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P193 Delayed diagnosis increases the risk of abdominal surgery in Crohn’s disease

D.-W. Lee, J. S. Koo*, E. S. Kim, B. Keum, Y. J. Jeen

Korea University College of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul, South Korea

Background

Crohn’s disease (CD) is a major type of inflammatory bowel disease that affects any part of the gastrointestinal tract from mouth to anus. The manifestations were so diverse that the diagnosis is often established following considerable delay (the period between symptom emergence and diagnosis). There have been few reports about delayed diagnosis associated with poor outcomes in CD. Therefore, we investigated the factors affecting diagnostic delay and the effects of diagnostic delay in CD.

Methods

Amongst 179 patients who were first diagnosed as having CD in Korea University Ansan Hospital from January 2000 to September 2014, 35 patients who had been managed for the duration less than 1 year were excluded. In total 144 patients were enrolled in the study. The diagnostic time interval was the duration from first symptom to the diagnosis of CD. The delayed diagnosis group was defined according to the time interval in which the 76th to 100th percentiles of patients were 
diagnosed.

Results

The mean duration of diagnostic interval was 19.3 ± 33.4 months (60.7 ± 46 in delayed group, 3.83 ± 13.8 in non-delayed group). Follow-up duration was 4.59 ± 3.02 year (4.73 ± 3.04 in delayed group, 4.16 ± 2.94 in non-delayed group). Though age, gender, smoking status, family history, diagnostic tools, and initial symptom and disease location at diagnosis were not different between the 2 groups, disease behaviour was significantly different; especially, stricture type was more prevalent in the delayed group (p-value = 0.041). In a multiple logistic regression model, the delayed diagnosis was significantly associated with perianal discomfort amongst the main symptoms before diagnosis (OR 9.78, p-value = 0.011) and stricture type (OR 3.02, p-value = 0.023). The delayed diagnosis significantly associated with the intra-abdominal surgery (OR 4.84, p-value = 0.007), but it was not associated with total surgical treatments including perianal surgery (OR 2.38, p-value = 0.076) and hospital admission because of the disease aggravation (OR 1.59, p-value = 0.319). Patient-dependent delay (a time interval from first symptoms to physician visit) and physician-dependent delay (a time interval from first physician visit to CD diagnosis) were also not associated with surgery and admission.

Conclusion

The patients with perianal discomfort as a first symptom could be diagnosed as having CD late, and diagnostic delay was associated with an intestinal stricture at diagnosis. In addition, the delayed diagnosis may increase the abdominal surgery being related with CD. Therefore, the efforts for early diagnosis are needed for the prevention of complications in CD.