In the Journals

Diagnostic delay for Crohn’s disease increased complication, surgery risk

Patients with Crohn’s disease who experienced a longer delay between symptom emergence and diagnosis were more likely to develop bowel stenosis and require surgery in a recent study.

Researchers evaluated 905 patients with Crohn’s disease (CD) enrolled in the Swiss IBD cohort study between July 2006 and June 2011.

Patients were stratified according to the length of diagnostic delay as indicated by patient questionnaires and physician reports: between 0 and 3 months (n=265), 4 and 9 months (n=196), 10 and 24 months (n=244) and 25 months or longer (n=200).

The median overall delay was 9 months. Delay of 10 months or more was significantly more frequent in women (P=.027), and patients aged 40 years or older at diagnosis also were more likely to have longer delay (P<.001). Disease location differed significantly (P=.037), with more ileal disease observed in patients with a delay of 10 months or more, and more colonic disease in those with shorter delays. Categorizing disease location according to ileal involvement eliminated this significance (P=.087).

Diagnostic delay was correlated with incidence of bowel stenosis (OR=1.756, P=.011 with a 25-month delay or longer; OR=1.551, P=.047 for 4-9 months) and need for both intestinal surgery (OR=2.025, P=.003 for 25 months or longer and OR=1.757, P=.014 for 10-24 months) and any CD-related surgery (OR=1.572, P=.032 for delay of 10-24 months; OR=1.895, P=.004 for 25 months or longer).

Investigators observed positive associations between disease duration and bowel stenosis (OR=1.069, P<.001) and intestinal surgery (OR=1.14, P<.001), while nonileal disease location was negatively associated with stenosis (OR=0.407, P=.005) and surgery (OR=0.282, P<.001).

“This is the first study to demonstrate that an increasing duration of diagnostic delay is proportionally associated with a higher risk for the occurrence of bowel stenosis and CD-related intestinal surgery,” the researchers wrote. “The increasing evidence of better therapeutic responses early in disease course as well as our present findings are arguments to promote awareness programs among members of [the] general public and among general practitioners.”

Disclosure: The researchers report no relevant financial disclosures.

Patients with Crohn’s disease who experienced a longer delay between symptom emergence and diagnosis were more likely to develop bowel stenosis and require surgery in a recent study.

Researchers evaluated 905 patients with Crohn’s disease (CD) enrolled in the Swiss IBD cohort study between July 2006 and June 2011.

Patients were stratified according to the length of diagnostic delay as indicated by patient questionnaires and physician reports: between 0 and 3 months (n=265), 4 and 9 months (n=196), 10 and 24 months (n=244) and 25 months or longer (n=200).

The median overall delay was 9 months. Delay of 10 months or more was significantly more frequent in women (P=.027), and patients aged 40 years or older at diagnosis also were more likely to have longer delay (P<.001). Disease location differed significantly (P=.037), with more ileal disease observed in patients with a delay of 10 months or more, and more colonic disease in those with shorter delays. Categorizing disease location according to ileal involvement eliminated this significance (P=.087).

Diagnostic delay was correlated with incidence of bowel stenosis (OR=1.756, P=.011 with a 25-month delay or longer; OR=1.551, P=.047 for 4-9 months) and need for both intestinal surgery (OR=2.025, P=.003 for 25 months or longer and OR=1.757, P=.014 for 10-24 months) and any CD-related surgery (OR=1.572, P=.032 for delay of 10-24 months; OR=1.895, P=.004 for 25 months or longer).

Investigators observed positive associations between disease duration and bowel stenosis (OR=1.069, P<.001) and intestinal surgery (OR=1.14, P<.001), while nonileal disease location was negatively associated with stenosis (OR=0.407, P=.005) and surgery (OR=0.282, P<.001).

“This is the first study to demonstrate that an increasing duration of diagnostic delay is proportionally associated with a higher risk for the occurrence of bowel stenosis and CD-related intestinal surgery,” the researchers wrote. “The increasing evidence of better therapeutic responses early in disease course as well as our present findings are arguments to promote awareness programs among members of [the] general public and among general practitioners.”

Disclosure: The researchers report no relevant financial disclosures.