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Erschienen in: Wiener klinische Wochenschrift 5-6/2019

04.02.2019 | original article

Diagnostic delay in patients with inflammatory bowel disease in Austria

verfasst von: Gottfried Novacek, M.D, Hans Peter Gröchenig, M.D., Thomas Haas, M.D., Heimo Wenzl, M.D., Pius Steiner, M.D., Robert Koch, M.D., Thomas Feichtenschlager, M.D., Gerald Eckhardt, M.D., Andreas Mayer, M.D., Andreas Kirchgatterer, M.D., Othmar Ludwiczek, M.D., Reingard Platzer, M.D., Pavol Papay, M.D., Johanna Gartner, M.D., Harry Fuchssteiner, M.D., Wolfgang Miehsler, M.D., Paul-Gerhard Peters, M.D., Gerhard Reicht, M.D., Harald Vogelsang, M.D., Clemens Dejaco, M.D., Thomas Waldhör, PhD, Austrian IBD Study Group (ATISG)

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2019

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Summary

Background

Delayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD patients.

Methods

In a multicenter cross-sectional study adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of IBD.

Results

A total of 1286 patients (Crohn’s disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21; females 651) with a median age of 40 years (interquartile range 31–52 years) and a median disease duration of 10 years (4–18 years) were analyzed. The median diagnostic delay was 6 months (2–23 months) in Crohn’s disease and 3 months (1–10 months) in ulcerative colitis (p < 0.001). In the multivariable regression analysis Crohn’s disease, greater age at diagnosis and a high educational level (compared to middle degree level) were independently associated with longer diagnostic delay.

