N25 Diagnostic delay and economic burden in ibd: a multicenter italian experience in patients treated with biologics

Mocci, G.(1);Onidi, F.M.(1)*;Magri', S.(2);Bodini, G.(3);Lorenzetti, R.(4);Binaghi, L.(1);Dore, M.F.(1);Martello , S.(1);Usai Satta, P.(1);Elisei, W.(5);Tursi, A.(6);

(1)Arnas- Brotzu Hospital- Gastroenterology Unit, Department of Internal Medicine, Cagliari, Italy;(2)Emergency Hospital company - Gastroenterology Unit, Department of Internal Medicine, Catania, Italy;(3)Policlinico S. Martino- Gastroenterology Unit, Department of Internal Medicine, Genova, Italy;(4)Nuovo Regina Margherita - Gastroenterology Unit, Department of Internal Medicine, Roma, Italy;(5)S.Camillo Fonanini Hospital, Division of Gastroenterology, Roma, Italy;(6)Gastroenterologoly Unit- territorial, Department of Internal Medicine, Andria, Italy;


Inflammatory bowel diseases (IBDs), Crohn's disease (CD) and ulcerative colitis (UC), are chronic and immune-mediated diseases with a relapsing-remitting trend. The overall incidence of these diseases is increasing. However, it is estimated that more than one third of patients experienced symptoms for more than one year before diagnosis. Delay in IBD diagnosis has several clinical, therapeutic and economic implications. Early diagnosis and proper treatment are the cornerstones for improving the standard of care for these patients. This study aims to evaluate the diagnostic delay (DD) in patients with IBD and to analyze the clinical burden of the delay in IBD diagnosis in patients treated with biological drugs.


An observational and retrospective study was performed in IBD patients, regularly followed in four IBD Units. Data regarding delay in IBD diagnosis were assessed through a questionnaire evaluating the disease course. Moreover, data about biologics dispensation were obtained from the medical records in the period 2020-2022


135 IBD patients were enrolled (UC 72, CD 63, M 80, F 55). Median age at diagnosis was 32 years (IQR 22-45); 7% of patients were ≤ 16 years old at diagnosis.  Median age on erollement was 47 ( IQR 4-59) Median DD was 12 months (IQR: 6-24). No significant difference was found in median DD between UC [12 months (IQR: 4.5-12.0)] and CD patients [12 months (IQR: 12-48)]. However, the proportion of patients with a DD >24 months was significantly (p=0.007) higher in CD (21/63 = 33%) than in UC patients (10/72=13%). After a median disease duration of 10 years (IQR: 4-17), overall, 67 patients (49.7%) were exposed to one biologic agent, 43 patients (31.8%) were exposed to two biologic agents, 25 (18.5%) to three or more biologic agents. 23% of patients (31/135) underwent surgery. The statistical analysis showed that DD >24 months was not statistically significant associated with history of ≥ 2 biological drugs (p=0.51). Conversely, there was association with surgical treatment (p=0.004).


The diagnostic delay in IBD represents a challenge with clinical and, therapeutic impact. It’s crucial to cooperate with general practitioner and gastroenterologists not dedicated to IBD in order to reduce the diagnostic delay and guarantee an effective, appropriate and early treatment that will improve the patients’ quality of life and meanwhile reduce the health care system costs.