title: 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.
abstract: OBJECTIVE
  Three patterns of Crohn's disease (CD) have been described. Our aim was to investigate for differences in diagnostic delay between patterns of CD, and differences in treatment outcomes, need for surgery and quality of life (QoL).
  
  
  METHODS
  This is a cross-sectional study. First, the data of CD patients observed at our IBD Referral Centre between 2000 and 2009 were analysed. We gathered demographical characteristics and data on the onset of clinical symptoms, progression until diagnosis and treatment. The risk of delayed diagnosis was computed for each pattern. We then asked patients to fill the Inflammatory Bowel Disease Questionnaire (IBDQ). QoL scores of patients receiving a diagnosis within 18 months from the onset of symptoms were matched with those of the remaining patients.
  
  
  RESULTS
  Three-hundred and sixty-one patients were identified. The mean age of the patients at the onset of symptoms and at diagnosis was 30 ± 14 and 32 ± 14 years. The penetrating pattern showed an association only with perianal symptoms at onset (P = 0.0015). The risk of delayed diagnosis was 21, 27 and 59% for inflammatory, stricturing and penetrating patterns. We found a significant difference between penetrating and nonpenetrating patterns (P = 0.043). A delayed diagnosis was associated with poorer treatment outcomes, QoL and higher surgery rate.
  
  
  CONCLUSIONS
  Our study suggests a correlation between delayed diagnosis and the CD pattern. The delay in diagnosis between the CD subtypes can influence outcomes and QoL.
authors.affiliation: aSurgery Unit bGastroenterology Unit, Inflammatory Bowel Diseases Referral Centre, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Riegler
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult