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P157. Reasons for a delayed diagnosis in inflammatory bowel disease

A. Degen1, C. Büning2, B. Siegmund3, M. Prager2, J. Maul3, J. Preiß3, B. Wiedenmann1, A. Sturm4, A. Schirbel1, 1Charite Campus Virchow Klinikum, Germany, 2Charite Campus Mitte, Germany, 3Charite Campus Benjamin Franklin, Germany, 4Waldfriede Krankenhaus, Germany

Background

The diagnosis of inflammatory bowel disease (IBD) takes still several years in western industrial countries. However, there are no data why it takes so long from first symptom to determine the correct diagnosis. Therefore, we evaluated which reasons and circumstances would lead to a delayed diagnosis of Crohn's disease (CD) or Ulcerative Colitis (UC).

Methods

222 adult IBD patients (118 CD=53.2%, 104 UC=46.8%, 121 females and 101 males) visiting 3 IBD outpatient clinics of the University hospital Charité were included. Patients with Indeterminate colitis were excluded.

We created a questionnaire to assess patient characteristics, intervals from begin of symptoms to first medical contact or determination of diagnosis and disease characteristics. Data analysis was performed using the SPSS 20.0.

Results

The mean time from first symptom to diagnosis for all included IBD patients was 1.8ys (0–20ys). UC patients were significantly faster diagnosed than CD patients (UC: 1.39y vs. CD: 2.08y, p = 0.035).

Interestingly, CD and UC patients waited about 7.6 months before they contacted a physician, whereas males waited longer than females (10.8 vs. 6 months, p < 0.05).

Female UC patients were diagnosed faster than female CD patients (p < 0.05), whereas there was no significant difference between male CD or UC patients.

Among CD patients there was no difference in time to diagnosis depending on disease location (small bowel involvement: 1.9ys vs. large bowel involvement: 2ys).

Patients under the age of 50 were significantly faster diagnosed compared to patients over 50ys (1.6y vs. 3.7y, p = 0.024).

The diagnosis of CD was fastest determined by gastroenterologists (10.1 months), the diagnosis of UC was fastest established during hospitalization (6.7 months).

Of note, there was no difference for time to diagnosis whether symptoms were mild or severe (p = 0.07). Unexpectedly, there was no difference in time span to diagnosis whether patients have IBD affected family members nor whether they have heard earlier from IBD (p = 0.3 and p = 0.22, respectively). There was no difference whether patients were residents of a city or countryside (p = 0.45).

Conclusion

The delay of diagnosis of IBD is still an underestimated problem leading to a prolonged period of time were patients suffer from symptoms. Surprisingly, patients and physicians share the responsibility for the delay of diagnosis indicating the need for a better information system for physicians but also patients.