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Laura Cantoro, Antonio Di Sabatino, Claudio Papi, Giovanna Margagnoni, Sandro Ardizzone, Paolo Giuffrida, Diana Giannarelli, Alessandro Massari, Rita Monterubbianesi, Marco Vincenzo Lenti, Gino Roberto Corazza, Anna Kohn, The Time Course of Diagnostic Delay in Inflammatory Bowel Disease Over the Last Sixty Years: An Italian Multicentre Study, Journal of Crohn's and Colitis, Volume 11, Issue 8, August 2017, Pages 975–980, https://doi.org/10.1093/ecco-jcc/jjx041
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Abstract
Inflammatory bowel disease [IBD] patients are still under-diagnosed or diagnosed with serious delay. We examined whether diagnostic delay [DD] in IBD has changed over the last 60 years, and explored the risk factors of longer DD.
In total, 3392 IBD patients recorded in the registry of four IBD Italian centres were divided according to the year of diagnosis into a historical cohort [HC: 1955–84] and modern cohort [MC: 1985–2014]. DD, i.e. time lapse between onset of symptoms indicative of IBD and definitive diagnosis, was divided into four sub-periods [0–6, 7–12, 13–24, >24 months], which were correlated with age and disease location/behaviour at diagnosis.
Median DD in IBD was 3.0 months, it was significantly [P < 0.0001] higher in Crohn’s disease [CD] [7.1 months] than in ulcerative colitis [UC] [2.0 months], and did not differ either between the HC and the MC or over the last three decades. However, the proportion of patients with a DD>24 months was significantly [P < 0.0001] higher in the HC [26.0%] than in the MC [18.2%], and the same trend was evident over the last three decades [1985–94: 19.9%; 1995–2004: 16.4%; 2005–14: 13.9%; P = 0.04]. At logistic regression analysis, age at diagnosis >40 years (CD: odds ratio 1.73, 95% confidence interval [CI] 1.31–2.28, P < 0.0001; UC: 1.41, 95% CI 1.02–1.96, P = 0.04) and complicated disease at CD diagnosis [1.39, 95% CI 1.06–1.82, P = 0.02] were independently associated with a DD>24 months.
DD duration has not changed over the last 60 years in Italy, but the number of IBD patients with a longer DD significantly decreased. Older age at diagnosis and a complicated disease at CD diagnosis are risk factors for longer DD.
