Abstract
Diagnostic delay frequently occurs in Crohn’s disease (CD) patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn’s Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years) (p = 0.014), concomitant upper gastrointestinal (UGI) disease (p = 0.012) and penetrating disease behavior at diagnosis (p = 0.001) were positively associated with long diagnostic delay (≥18 months). During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07–1.93; p = 0.017), internal fistulas (HR, 1.62; 95% CI, 1.12–2.33; p = 0.011), and perianal fistulas (HR, 1.38; 95% CI, 1.06–1.80; p = 0.016). However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.
Highlights
Crohn’s disease (CD) is a chronic relapsing and destructive inflammatory condition of the gastrointestinal tract that progresses to bowel damage related to impaired functioning
0.957 0.720 0.011 (HR = 1.66, p = 0.014), stricturing (HR = 4.83, p < 0.001), and penetrating behavior (HR = 5.99, p < 0.001) at diagnosis were associated with abdominal surgery (S3 Table). This nationwide CD cohort study in Korea showed that long diagnostic delay was significantly associated with an increased risk of CD-related complications, such as intestinal stenosis, internal fistulas, and perianal fistulas
A Swiss inflammatory bowel disease (IBD) cohort study reported that a long diagnostic delay was associated with the further development of bowel stenosis and intestinal surgery [18]
Summary
Crohn’s disease (CD) is a chronic relapsing and destructive inflammatory condition of the gastrointestinal tract that progresses to bowel damage related to impaired functioning. Studies have shown that early diagnosis and intensive treatment of CD are necessary to prevent bowel damage and unexpected surgery in patients [3,4,5]. Considering that intestinal inflammation occurs after the onset of the first symptoms in CD patients, reducing diagnostic delay could have clinical implications in real clinical practice. Several studies have evaluated clinical factors associated with diagnostic delay in Western patients [8,9] and few studies have examined these factors in Eastern patients [10]. Considering the significant differences in the epidemiologic and clinical features of CD according to ethnicities and environmental factors [11,12,13], diagnostic delay and its associated factors may differ with countries
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