6.2 and 2.4 mo in the patients with CD and UC, respectively. Among the initial symptoms, perianal discomfort before di-agnosis (OR = 10.2, 95%CI: 1.93-54.3, P = 0.006) was associated with diagnostic delays in patients with CD; however, no clinical factor was associated with diagnostic delays in patients with UC. Diagnostic delays, stricturing type, and penetrating type were associated with increased intestinal surgery risks in CD (OR = 2.54, 95%CI: 1.06-6.09; OR = 4.44, 95%CI: 1.67-11.8; OR = 3.79, 95%CI: 1.14-12.6, respectively). In UC, a diagnostic delay was the only factor associated increased intestinal surgery risks (OR = 6.81, 95%CI: 1.12-41.4).

A diagnostic delay was associated with poor outcomes, such as increased intestinal surgery risks in patients with CD and UC.

• Diagnostic delay
• Intestinal surgery
• Inflammatory bowel disease
• Crohn’s disease
• Ulcerative colitis

• Adolescent
• Adult
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/surgery
• Crohn Disease/diagnosis
• Crohn Disease/surgery
• Delayed Diagnosis/adverse effects
• Digestive System Surgical Procedures/statistics & numerical data
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Time Factors
• Young Adult

• Crohn’s disease
• Korea
• Ulcerative colitis
• cancer
• population-based

• Age at diagnosis
• Crohn’s disease
• disease behaviour
• misdiagnosis
• ulcerative colitis