Conclusion

The diagnostic delay was longer in Crohn’s disease than in ulcerative colitis patients and was associated with greater age at diagnosis and a higher educational level.
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Literatur
1.
Zurück zum Zitat Danese S, Fiorino G, Mary JY, Lakatos PL, D’Haens G, Moja L, et al. Development of red flags index for early referral of adults with symptoms and signs suggestive of Crohn’s disease: An IOIBD initiative. J Crohns Colitis. 2015;9:601–6.CrossRef Danese S, Fiorino G, Mary JY, Lakatos PL, D’Haens G, Moja L, et al. Development of red flags index for early referral of adults with symptoms and signs suggestive of Crohn’s disease: An IOIBD initiative. J Crohns Colitis. 2015;9:601–6.CrossRef
2.
Zurück zum Zitat Burgmann T, Clara I, Graff L, Walker J, Lix L, Rawsthorne P, et al. The Manitoba Inflammatory Bowel Disease Cohort Study: prolonged symptoms before diagnosis-how much is irritable bowel syndrome? Clin Gastroenterol Hepatol. 2006;4:614–20.CrossRef Burgmann T, Clara I, Graff L, Walker J, Lix L, Rawsthorne P, et al. The Manitoba Inflammatory Bowel Disease Cohort Study: prolonged symptoms before diagnosis-how much is irritable bowel syndrome? Clin Gastroenterol Hepatol. 2006;4:614–20.CrossRef
3.
Zurück zum Zitat Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–8.CrossRef Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–8.CrossRef
4.
Zurück zum Zitat Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn’s disease but not ulcerative colitis. Am J Gastroenterol. 2000;95:3458–62.CrossRef Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn’s disease but not ulcerative colitis. Am J Gastroenterol. 2000;95:3458–62.CrossRef
5.
Zurück zum Zitat Romberg-Camps MJL, Hesselink-van de Kruijs MAM, Schouten LJ, Dagnelie PC, Limonard CB, Kester ADM, et al. Inflammatory bowel disease in South Limburg (the Netherlands) 1991–2002: incidence, diagnostic delay, and seasonal variations in onset of symptoms. J Crohns Colitis. 2009;3:115–24.CrossRef Romberg-Camps MJL, Hesselink-van de Kruijs MAM, Schouten LJ, Dagnelie PC, Limonard CB, Kester ADM, et al. Inflammatory bowel disease in South Limburg (the Netherlands) 1991–2002: incidence, diagnostic delay, and seasonal variations in onset of symptoms. J Crohns Colitis. 2009;3:115–24.CrossRef
6.
Zurück zum Zitat Vavricka SR, Spigaglia SM, Rogler G, Pittet V, Michetti P, Felley C, et al. Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:496–505.CrossRef Vavricka SR, Spigaglia SM, Rogler G, Pittet V, Michetti P, Felley C, et al. Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:496–505.CrossRef
7.
Zurück zum Zitat Schoepfer AM, Dehlavi MA, Fournier N, Safroneeva E, Straumann A, Pittet V, et al. Diagnostic delay in Crohn’s disease is associated with a complicated disease course and increased operation rate. Am J Gastroenterol. 2013;108:1744–53.CrossRef Schoepfer AM, Dehlavi MA, Fournier N, Safroneeva E, Straumann A, Pittet V, et al. Diagnostic delay in Crohn’s disease is associated with a complicated disease course and increased operation rate. Am J Gastroenterol. 2013;108:1744–53.CrossRef
8.
Zurück zum Zitat Nahon S, Lahmek P, Lesgourgues B, Poupardin C, Chaussade S, Peyrin-Biroulet L, et al. Diagnostic delay in a French cohort of Crohn’s diease patients. J Crohns Colitis. 2014;8:964–9.CrossRef Nahon S, Lahmek P, Lesgourgues B, Poupardin C, Chaussade S, Peyrin-Biroulet L, et al. Diagnostic delay in a French cohort of Crohn’s diease patients. J Crohns Colitis. 2014;8:964–9.CrossRef
9.
Zurück zum Zitat Burisch J, Pedersen N, Cukovic-Cavka S, Brinar M, Kaimakliotis I, Duricova D, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut. 2014;63:588–97.CrossRef Burisch J, Pedersen N, Cukovic-Cavka S, Brinar M, Kaimakliotis I, Duricova D, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut. 2014;63:588–97.CrossRef
10.
Zurück zum Zitat Lönnfors S, Vermeire S, Greco M, Hommes D, Bell C, Avedano L. IBD and health-related quality of life—discovering the true impact. J Crohns Colitis. 2014;8:1281–6.CrossRef Lönnfors S, Vermeire S, Greco M, Hommes D, Bell C, Avedano L. IBD and health-related quality of life—discovering the true impact. J Crohns Colitis. 2014;8:1281–6.CrossRef
11.
Zurück zum Zitat Maconi G, Orlandi L, Asthana AK, Sciurti R, Furfaro F, Bezzio, et al. The impact of symptoms, irritable bowel syndrome pattern and diagnostic investigations on the diagnostic delay of Crohn’s disease: a prospective study. Dig Liver Dis. 2015;47:646–51.CrossRef Maconi G, Orlandi L, Asthana AK, Sciurti R, Furfaro F, Bezzio, et al. The impact of symptoms, irritable bowel syndrome pattern and diagnostic investigations on the diagnostic delay of Crohn’s disease: a prospective study. Dig Liver Dis. 2015;47:646–51.CrossRef
12.
Zurück zum Zitat Li Y, Ren J, Wang G, Gu G, Wu X, Ren H, et al. Diagnostic delay in Crohn’s disease is associated with increased rate of abdominal surgery: a retrospective study in Chinese patients. Dig Liver Dis. 2015;47:544–8.CrossRef Li Y, Ren J, Wang G, Gu G, Wu X, Ren H, et al. Diagnostic delay in Crohn’s disease is associated with increased rate of abdominal surgery: a retrospective study in Chinese patients. Dig Liver Dis. 2015;47:544–8.CrossRef
