Diagnostic Delay in Crohn's Disease Is Associated With a Complicated Disease Course and Increased Operation Rate

Schoepfer, Alain; Dehlavi, Mohamed-Ali; Fournier, Nicolas; Safroneeva, Ekaterina; Straumann, Alex; Pittet, Valérie; Peyrin–Biroulet, Laurent; Michetti, Pierre; Rogler, Gerhard; Vavricka, Stephan R.

doi:10.1038/ajg.2013.248

Cited by 182 publications

(122 citation statements)

References 28 publications

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“…These findings probably reflect that patients are diagnosed earlier in their disease course today than in the past, and that this improves treatment outcomes in terms of surgery at five years after diagnosis. This theory is supported by the previous reported association between diagnostic delay and increased risk for surgery (12). Improved diagnostic procedures leading to the identification of a subset of patients with non-stricturing, non-penetrating disease and a milder disease course might also have played a role, since we previously observed an increasing incidence over time in the cohorts (13).…”

Section: Discussionsupporting

confidence: 71%

“…Time from onset of symptoms until diagnosis and initiation of treatment, that is diagnostic delay, has been associated with increased risk of stricturing disease and surgery (12). We have previously reported an increasing proportion of patients with non-stricturing, non-penetrating behaviour at diagnosis over time, pointing towards an earlier diagnosis or change in disease phenotype (13).…”

Section: Introduction and Aimsmentioning

confidence: 99%

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The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Zhulina¹,

Udumyan

Tysk³

et al. 2015

Scandinavian Journal of Gastroenterology

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ObjectiveChanges in medical therapy and surgery might have influenced the natural history of Crohn's disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis. Material and MethodsA population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis. ResultsThe proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, nonpenetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001). ConclusionsWe observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that

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Section: Discussionsupporting

confidence: 71%

Section: Introduction and Aimsmentioning

confidence: 99%

The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Zhulina¹,

Udumyan

Tysk³

et al. 2015

Scandinavian Journal of Gastroenterology

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“…Several studies indicate that a delayed diagnosis is associated with the development of complications and consequent bowel resection [2,[4][5][6] Bowel damage increases over time [7], with evolution from non-complicated CD to the development of extensive and irreversible bowel damage that sometimes occurs quickly. Thia et al [8] concluded from data gathered from a large populationbased study that the cumulative risk for complications was 18.6 % at 90 days, 22.0 % at 1 year.…”

mentioning

confidence: 99%

Diagnostic Delay in Crohn’s Disease: Time for Red Flags

Fiorino

Danese

2016

Dig Dis Sci

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“…Diagnostic delay of IBD correlates with increased disease complications and affects quality of life, with median delays in diagnosis of 9 months (3-24 months) [7]. Similarly, delays in MC diagnosis impact quality of life and healthcare costs to the patient and to the institution, which may lead to unnecessary diagnostic testing.…”

mentioning

confidence: 99%

The Incidence of Microscopic Colitis: Microscopic No More

Gentile

Yen

2017

Dig Dis Sci

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Diagnostic Delay in Crohn's Disease Is Associated With a Complicated Disease Course and Increased Operation Rate

Abstract: The length of diagnostic delay is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery. Efforts should be undertaken to shorten the diagnostic delay.

Cited by 182 publications

References 28 publications

The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Diagnostic Delay in Crohn’s Disease: Time for Red Flags

The Incidence of Microscopic Colitis: Microscopic No More

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