title: Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery.
abstract: BACKGROUND
  The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures.
  
  
  METHODS
  A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients.
  
  
  RESULTS
  The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01].
  
  
  CONCLUSIONS
  A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
authors.affiliation: University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania.
authors.forename: Roxana
authors.initials: R
authors.lastname: Zaharie
authors.affiliation: University of Medicine and Pharmacy 'Iuliu Hatieganu', 4th Medical Clinic, Cluj-Napoca, Romania alina.i.tantau@gmail.com.
authors.forename: Alina
authors.initials: A
authors.lastname: Tantau
authors.affiliation: University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Zaharie
authors.affiliation: University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tantau
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania.
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Elias University Hospital, Gastroenterology, Bucuresti, Romania.
authors.forename: Serban
authors.initials: S
authors.lastname: Gologan
authors.affiliation: University of Medicine and Pharmacy 'Gr. T. Popa', Gastroenterology and Hepatology Institute, Iasi, Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Cijevschi
authors.affiliation: University of Medicine and Pharmacy 'Gr. T. Popa', Gastroenterology and Hepatology Institute, Iasi, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Trifan
authors.affiliation: University of Medicine and Pharmacy, Municipal Hospital, Gastroenterology, Targu-Mures, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dobru
authors.affiliation: University of Medicine and Pharmacy 'Victor Babes', District Hospital, Gastroenterology, Timisoara, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Goldis
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Gastroenterology Department, Bucuresti, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Constantinescu
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania.
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Diculescu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D012383:Romania; D013997:Time Factors
keywords: Diagnostic delay; IBD; complications; surgery