Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6474-6481
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6474
Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery
Dong-won Lee, Ja Seol Koo, Jung Wan Choe, Sang Jun Suh, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Young Kul Jung, Hyung Joon Yim, Sang Woo Lee
Dong-won Lee, Ja Seol Koo, Jung Wan Choe, Sang Jun Suh, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Young Kul Jung, Hyung Joon Yim, Sang Woo Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, South Korea
Author contributions: Koo JS contributed to study conception and design; Lee D, Koo JS, Choe JW, Suh SJ, Kim SY, Hyun JJ, Jung SW, Jung YG, Yim HJ and Lee SW contributed to patient recruitment and data collection; Lee D and Koo JS contributed to data generation and analysis; Lee D and Koo JS contributed to manuscript drafting; all authors reviewed, commented upon, and approved the final submission.
Institutional review board statement: This study was approved by the Institutional Review Board of Korea University Ansan Hospital (IRB number AS16206).
Informed consent statement: The requirement for obtaining informed patient consent was waived because the present study has been based on the retrospective analysis of existing medical records.
Conflict-of-interest statement: The authors do not have any disclosures to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ja Seol Koo, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, South Korea. jskoo@korea.ac.kr
Telephone: +82-31-4124853 Fax: +82-31-4125582
Received: June 14, 2017
Peer-review started: June 15, 2017
First decision: July 17, 2017
Revised: July 28, 2017
Accepted: July 28, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
Processing time: 99 Days and 4 Hours
Abstract
AIM

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

METHODS

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 76th to 100th percentiles of patients were diagnosed.

RESULTS

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).

CONCLUSION

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

Keywords: Diagnostic delay; Intestinal surgery; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis

Core tip: As the manifestations of inflammatory bowel disease (IBD) were nonspecific, the diagnosis is often established following considerable delay. There have been few reports about diagnostic delay associated with poor outcomes in Asian IBD patients. We aimed to investigate the factor affecting diagnostic delay and its effect in Korean IBD patients. In present study, a diagnostic delay was significantly associated with poor outcomes, such as increased IBD related intestinal surgery risks in patients with Crohn’s disease and ulcerative colitis. Therefore, it is important for the improvement of clinical outcomes in IBD patients to early diagnose and manage adequately.