13.
Zurück zum Zitat Pellino G, Sciaudone G, Selvaggi F, Riegler G. Delayed diagnosis is influenced by the clinical pattern of Crohn’s disease and affects treatment outcomes and quality of life in the long term: a cross-sectional study of 361 patients in southern Italy. Eur J Gastroenterol Hepatol. 2015;27:175–81.CrossRef Pellino G, Sciaudone G, Selvaggi F, Riegler G. Delayed diagnosis is influenced by the clinical pattern of Crohn’s disease and affects treatment outcomes and quality of life in the long term: a cross-sectional study of 361 patients in southern Italy. Eur J Gastroenterol Hepatol. 2015;27:175–81.CrossRef
14.
Zurück zum Zitat Moon CM, Jung SA, Kim SE, Song HJ, Ye BD, Cheon JH, et al. Clinical factors and disease course related to diagnostic delay in Korean Crohn’s disease patients: results from the CONNECT study. PLoS ONE. 2015;10(12):e144390.CrossRef Moon CM, Jung SA, Kim SE, Song HJ, Ye BD, Cheon JH, et al. Clinical factors and disease course related to diagnostic delay in Korean Crohn’s disease patients: results from the CONNECT study. PLoS ONE. 2015;10(12):e144390.CrossRef
15.
Zurück zum Zitat Zaharie R, Tantau A, Zaharie F, Tantau M, Gheorghe L, Cheorghe C, et al. Diagnostic delay in Romanian patients with inflammatory bowel disease: risk factors and impact on the disease course and need for surgery. J Crohns Colitis. 2016;10:306–14.CrossRef Zaharie R, Tantau A, Zaharie F, Tantau M, Gheorghe L, Cheorghe C, et al. Diagnostic delay in Romanian patients with inflammatory bowel disease: risk factors and impact on the disease course and need for surgery. J Crohns Colitis. 2016;10:306–14.CrossRef
16.
Zurück zum Zitat Nahon S, Lahmek P, Paupard T, Lesgourgues B, Chaussade S, Peyrin-Biroulet L, et al. Diagnostic delay is associated with a greater risk of early surgery in a French cohort of Crohn’s disease patients. Dig Dis Sci. 2016;61:3278–84.CrossRef Nahon S, Lahmek P, Paupard T, Lesgourgues B, Chaussade S, Peyrin-Biroulet L, et al. Diagnostic delay is associated with a greater risk of early surgery in a French cohort of Crohn’s disease patients. Dig Dis Sci. 2016;61:3278–84.CrossRef
17.
Zurück zum Zitat Cantoro L, Di Sabatino A, Papi C, Margagnoni G, Ardizzone S, Giuffrida P, et al. The time course of diagnostic delay in inflammatory bowel disease over the last sixty years: an Italian multicenter study. J Crohns Colitis. 2017;11:975–80.CrossRef Cantoro L, Di Sabatino A, Papi C, Margagnoni G, Ardizzone S, Giuffrida P, et al. The time course of diagnostic delay in inflammatory bowel disease over the last sixty years: an Italian multicenter study. J Crohns Colitis. 2017;11:975–80.CrossRef
18.
Zurück zum Zitat Nguyen VQ, Jiang D, Hoffman SN, Guntaka S, Mays JL, Wang A, et al. Impact of diagnostic delay and associated factors on clinical outcomes in a U.S: inflammatory bowel disease cohort. Inflamm Bowel Dis. 2017;23:1825–31.CrossRef Nguyen VQ, Jiang D, Hoffman SN, Guntaka S, Mays JL, Wang A, et al. Impact of diagnostic delay and associated factors on clinical outcomes in a U.S: inflammatory bowel disease cohort. Inflamm Bowel Dis. 2017;23:1825–31.CrossRef
19.
Zurück zum Zitat Lee DW, Koo JS, Choe JW, Suh SJ, Kim SY, Hyun JJ, et al. Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery. World J Gastroenterol. 2017;23:6474–81.CrossRef Lee DW, Koo JS, Choe JW, Suh SJ, Kim SY, Hyun JJ, et al. Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery. World J Gastroenterol. 2017;23:6474–81.CrossRef
20.
Zurück zum Zitat Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: Diagnosis and medical management. J Crohns Colitis. 2017;11:3–25.CrossRef Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: Diagnosis and medical management. J Crohns Colitis. 2017;11:3–25.CrossRef
21.
Zurück zum Zitat Gionchetti P, Dignass A, Danese S, Magro DFJ, Rogler G, Lakatos PL, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis. 2017;11:135–49.CrossRef Gionchetti P, Dignass A, Danese S, Magro DFJ, Rogler G, Lakatos PL, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis. 2017;11:135–49.CrossRef
22.
Zurück zum Zitat Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. Long-term complications, extraintestinal manifestations, and mortality in adult Crohn’s disease in population-based cohorts. Inflamm Bowel Dis. 2011;17:471–8.CrossRef Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. Long-term complications, extraintestinal manifestations, and mortality in adult Crohn’s disease in population-based cohorts. Inflamm Bowel Dis. 2011;17:471–8.CrossRef
23.
Zurück zum Zitat Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systemic review. Gut. 2013;62:1072–84.CrossRef Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systemic review. Gut. 2013;62:1072–84.CrossRef
24.
Zurück zum Zitat Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017;11:649–70.CrossRef Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017;11:649–70.CrossRef
