P135 Diagnostic delay in IBD- Evaluation of risk factors
A. Degen*1, C. Buening2, B. Siegmund3, M. Prager4, J. Maul3, J. Preiss3, B. Wiedenmann1, A. Sturm5, A. Schirbel1
1Charite Campus Virchow Klinikum, Hepatology and Gastroenterology, Berlin, Germany, 2Krankenhaus Waldfriede, Internal Medicine, Berlin, Germany, 3Charite, Hepatology and Gastroenterology Campus Benjamin Franklin, Berlin, Germany, 4Charite Campus Mitte, Gastroenterology, Hepatology & Endocrinology, Berlin, Germany, 5DRK Klinikum Westend, Gastroenterology, Berlin, Germany
The diagnosis of IBD is often delayed, however, the underlying causes are unclear and may vary. Therefore, we evaluated reasons and circumstances which lead to a delayed diagnosis of Crohn's disease (CD) or Ulcerative Colitis (UC).
386 adult IBD patients (200 CD=51.8%, 186 UC=48.2%, 210 females and 176 males) visiting 3 IBD outpatient clinics of the University hospital Charité and the City Hospital Waldfriede were included. We created a questionnaire to assess patient characteristics like gender, age, residence at diagnosis, intervals from begin of symptoms to first medical contact and determination of diagnosis. Disease characteristics such as disease location, symptom intensity or leading symptoms were assessed. Data were analyzed using the SPSS 20.0.
The mean time from first symptom to diagnosis for all IBD patients was 1.53ys (0-15ys). UC patients were significantly faster diagnosed than CD patients (UC 1.2ys vs. CD 1.9ys, p=0.002). Males were significantly faster diagnosed than females (0.8 vs. 1.2ys; p=0.048). Interestingly, CD patients waited 0.4ys and UC patients about 0.5ys from beginning of symptoms to contact a physician (no significant difference), whereas CD males waited significantly longer than CD females (0.7 vs. 0.4ys, p< 0.05). Female UC patients were significantly faster diagnosed than female CD patients (1.2ys vs. 1.9ys (p=0.02), whereas there was no difference between male CD or UC patients.
Patients under the age of 50 were significantly faster diagnosed compared to patients >50ys (1.4ys vs. 2.7ys, p=0.022).
The diagnosis of CD was fastest determined by gastroenterologists (1.2ys), the diagnosis of UC was fastest established during hospitalization (0.7ys).
Before 1990 patients waited significantly shorter (0.3ys) to contact a physician than after 1990 (0.6ys), (p=0.042). Nevertheless, time from contact a physician to diagnosis did not change over the decades (1.1ys).
Interestingly, patients with nausea and vomiting, weight loss or fever contacted significantly faster a physician than without (p< 0.02 each), whereas heartburn delayed correct diagnosis (p=0.04).
Patients, who were residents of a town (20,000-100,000 inhabitants) waited shortest with 0.25ys until they contacted a physician compared to residents of a city ( >100,000 inhabitants) (0.9ys; p=0.016) or village (<5,000 inhabitants)(0.7ys; p=0.17). There was no significant difference between time to diagnosis of patients living in a town compared to a city (1.1ys vs. 2.2ys, p=0.062).
The delay of diagnosis of IBD is still an underestimated problem in western industrial countries, especially in female CD patients, indicating the need for a better information system for physicians but also patients.