Stéphane Nahon1, Pierre Lahmek2, Thierry Paupard3, Bruno Lesgourgues4, Stanislas Chaussade5, Laurent Peyrin-Biroulet6, Vered Abitbol5. 1. Service d'Hépato-Gastroentérologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10, avenue du Général Leclerc, 93370, Montfermeil, France. snahon@ch-montfermeil.fr. 2. Hôpital Emile Roux, Limeil-Brevannes, France. 3. Division of Gastroenterology and Hepatology, Hôpital de Dunkerque, Dunkirk, France. 4. Service d'Hépato-Gastroentérologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10, avenue du Général Leclerc, 93370, Montfermeil, France. 5. Division of Gastroenterology and Hepatology, Hopital Cochin, Paris, France. 6. Inserm U954 and Department of Gastroenterology, Lorraine University, Vandoeuvre-les-Nancy, France.
Abstract
AIM: To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD). METHODS: 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. RESULTS: A total of 497 patients with CD (53.6 % women) were analyzed. Median diagnostic delay was 5 months (IQR 25-75 %: 2-13 months). Median follow-up was 9 years (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). CONCLUSION: In this large multicenter prospective cohort of French CD patients, a long diagnostic delay (>13 months) increased the risk of early surgery. No associated factors could be identified in this study.
AIM: To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD). METHODS: 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-tumornecrosis factor (anti-TNF) therapy using the Kaplan-Meier test and the log-rank test. RESULTS: A total of 497 patients with CD (53.6 % women) were analyzed. Median diagnostic delay was 5 months (IQR 25-75 %: 2-13 months). Median follow-up was 9 years (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). CONCLUSION: In this large multicenter prospective cohort of French CDpatients, a long diagnostic delay (>13 months) increased the risk of early surgery. No associated factors could be identified in this study.
Entities:
Keywords:
Crohn’s disease; Diagnostic delay; Surgery
Authors: A Dignass; G Van Assche; J O Lindsay; M Lémann; J Söderholm; J F Colombel; S Danese; A D'Hoore; M Gassull; F Gomollón; D W Hommes; P Michetti; C O'Morain; T Oresland; A Windsor; E F Stange; S P L Travis Journal: J Crohns Colitis Date: 2010-01-15 Impact factor: 9.071
Authors: Geert D'Haens; Filip Baert; Gert van Assche; Philip Caenepeel; Philippe Vergauwe; Hans Tuynman; Martine De Vos; Sander van Deventer; Larry Stitt; Allan Donner; Severine Vermeire; Frank J Van De Mierop; Jean-Charles R Coche; Janneke van der Woude; Thomas Ochsenkühn; Ad A van Bodegraven; Philippe P Van Hootegem; Guy L Lambrecht; Fazia Mana; Paul Rutgeerts; Brian G Feagan; Daniel Hommes Journal: Lancet Date: 2008-02-23 Impact factor: 79.321
Authors: V Chouraki; G Savoye; L Dauchet; G Vernier-Massouille; J-L Dupas; V Merle; J-E Laberenne; J-L Salomez; E Lerebours; D Turck; A Cortot; C Gower-Rousseau; J-F Colombel Journal: Aliment Pharmacol Ther Date: 2011-03-16 Impact factor: 8.171
Authors: Jean Frédéric Colombel; William J Sandborn; Walter Reinisch; Gerassimos J Mantzaris; Asher Kornbluth; Daniel Rachmilewitz; Simon Lichtiger; Geert D'Haens; Robert H Diamond; Delma L Broussard; Kezhen L Tang; C Janneke van der Woude; Paul Rutgeerts Journal: N Engl J Med Date: 2010-04-15 Impact factor: 91.245
Authors: Stephan R Vavricka; Sabrina M Spigaglia; Gerhard Rogler; Valérie Pittet; Pierre Michetti; Christian Felley; Christian Mottet; Christian P Braegger; Daniela Rogler; Alex Straumann; Peter Bauerfeind; Michael Fried; Alain M Schoepfer Journal: Inflamm Bowel Dis Date: 2011-04-20 Impact factor: 5.325
Authors: Kelvin T Thia; William J Sandborn; William S Harmsen; Alan R Zinsmeister; Edward V Loftus Journal: Gastroenterology Date: 2010-07-14 Impact factor: 22.682
Authors: Alain M Schoepfer; Mohamed-Ali Dehlavi; Nicolas Fournier; Ekaterina Safroneeva; Alex Straumann; Valérie Pittet; Laurent Peyrin-Biroulet; Pierre Michetti; Gerhard Rogler; Stephan R Vavricka Journal: Am J Gastroenterol Date: 2013-08-27 Impact factor: 10.864
Authors: Gottfried Novacek; Hans Peter Gröchenig; Thomas Haas; Heimo Wenzl; Pius Steiner; Robert Koch; Thomas Feichtenschlager; Gerald Eckhardt; Andreas Mayer; Andreas Kirchgatterer; Othmar Ludwiczek; Reingard Platzer; Pavol Papay; Johanna Gartner; Harry Fuchssteiner; Wolfgang Miehsler; Paul-Gerhard Peters; Gerhard Reicht; Harald Vogelsang; Clemens Dejaco; Thomas Waldhör Journal: Wien Klin Wochenschr Date: 2019-02-04 Impact factor: 1.704
Authors: Mohammad I El Mouzan; Badr I AlSaleem; Mohammed Y Hasosah; Abdulrahman A Al-Hussaini; Aziz H Al Anazi; Omar I Saadah; Ahmed A Al Sarkhy; Mohammad A Al Mofarreh; Asaad A Assiri Journal: Saudi J Gastroenterol Date: 2019 Jul-Aug Impact factor: 2.485
Authors: James L Turvill; Daniel Turnock; Dan Cottingham; Monica Haritakis; Laura Jeffery; Annabelle Girdwood; Tom Hearfield; Alex Mitchell; Ada Keding Journal: Br J Gen Pract Date: 2021-07-29 Impact factor: 6.302
Authors: Lorenz Grob; Sena Bluemel; Luc Biedermann; Nicolas Fournier; Jean-Benoit Rossel; Stephan R Vavricka; Jonas Zeitz; Gerhard Rogler; Andreas Stallmach; Michael Scharl Journal: Therap Adv Gastroenterol Date: 2020-01-24 Impact factor: 4.409