The Time Course of Diagnostic Delay in Inflammatory Bowel Disease Over the Last Sixty Years: An Italian Multicentre Study.
OBJECTIVE
Inflammatory bowel disease [IBD] patients are still under-diagnosed or diagnosed with serious delay. We examined whether diagnostic delay [DD] in IBD has changed over the last 60 years, and explored the risk factors of longer DD.


METHODS
In total, 3392 IBD patients recorded in the registry of four IBD Italian centres were divided according to the year of diagnosis into a historical cohort [HC: 1955-84] and modern cohort [MC: 1985-2014]. DD, i.e. time lapse between onset of symptoms indicative of IBD and definitive diagnosis, was divided into four sub-periods [0-6, 7-12, 13-24, >24 months], which were correlated with age and disease location/behaviour at diagnosis.


RESULTS
Median DD in IBD was 3.0 months, it was significantly [P < 0.0001] higher in Crohn's disease [CD] [7.1 months] than in ulcerative colitis [UC] [2.0 months], and did not differ either between the HC and the MC or over the last three decades. However, the proportion of patients with a DD>24 months was significantly [P < 0.0001] higher in the HC [26.0%] than in the MC [18.2%], and the same trend was evident over the last three decades [1985-94: 19.9%; 1995-2004: 16.4%; 2005-14: 13.9%; P = 0.04]. At logistic regression analysis, age at diagnosis >40 years (CD: odds ratio 1.73, 95% confidence interval [CI] 1.31-2.28, P < 0.0001; UC: 1.41, 95% CI 1.02-1.96, P = 0.04) and complicated disease at CD diagnosis [1.39, 95% CI 1.06-1.82, P = 0.02] were independently associated with a DD>24 months.


CONCLUSIONS
DD duration has not changed over the last 60 years in Italy, but the number of IBD patients with a longer DD significantly decreased. Older age at diagnosis and a complicated disease at CD diagnosis are risk factors for longer DD.
IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Laura
L
Cantoro
First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Antonio
A
Di Sabatino
IBD Unit, San Filippo Neri Hospital, Rome, Italy.
Claudio
C
Papi
IBD Unit, San Filippo Neri Hospital, Rome, Italy.
Giovanna
G
Margagnoni
Gastroenterology Unit, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Italy.
Sandro
S
Ardizzone
First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Paolo
P
Giuffrida
Biostatistics Unit, Regina Elena National Cancer Institute, Rome, Italy.
Diana
D
Giannarelli
Gastroenterology Unit, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Italy.
Alessandro
A
Massari
IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Rita
R
Monterubbianesi
First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Marco Vincenzo
MV
Lenti
First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Gino Roberto
GR
Corazza
IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Anna
A
Kohn
D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D007558:Italy / Q000453:epidemiology; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
Age at diagnosis; Crohn’s disease; disease behaviour; misdiagnosis; ulcerative colitis