Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P118. Previous misdiagnosis and diagnostic delay in inflammatory bowel diseases

A. Di Sabatino1, A. Massari1, S. Ardizzone2, P. Biancheri1, A. Cassinotti2, M. Bosani2, L. Rovedatti1, V. Imbesi1, M. Guerci1, G. Bianchi Porro2, G.R. Corazza1

1First Department of Medicine, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy; 2Gastroenterology Unit, Department of Clinical Sciences, Luigi Sacco University Hospital, Milan, Italy

Background and Aims: Diagnostic delay may represent a significant problem in inflammatory bowel diseases (IBD) which are burdened by a poor quality of life. Even when classic symptoms such as diarrhoea, abdominal pain, weight loss and hematochezia are prominent, IBD are often mistaken for other diseases. Therefore, despite the increasing development of diagnostic tools, IBD patients are still under-diagnosed or diagnosed with serious delay.

Methods: In our series of Crohn's disease (CD) and ulcerative colitis (UC) patients we evaluated the relationship between pattern of clinical presentation, previous misdiagnosis, and diagnostic delay. 297 CD patients (median age 43 yrs) and 262 UC patients (median age 49 yrs) were participated to the study. We recorded any previous misdiagnosis, formally made before the definitive diagnosis of CD or UC, and calculated the diagnostic delay, i.e. the time between onset of the symptoms indicative of CD or UC and definitive diagnosis.

Results: Of 297 CD patients, 109 (36.7%) had been misdiagnosed before the correct diagnosis of CD. The mean diagnostic delay was significantly (p < 0.05) higher in CD (18.5 months) than UC (7.4 months). In CD, the mean diagnostic delay was significantly (p < 0.05) higher in the 109 patients with previous misdiagnosis (40 months) compared with the remaining 188 (6.1 months). The most frequent wrong diagnosis in CD patients was irritable bowel syndrome (IBS), followed by UC and appendicitis. Of 262 UC patients, 54 (20.6%) proved to have been misdiagnosed before the correct diagnosis of UC. In UC, the mean diagnostic delay was significantly (p < 0.05) higher in the 54 patients with previous misdiagnosis (29.7 months) compared with the remaining 212 (7.7 months). The most frequent wrong diagnosis in UC patients was IBS, followed by CD and diverticular disease. In CD but not UC, the mean number of recurrences was significantly (p < 0.05) higher in misdiagnosed (3.8) than in correctly diagnosed patients (2.2). No significant difference was found in the mean number of surgical interventions and hospitalizations between misdiagnosed and correctly diagnosed patients, both in CD and UC. A significant positive correlation was found between the diagnosic delay and the age at diagnosis both in CD (rs = 0.26; p < 0.05) and UC (rs = 0.24; p < 0.05).

Conclusions: The diagnostic delay was greater in CD than UC, and directly correlated with age at diagnosis. IBD patients who had been misdiagnosed showed a higher diagnostic delay in comparison to correctly diagnosed ones, and a significantly higher number of recurrences was found in misdiagnosed CD patients. An earlier and correct diagnosis could ameliorate the outcome of CD and UC patients.