title: Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease.
abstract: BACKGROUND
  The diagnosis of inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), continues to present difficulties due to unspecific symptoms and limited test accuracies. We aimed to determine the diagnostic delay (time from first symptoms to IBD diagnosis) and to identify associated risk factors.
  
  
  METHODS
  A total of 1591 IBD patients (932 CD, 625 UC, 34 indeterminate colitis) from the Swiss IBD cohort study (SIBDCS) were evaluated. The SIBDCS collects data on a large sample of IBD patients from hospitals and private practice across Switzerland through physician and patient questionnaires. The primary outcome measure was diagnostic delay.
  
  
  RESULTS
  Diagnostic delay in CD patients was significantly longer compared to UC patients (median 9 versus 4 months, P < 0.001). Seventy-five percent of CD patients were diagnosed within 24 months compared to 12 months for UC and 6 months for IC patients. Multivariate logistic regression identified age <40 years at diagnosis (odds ratio [OR] 2.15, P = 0.010) and ileal disease (OR 1.69, P = 0.025) as independent risk factors for long diagnostic delay in CD (>24 months). In UC patients, nonsteroidal antiinflammatory drug (NSAID intake (OR 1.75, P = 0.093) and male gender (OR 0.59, P = 0.079) were associated with long diagnostic delay (>12 months).
  
  
  CONCLUSIONS
  Whereas the median delay for diagnosing CD, UC, and IC seems to be acceptable, there exists a long delay in a considerable proportion of CD patients. More public awareness work needs to be done in order to reduce patient and doctor delays in this target population.
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland. stephan.vavricka@usz.ch
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Spigaglia
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.forename: Christian
authors.initials: C
authors.lastname: Felley
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
authors.forename: Christian P
authors.initials: CP
authors.lastname: Braegger
authors.forename: Daniela
authors.initials: D
authors.lastname: Rogler
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013557:Switzerland; D013997:Time Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal