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Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease

Vavricka, Stephan R. MD1,*; Spigaglia, Sabrina M.1; Rogler, Gerhard MD, PhD1; Pittet, Valérie PhD2; Michetti, Pierre MD3; Felley, Christian MD3; Mottet, Christian MD3; Braegger, Christian P. MD4; Rogler, Daniela MD4; Straumann, Alex MD5; Bauerfeind, Peter MD1; Fried, Michael MD1; Schoepfer, Alain M. MD3,6‡the Swiss IBD Cohort Study Group

doi: 10.1002/ibd.21719
Original Article

Background: The diagnosis of inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), continues to present difficulties due to unspecific symptoms and limited test accuracies. We aimed to determine the diagnostic delay (time from first symptoms to IBD diagnosis) and to identify associated risk factors.

Methods: A total of 1591 IBD patients (932 CD, 625 UC, 34 indeterminate colitis) from the Swiss IBD cohort study (SIBDCS) were evaluated. The SIBDCS collects data on a large sample of IBD patients from hospitals and private practice across Switzerland through physician and patient questionnaires. The primary outcome measure was diagnostic delay.

Results: Diagnostic delay in CD patients was significantly longer compared to UC patients (median 9 versus 4 months, P < 0.001). Seventy-five percent of CD patients were diagnosed within 24 months compared to 12 months for UC and 6 months for IC patients. Multivariate logistic regression identified age <40 years at diagnosis (odds ratio [OR] 2.15, P = 0.010) and ileal disease (OR 1.69, P = 0.025) as independent risk factors for long diagnostic delay in CD (>24 months). In UC patients, nonsteroidal antiinflammatory drug (NSAID intake (OR 1.75, P = 0.093) and male gender (OR 0.59, P = 0.079) were associated with long diagnostic delay (>12 months).

Conclusions: Whereas the median delay for diagnosing CD, UC, and IC seems to be acceptable, there exists a long delay in a considerable proportion of CD patients. More public awareness work needs to be done in order to reduce patient and doctor delays in this target population. (Inflamm Bowel Dis 2012;)

1 Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland

2 Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland

3 Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland

4 Division of Paediatric Gastroenterology and Nutrition, University Hospital Zurich, Switzerland

5 Division of Gastroenterology, University Hospital Basel, Switzerland

6 Farncombe Family Institute of Digestive Health Research, McMaster University, ON, Canada

* Division of Gastroenterology and Hepatology, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland

Dept. of Gastroenterology and Hepatology, CHUV / University hospital Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland



Received 27 February 2011; Accepted 2 March 2011

Published online 20 April 2011 in Wiley Online Library (

Supported by research grants from the Swiss National Science Foundation (320000-114009/1 to S.R.V., 3347CO-108792 Swiss IBD Cohort) and a grant of the Zurich Centre of Integrative Human Physiology.

The first two authors contributed equally.

© Crohn's & Colitis Foundation of America, Inc.
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