P251 Diagnostic delay in IBD: a comparison in the last thirty years, an Italian multicentric study
L. Cantoro*1, A. Di Sabatino2, C. Papi3, G. Margagnoni3, S. Ardizzone4, A. Massari4, P. Giuffrida2, R. Monterubbianesi5, A. Kohn5
1Azienda Ospedaliera San Camillo-Forlanini, Gastroenterology, Rome, Italy, 2Fondazione IRCCS Policlinico San Matteo, University of Pavia, First Department of Medicine, Pavia, Italy, 3A.O.San Filippo Neri, Gastroenterology and Hepatology Unit, Rome, Italy, 4Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy, 5Azienda Ospedaliera San Camillo-Forlanini , Gastroenterology, Roma, Italy
IBD patients are still under-diagnosed or diagnosed with serious delay. The aim of our study was to examine whether diagnostic delay in IBD has changed over the last thirty-three years and to investigate its correlation with Crohn's disease (CD) phenotype and Ulcerative Colitis (UC) location at diagnosis.
Cases included all IBD patients recorded in the registry of four IBD referral Centres in Italy. Diagnostic delay was calculated from the onset of the symptoms indicative of CD or UC to the definitive diagnosis. Data reported included date of birth, gender, IBD location and CD behavior at diagnosis, according to the Montreal classification.
Of 3393 IBD patients, 2499 (74%) had a diagnostic delay ≥ 1 month, 1046 (31%) ≥ 12 month. Median diagnostic delay was 3 months (7 months in CD e 2 months in UC). Mean diagnostic delay was 19 month, standard deviation (SD) 45, (significantly higher in CD than UC, 29 vs 11 months,SD 54 vs 34, p<0.0005). In CD, mean diagnostic delay was higher in patients with penetrating/stricturing behavior at diagnosis (n=870) compared to patients with inflammatory behavior at diagnosis (n=667), (32 vs 23 month,SD 49 vs 57, p<0.0005).
242 patients were diagnosed between 1952-1979 (historical cohort), while 3151 were diagnosed between 1980 and 2013 (modern cohort). Mean diagnostic delay was significantly higher in the historical cohort in comparison to the modern cohort (31 vs 18 month,SD 58 vs 44, p<0.0005).
IBD patients belonging to the modern cohort were stratified according to the time of diagnosis into three subgroups (1980-89, 1990-99, 2000-13). There was no significant difference in the mean diagnostic delay between the three periods (18, 17 and 19 months, SD 41,37 and 50 respectively).
No significant difference was found in the mean diagnostic delay according to gender or disease location at diagnosis.
Diagnostic delay in IBD was significantly decreased in recent years (1980-2013) in comparison to the past (1952-1979), however it did not change over the last thirty-three years, despite increasing the diagnostic tools.
Compared with UC, diagnostic delay is higher in CD, especially in patients with penetrating/stricturing behavior at diagnosis.