title: Celiac disease diagnosis still significantly delayed - Doctor's but not patients' delay responsive for the increased total delay in women.
abstract: BACKGROUND
  There is insufficient data on diagnostic delay and associated factors in celiac disease (CeD) as well as on its potential impact on the course of disease.
  
  
  METHODS
  Specifically taking its two components - patients' and doctors' delay - into account, we performed a large systematic patient survey study among unselected CeD patients in Switzerland.
  
  
  RESULTS
  We found a mean/median total diagnostic delay of 87/24 months (IQR 5-96), with a range from 0 up to 780 months and roughly equal fractions of patients' and doctors' delay. Both mean/median total (93.1/24 vs. 60.2/12, p<0.001) and doctors' (41.8/3 vs. 23.9/2, p<0.001) diagnostic delay were significantly higher in female vs. male patients, whereas patients' delay was similar, regardless of preceding irritable bowel syndrome diagnosis. Patients with a diagnostic delay shorter than 2 years were significantly less often in need of steroids and/or immunosuppressants, substitution for any nutritional deficiency but more often free of symptoms 6 and 12 months after diagnosis.
  
  
  CONCLUSIONS
  There is a substantial diagnostic delay in CeD, which is associated with a worse clinical outcome and significantly longer in female patients. This increased diagnostic delay in women is due to doctors' but not patients' delay and cannot be explained by antecedent IBS prior to establishing the CeD diagnosis.
authors.affiliation: Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.affiliation: Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Nina
authors.initials: N
authors.lastname: Vadasz
authors.affiliation: Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stotz
authors.affiliation: Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Romina
authors.initials: R
authors.lastname: Lehmann
authors.affiliation: IG Zöliakie, Basel, Switzerland.
authors.forename: Diana
authors.initials: D
authors.lastname: Studerus
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Greuter
authors.affiliation: Division of Gastroenterology and Hepatology, Gastroenterology Bethanien, Zurich, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Zeitz
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Scharl
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pohl
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.affiliation: Division of Gastroenterology and Hepatology, Spital Tiefenau, Bern, Switzerland.
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
authors.affiliation: Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. Electronic address: luc.biedermann@usz.ch.
authors.forename: Luc
authors.initials: L
authors.lastname: Biedermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D057210:Delayed Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D043183:Irritable Bowel Syndrome / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013557:Switzerland; D055815:Young Adult
keywords: Celiac disease; Diagnostic delay; Doctors’ delay; Gender; Irritable bowel syndrome; Patients’ delay