title: Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate.
abstract: OBJECTIVE
  The impact of diagnostic delay (a period from appearance of first symptoms to diagnosis) on the clinical course of Crohn's disease (CD) is unknown. We examined whether length of diagnostic delay affects disease outcomes.
  
  
  METHODS
  Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). The frequencies of occurrence of bowel stenoses, internal fistulas, perianal fistulas, and CD-related surgery (intestinal and perianal) were analyzed.
  
  
  RESULTS
  A total of 905 CD patients (53.4% female, median age at diagnosis 26 (20-36) years) were stratified into four groups according to the quartiles of diagnostic delay (0-3, 4-9, 10-24, and ≥25 months, respectively). Median diagnostic delay was 9 (3-24) months. The frequency of immunomodulator and/or antitumor necrosis factor drug use did not differ among the four groups. The length of diagnostic delay was positively correlated with the occurrence of bowel stenosis (odds ratio (OR) 1.76, P=0.011 for delay of ≥25 months) and intestinal surgery (OR 1.76, P=0.014 for delay of 10-24 months and OR 2.03, P=0.003 for delay of ≥25 months). Disease duration was positively associated and non-ileal disease location was negatively associated with bowel stenosis (OR 1.07, P<0.001, and OR 0.41, P=0.005, respectively) and intestinal surgery (OR 1.14, P<0.001, and OR 0.23, P<0.001, respectively).
  
  
  CONCLUSIONS
  The length of diagnostic delay is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery. Efforts should be undertaken to shorten the diagnostic delay.
authors: Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
authors: Alain M
authors: AM
authors: Schoepfer
authors: Mohamed-Ali
authors: MA
authors: Dehlavi
authors: Nicolas
authors: N
authors: Fournier
authors: Ekaterina
authors: E
authors: Safroneeva
authors: Alex
authors: A
authors: Straumann
authors: Valérie
authors: V
authors: Pittet
authors: Laurent
authors: L
authors: Peyrin-Biroulet
authors: Pierre
authors: P
authors: Michetti
authors: Gerhard
authors: G
authors: Rogler
authors: Stephan R
authors: SR
authors: Vavricka
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000150:complications; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D057210:Delayed Diagnosis; D018450:Disease Progression; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors