Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn's Disease Patients.

Abstract

To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD). Medical and socioeconomic characteristics as well as medications and need for surgery of consecutive CD adults patients followed in three referral centers were prospectively recorded using an electronic database (Focus_MICI®). A long diagnostic delay was defined by the upper quartile. We compared patients with long diagnostic delay to those with earlier diagnosis regarding the time to: (1) first intestinal surgery, (2) first use of immunosuppressants (IMSs), and (3) first use of anti-tumor necrosis factor (anti-TNF) therapy using the Kaplan-Meier test and the log-rank test. A total of 497 patients with CD (53.6% women) were analyzed. Median diagnostic delay was 5months (IQR 25-75%: 2-13months). Median follow-up was 9years (IQR 4-16.2), and 148 (29.8%) patients had major surgery. There were no significant differences between patients with late and early diagnosis regarding age at diagnosis, disease phenotype, need for IMS therapy, and need for anti-TNF therapy. Time to first major surgery was shorter in patients with late diagnosis (p=0.05). In this large multicenter prospective cohort of French CD patients, a long diagnostic delay (>13months) increased the risk of early surgery. No associated factors could be identified in this study.