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Impact of Diagnostic Delay and Associated Factors on Clinical Outcomes in a U.S. Inflammatory Bowel Disease Cohort

Nguyen, Vu Q. MD*; Jiang, Dingfeng MD, MS, PhD; Hoffman, Sharon N. PharmD; Guntaka, Srikar MD; Mays, Jessica L. BS*; Wang, Anthony PhD, MPH; Gomes, Joseph PharmD, MS, BCPS; Sorrentino, Dario MD*,‡

doi: 10.1097/MIB.0000000000001257
Original Clinical Articles
Video

Background: The impact of diagnostic delay in inflammatory bowel disease, including Crohn's disease (CD) and ulcerative colitis (UC), on disease course remains uncertain. This study examines factors that may influence time to diagnosis and disease outcomes in a U.S. patient cohort.

Methods: We retrospectively collected data on patient characteristics, time to diagnosis, disease phenotype, and complications in 177 patients with inflammatory bowel disease (110 CD and 67 UC) diagnosed at our institution from 2008 to 2015. Factors potentially affecting time to diagnosis were analyzed. Association between disease complications (perianal disease, intestinal strictures, surgery, fistula, abscess, and perforation) and time to diagnosis was tested by multivariable analysis.

Results: The median time to diagnosis was longer for patients with CD compared with patients with UC (median 9.5 versus 3.1 months; P < 0.001). The median time from symptom onset to initial physician visit was similar for patients with CD and patients with UC (1 month). However, the median time from symptom onset to specialist evaluation was longer for patients with CD compared with patients with UC: 7 months (interquartile range: 3–23) versus 3 months (interquartile range: 1–8), respectively (P < 0.001). In CD, ileal disease and hematochezia were positively and negatively correlated, respectively, with longer time to diagnosis (P < 0.05). Compared with patients with time to diagnosis ≤4 months, patients with time >26 months had increased overall complications (odds ratio, 8.22; P = 0.007) and intestinal strictures (odds ratio, 8.96; P = 0.012) at time of diagnosis. Such correlation persisted at follow-up.

Conclusions: Time to diagnosis was long in CD. Physician-related delay in diagnosing CD was associated with increased overall complications and intestinal strictures (See Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B646).

Article first published online 7 September 2017.

*Division of Gastroenterology, IBD Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia;

AbbVie Inc., North Chicago, Illinois; and

Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy.

Address correspondence to: Dario Sorrentino, MD, Division of Gastroenterology, 3 Riverside Circle, Roanoke, VA 24016 (e-mail: drsorrentino@carilionclinic.org).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

Supported by an institutional grant from Carilion Clinic and AbbVie Inc.

V. Q. Nguyen has received grant support from AbbVie Inc. D. Sorrentino has received consulting fees from Abbott/AbbVie, Schering-Plough, MSD, Janssen Research & Development, LLC., Centocor Inc., TechLab, Hoffmann-LaRoche, Giuliani, Schering-Plough, and Ferring; research grants from AbbVie, Janssen Research & Development, LLC, Schering-Plough, TechLab, Centocor and serves in the Speakers Bureau of AbbVie and the National Faculty of Janssen. The remaining authors have no conflict of interest to disclose in relation to this study.

Received February 01, 2017

Accepted July 09, 2017

© Crohn's & Colitis Foundation
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