25.
Zurück zum Zitat Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017;11:769–84.CrossRef Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017;11:769–84.CrossRef
26.
Zurück zum Zitat Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–25.CrossRef Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–25.CrossRef
27.
Zurück zum Zitat D’Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008;371(9613):660–7.CrossRef D’Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008;371(9613):660–7.CrossRef
28.
Zurück zum Zitat Schreiber S, Colombel JF, Bloomfield R, Nikolaus S, Schölmerich J, Panés J, et al. Increased response and remission rates in short-duration Crohn’s disease with subcutaneous certolizumab pegol: an analysis of PRECISE 2 randomized maintenance trial data. Am J Gastroenterol. 2010;105:1574–82.CrossRef Schreiber S, Colombel JF, Bloomfield R, Nikolaus S, Schölmerich J, Panés J, et al. Increased response and remission rates in short-duration Crohn’s disease with subcutaneous certolizumab pegol: an analysis of PRECISE 2 randomized maintenance trial data. Am J Gastroenterol. 2010;105:1574–82.CrossRef
29.
Zurück zum Zitat Khanna R, Bressler B, Levesque BG, Zou G, Stitt LW, Greenberg GR, et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomized controlled trial. Lancet. 2015;386(10006):1825–34.CrossRef Khanna R, Bressler B, Levesque BG, Zou G, Stitt LW, Greenberg GR, et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomized controlled trial. Lancet. 2015;386(10006):1825–34.CrossRef
30.
Zurück zum Zitat Allen PB, Peyrin-Biroulet L. Moving towards disease modification in inflammatory bowel disease therapy. Curr Opin Gastroenterol. 2013;29:397–404.CrossRef Allen PB, Peyrin-Biroulet L. Moving towards disease modification in inflammatory bowel disease therapy. Curr Opin Gastroenterol. 2013;29:397–404.CrossRef
31.
Zurück zum Zitat Peyrin-Biroulet L, Billioud V, D’Haens G, Panaccione R, Feagan B, Panés J, et al. Development of the Paris definition of early Crohn’s disease for disease-modification trials results of an international expert opinion process. Am J Gastroenterol. 2012;107:1770–6.CrossRef Peyrin-Biroulet L, Billioud V, D’Haens G, Panaccione R, Feagan B, Panés J, et al. Development of the Paris definition of early Crohn’s disease for disease-modification trials results of an international expert opinion process. Am J Gastroenterol. 2012;107:1770–6.CrossRef
32.
Zurück zum Zitat Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324–38.CrossRef Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324–38.CrossRef
33.
Zurück zum Zitat Molodecky NA, Soon IS, Rabi DM, Ghail WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.CrossRef Molodecky NA, Soon IS, Rabi DM, Ghail WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.CrossRef
34.
Zurück zum Zitat Van den Heuvel TRA, Jeuring SFG, Zeegers MP, van Dongen DHE, Wolters A, Masclee AAM, et al. A 20 year temporal change analysis in incidence, presenting phenotype and mortality in the Dutch IBDSL cohort—can diagnostic factors explain the increase in IBD incidence? J Crohns Colitis. 2017;11:1169–79.CrossRef Van den Heuvel TRA, Jeuring SFG, Zeegers MP, van Dongen DHE, Wolters A, Masclee AAM, et al. A 20 year temporal change analysis in incidence, presenting phenotype and mortality in the Dutch IBDSL cohort—can diagnostic factors explain the increase in IBD incidence? J Crohns Colitis. 2017;11:1169–79.CrossRef
35.
Zurück zum Zitat Ghione S, Sarter H, Fumery M, Armengol-Debeir L, Savoye G, Ley D, et al. Dramatic increase in incidence of ulcerative colitis and Crohn’s disease (1988–2011): a population-based study of French adolescents. Am J Gastroenterol. 2018;113:265–72.CrossRef Ghione S, Sarter H, Fumery M, Armengol-Debeir L, Savoye G, Ley D, et al. Dramatic increase in incidence of ulcerative colitis and Crohn’s disease (1988–2011): a population-based study of French adolescents. Am J Gastroenterol. 2018;113:265–72.CrossRef
36.
Zurück zum Zitat Bennette C, Vickers A. Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. Bmc Med Res Methodol. 2012;12:21.CrossRef Bennette C, Vickers A. Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. Bmc Med Res Methodol. 2012;12:21.CrossRef
Metadaten
Titel
Diagnostic delay in patients with inflammatory bowel disease in Austria
verfasst von
Gottfried Novacek, M.D
Hans Peter Gröchenig, M.D.
Thomas Haas, M.D.
Heimo Wenzl, M.D.
Pius Steiner, M.D.
Robert Koch, M.D.
Thomas Feichtenschlager, M.D.
Gerald Eckhardt, M.D.
Andreas Mayer, M.D.
Andreas Kirchgatterer, M.D.
Othmar Ludwiczek, M.D.
Reingard Platzer, M.D.
Pavol Papay, M.D.
Johanna Gartner, M.D.
Harry Fuchssteiner, M.D.
Wolfgang Miehsler, M.D.
Paul-Gerhard Peters, M.D.
Gerhard Reicht, M.D.
Harald Vogelsang, M.D.
Clemens Dejaco, M.D.
Thomas Waldhör, PhD
Austrian IBD Study Group (ATISG)
Publikationsdatum
04.02.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 5-6/2019
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-019-1451-3

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