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P242. Factors associated with diagnostic delay in Crohn's disease (CD)

S. Nahon1, P. Lahmek2, B. Lesgourgues1, C. Poupardin1, S. Chaussade3, L. Peyrin-Biroulet4, V. Abitbol3, 1Montfermeil, France, 2Limeil-Brevannes, France, 3Cochin, Paris, France, 4Vandoeuvre-les-Nancy, France

Background

CD is a chronic and disabling disease leading to irreversible bowel damage over time. Only an early treatment may change its natural history. Biologics are more effective in early than in late CD. The aim of the study was to identify factors associated with diagnostic delay in CD.

Methods

Medical and socio-economic characteristics of all consecutive CD patients followed in 2 referral centers between September 2006 and July 2012 were prospectively recorded using an electronic database. Diagnostic delay (DD) was defined as the time period (months) from the first symptom onset to establishment of CD diagnosis. Early diagnosis was defined by DD <25th percentile and late diagnosis by DD >75th percentile. Univariate and multivariate analysis were performed to compare baseline characteristics of patients with early and late diagnosis for the following data: age, gender, age at diagnosis, family history of IBD, extra-intestinal manifestations, appendectomy, complications (occlusion, abscess, peritonitis), CD location, year of diagnosis divided into 3 study periods (<2000, 2000–2010, >2010), marital status, education, language understanding, birth country, geographic origin, EPICES score (socio-economic deprivation score validated for use in France: scores >30 define deprivation).

Results

Data of 314 patients with CD (40.8% men) were analyzed. Median DD was 5 months. Early diagnosis was <2 months and late diagnosis a period >12 months. At diagnosis, mean age was 29.2±12.6 years, 33 patients (10.5%) had perianal lesions and 27 (8.6%) had disease complications (occlusion n = 21, intra-abdominal abscess n = 5, peritonitis n = 1). Univariate analysis showed that patients with early diagnosis had more often family history of IBD (OR 0.45;95% CI:0.23–0.88); patients with late diagnosis had more often extra-intestinal manifestations (OR 2.1;95% CI:1.3–3.5). None of the following factors were found to differ significantly between patients with early and late diagnosis: age at diagnosis, gender, CD location, appendectomy, complications, year of diagnosis, marital status, education, language understanding, birth country, geographic origin, socio-economic deprivation score.

Conclusion

In the French referral center-based cohort, the median diagnostic delay of CD was only 5 months. Family history of IBD was associated with early diagnosis and extra-intestinal manifestations with late diagnosis. Socio-economic deprivation did not influence DD. These results indirectly confirm easy access to health care in France.