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Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn’s Disease Patients

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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.

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Abbreviations

CD:

Crohn’s disease

anti-TNF:

Anti-tumor necrosis factor

IMS:

Immusuppressant

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Author information

Authors and Affiliations

  1. Service d’Hépato-Gastroentérologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10, avenue du Général Leclerc, 93370, Montfermeil, France

    Stéphane Nahon & Bruno Lesgourgues

  2. Hôpital Emile Roux, Limeil-Brevannes, France

    Pierre Lahmek

  3. Division of Gastroenterology and Hepatology, Hôpital de Dunkerque, Dunkirk, France

    Thierry Paupard

  4. Division of Gastroenterology and Hepatology, Hopital Cochin, Paris, France

    Stanislas Chaussade & Vered Abitbol

  5. Inserm U954 and Department of Gastroenterology, Lorraine University, Vandoeuvre-les-Nancy, France

    Laurent Peyrin-Biroulet

Authors
  1. Stéphane Nahon
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  2. Pierre Lahmek
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  3. Thierry Paupard
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  4. Bruno Lesgourgues
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  5. Stanislas Chaussade
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  6. Laurent Peyrin-Biroulet
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  7. Vered Abitbol
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Corresponding author

Correspondence to Stéphane Nahon.

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Conflict of interest

Stéphane Nahon reports lecturer or advisory board fees from AbbVie, MSD, Vifor Pharma, and Ferring all outside the submitted work. Pierre Lahmek has nothing to disclose. Thierry Paupard reports lecturer or advisory board fees from AbbVie, MSD, Gilead, and Janssen all outside the submitted work. Stanislas Chaussade reports lecturer or advisory board fees from Mayoli, Fujifilm, Given Imaging, MauneaKea. Laurent Peyrin-Biroulet reports consulting fees from Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Therakos, Pharmacosmos, Pilège, BMS, UCB-pharma, Hospira, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, HAC-Pharma, Index Pharmaceuticals. Lecture fees from Merck, Abbvie, Takeda, Janssen, Takeda, Ferring, Norgine, Tillots, Vifor, Therakos, Mitsubishi, HAC-Pharma. Vered Abitbol reports lecturer or advisory board fees from AbbVie, MSD, Vifor Pharma, and Ferring all outside the submitted work.

Author contributions

Stéphane Nahon contributed to study concept and design; Stéphane Nahon, Thierry Paupard, and Vered Abitbol contributed to acquisition of data; Stéphane Nahon, Pierre Lahmek, and Vered Abitbol analyzed and interpreted the data; Stéphane Nahon drafted the manuscript; Bruno Lesgourgues, Thierry Paupard, Stanislas Chaussade, Laurent Peyrin-Biroulet, and Vered Abitbol contributed to critical revision of the manuscript for important intellectual content; Pierre Lahmek performed statistical analysis; Bruno Lesgourgues contributed to technical or material support; Stéphane Nahon and Vered Abitbol supervised the study.

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Nahon, S., Lahmek, P., Paupard, T. 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 61, 3278–3284 (2016). https://doi.org/10.1007/s10620-016-4189-z

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  • DOI: https://doi.org/10.1007/s10620-016-4189-z

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