Roxana Zaharie1, Alina Tantau2, Florin Zaharie1, Marcel Tantau1, Liana Gheorghe3, Cristian Gheorghe3, Serban Gologan4, Cristina Cijevschi5, Anca Trifan5, Daniela Dobru6, Adrian Goldis7, Gabriel Constantinescu8, Razvan Iacob3, Mircea Diculescu3. 1. University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania. 2. University of Medicine and Pharmacy 'Iuliu Hatieganu', 4th Medical Clinic, Cluj-Napoca, Romania alina.i.tantau@gmail.com. 3. Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania. 4. Carol Davila University of Medicine and Pharmacy, Elias University Hospital, Gastroenterology, Bucuresti, Romania. 5. University of Medicine and Pharmacy 'Gr. T. Popa', Gastroenterology and Hepatology Institute, Iasi, Romania. 6. University of Medicine and Pharmacy, Municipal Hospital, Gastroenterology, Targu-Mures, Romania. 7. University of Medicine and Pharmacy 'Victor Babes', District Hospital, Gastroenterology, Timisoara, Romania. 8. Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Gastroenterology Department, Bucuresti, Romania.
Abstract
BACKGROUND: The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. METHODS: A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. RESULTS: The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. CONCLUSIONS: A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
BACKGROUND: The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. METHODS: A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CDpatients. RESULTS: The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CDpatients were diagnosed within 18 months of symptom onset. In CDpatients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CDpatients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. CONCLUSIONS: A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
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