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P586. Time-to-diagnosis in inflammatory bowel disease

Background

Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disease group. It was shown in recent studies that inflammatory bowel disease has a progressive course. Early diagnosis and treatment may alter the course of disease. Because of that, the time from onset of symptoms to established diagnosis is important. In our study, we aimed to investigate the time to diagnosis in ulcerative colitis (UC) and Crohn's disease (CD) in our population.

Methods

The clinical data was collected from patients followed up between 1999–2013 in our clinic. It was retrospectively evaluated in terms of IBD, the time to diagnosis and the physicians diagnosed the diseases. Descriptive statistical analysis was made.

Results

We have totally 450 IBD patients [333 UC, 108 CD, 9 indeterminate colitis (IC)] followed between 1998–2013 in our clinic. The patients that have an IC were not included the study. Nine CD and 31 UC patients were excluded the study because of inadequacy of clinical data. UC and CD were diagnosed in the first 6 months in 176 (58.3%) of 302 UC patients and 41 (41.4%) of 99 CD patients. The number of patients that the time to diagnosis is longer than 24 months was 26 (8.6%) in UC, 4 (4%) in CD (Table 1). Most of the patients have been diagnosed in first 12 months in both diseases. We have a data about the physicians diagnosed an IBD only in 294 patients. Most of the patients were diagnosed by gastroenterologists (92.2%) (Table 2).

Table 1. Time to diagnosis in ulcerative colitis and Crohn's disease
MonthUlcerative colitis, n (%)Crohn's disease, n (%)IBD, n (%)
0–6176 (58.3)41 (41.4)217 (54.1)
7–1272 (23.8)29 (29.3)101 (25.2)
13–1820 (6.6)15 (15.2)35 (8.7)
19–248 (2.6)10 (10.1)18 (4.5)
>2426 (8.6)4 (4.0)30 (7.5)
Table 2. The diagnosis rates of ulcerative colitis and Crohn's disease by different medical experts
GastroenterologistGeneral surgeonInternal medicine expert
MonthUC (%)CD (%)IBD (%)UC (%)CD (%)IBD (%)UC (%)CD (%)IBD (%)
0–695.284.493.23.412.55.11.43.11.7
7–1293.510095.24.33.03.22.20.01.6
13–1866.710088.233.30.011.80.00.00.0
19–2485.787.586.714.312.513.30.00.00.0
>2478.987.582.610.50.08.710.50.08.7
Total, n (%)206 (92.4)65 (91.5)271 (92.2)12 (5.4)5 (7)17 (5.8)5 (2.2)1 (1.4)6 (2)

Conclusion

Accurate diagnosis of IBD is made by experienced physicians. The patients having suspicious symptoms must be sent to most experienced physicians without delay. The time from onset of symptoms to diagnosis was median 8.3 months in CD, 4.5 months in UC in IBSEN study. Our study results were generally compatiple with the literature. Early diagnosis can decrease the risk of progression to complicated disease that is required more effective and expensive drugs.

  • Written by:

    G. Can, A. Tezel, G. Ünsal, A. Üstündag, H. Ümit, A.R. Soylu, Trakya University Faculty of Medicine, Gastroenterology Department, Edirne, Turkey