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P310 Diagnostic delay: assessment, improvement and outcome consequences in inflammatory bowel disease

M. Vernero*1, D. G. Ribaldone1, M. Astegiano1

1città della salute e della scienza di torino, Torino, Italy

Background

Classically diagnostic delay has always been associated to Crohn’s disease (CD), especially when only ileum is involved and to male sex and higher age. Moreover, some authors believe that diagnostic delay may worsen the outcome (higher surgery risk). The aim of the study was to assess diagnostic delay in inflammatory bowel diseases and to evaluate its consequences on the outcome.

Methods

We conducted an observational retrospective study. We included all patients that have been recruited in a previous study about adherence to the therapy. Diagnostic delay was defined as a diagnosis made later than 1 year after the beginning of the symptoms.

Results

221 patients were affected by CD and 147 by ulcerative colitis (UC); 157 were female and 211 were male. The diagnostic time ranged from 6 months to 30 years ago (mean time 15 years ago). Our results confirmed that diagnostic delay is more common in CD patients (38% in CD vs. 18% in UC; p = 0.001); no significant difference was found between male and female group. In UC group diagnostic delay was significantly higher in patients who received diagnosis before 2010 (18.5% before 2010 vs. 3.3% after 2010; p = 0.01); no significant improvement resulted in CD patients. In patients with a delayed diagnosis a higher need of immunosuppressive or biological therapy (35.4% in diagnostic delay group vs. 20.5% in non-delay group; p = 0.0045) and major risk of surgery (41.6% in diagnostic delay group vs. 24.2% non-delay; p = 0.0016) resulted. On the other hand, no difference was found regarding intestinal and extra-intestinal complications.

Conclusion

Over time there has been a significant improvement in UC diagnosis, while CD diagnosis still remains a challenge for the physicians, suggesting that higher sensibility of new available diagnostic tests is not the only reason for IBD increasing diagnosis (especially in CD). Moreover, the need for immunosuppressive and/or biological therapies and of surgery may be consequences of diagnostic delay.