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P231 Diagnostic delay is associated with higher rate of major surgery in a French prospective cohort of patients with Crohn's Disease

S. Nahon1, T. Paupard2, P. Lahmek3, B. Lesgourgues1, S. Chaussade4, L. Peyrin-Biroulet5, V. Abitbol*4

1Centre Hospitalier Le Raincy, Gastroenterology, Montfermeil, France, 2Centre hospitalier Dunkerque, Division of Gastroenterology and Hepatology, Dunkerque, France, 3Hôpital Emile Roux, Gastroenterology Addictology, Limeil-Brevannes, France, 4Hôpital Cochin, Gastroenterology, Paris, France, 5University and Hospital, Gastroenterology, Nancy, France

Background

The aim of the study was to determine whether a diagnostic delay is associated with poor evolution of Crohn's disease (CD) as recently observed in the Swiss IBD cohort [1].

Methods

Medical and socioeconomic characteristics of consecutive Crohn's Disease (CD) patients followed in 3 referral centers were prospectively recorded using an electronic database (Focus_MICI®). Medical treatments and surgery procedures were recorded. Diagnostic delay was defined as the time period (months) from the first symptom onset to CD diagnosis. A long diagnostic delay was defined by the upper quartile of this time period. Univariate and multivariate analyses were performed to compare patients with long diagnostic delay to those with earlier diagnosis regarding the rates of: 1) the first major intestinal surgery (excluding anal surgery), 2) immunosuppressive therapies (IMS) and 3) anti TNF therapies. Analysis of the cumulative durations (months) from diagnosis to: 1) the first surgery, 2) the first anti-TNF therapy, and 3) the first IMS, were conducted using the Kaplan-Meier; distributions of these groups were compared with the log-rank method.

Results

A total of 497 patients with CD (53.6% women) were analyzed. Median age at diagnosis was 25.6 years (IQR 25-75: 19.4-35.2). Median diagnostic delay was 5 months. Early diagnosis corresponded to a period < 2 months from first symptoms to CD diagnosis (n=122). Late diagnosis was > 13 months. Median follow up was 9 years (IQR 25-75: 4-16.2). 138 (28.3%) patients were active smokers and 109 (22.4%) former smokers. CD location and phenotype according to Montreal classification were: 196 (41.1%) L1, 121 (25.4%) L2 and 154 (32.3%) L3; 272 (58.1%) B1, 143 (30.6%) B2 and 53 (11.3%) B3. 148 (29.8%) patients had major surgery. Regarding treatment history: 161 (37.1%) patients had ongoing thiopurines, whereas 132 (30.4%) had it in the past; 28 (65%) had ongoing methotrexate, whereas 50 (11.7%) had it previously; 87 (20.2%) had ongoing infliximab, whereas 69 (16%) had it previously; 118 (27.3%) had ongoing adalimumab, whereas 48 (11.1%) had it in the past. There were no significant differences between patients with late and earlier diagnosis regarding: age at diagnosis, location and phenotype, overall rates of IMS (p=0.6) and anti-TNF (p=0.7) and duration from diagnosis to the first IMS or the first anti-TNF. In contrast, the time period from diagnosis to the first major surgery was shorter in patients with late diagnosis (p=0.05).

Conclusion

In this large prospective cohort of CD patients, those with longer diagnostic delay have earlier surgery. In contrast, overall rates of IMS and anti-TNF therapies and time of their introduction are not affected by a diagnostic delay.

References:

[1] Schoeper A.M et al., (2013), Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate, Am J Gastroenterol