title: Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn's Disease Patients.
abstract: To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD).
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Service d'Hépato-Gastroentérologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10, avenue du Général Leclerc, 93370, Montfermeil, France. snahon@ch-montfermeil.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nahon
authors.affiliation: Hôpital Emile Roux, Limeil-Brevannes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lahmek
authors.affiliation: Division of Gastroenterology and Hepatology, Hôpital de Dunkerque, Dunkirk, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Paupard
authors.affiliation: Service d'Hépato-Gastroentérologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10, avenue du Général Leclerc, 93370, Montfermeil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lesgourgues
authors.affiliation: Division of Gastroenterology and Hepatology, Hopital Cochin, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: Inserm U954 and Department of Gastroenterology, Lorraine University, Vandoeuvre-les-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Division of Gastroenterology and Hepatology, Hopital Cochin, Paris, France.
authors.forename: Vered
authors.initials: V
authors.lastname: Abitbol
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D004766:Enterostomy / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D008727:Methotrexate
keywords: Crohn’s disease; Diagnostic delay; Surgery