Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
Am J Gastroenterol. 2013 Nov;108(11):1744-53; quiz 1754. doi: 10.1038/ajg.2013.248. Epub 2013 Aug 27.
The impact of diagnostic delay (a period from appearance of first symptoms to diagnosis) on the clinical course of Crohn's disease (CD) is unknown. We examined whether length of diagnostic delay affects disease outcomes.
Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). The frequencies of occurrence of bowel stenoses, internal fistulas, perianal fistulas, and CD-related surgery (intestinal and perianal) were analyzed.
A total of 905 CD patients (53.4% female, median age at diagnosis 26 (20-36) years) were stratified into four groups according to the quartiles of diagnostic delay (0-3, 4-9, 10-24, and ≥25 months, respectively). Median diagnostic delay was 9 (3-24) months. The frequency of immunomodulator and/or antitumor necrosis factor drug use did not differ among the four groups. The length of diagnostic delay was positively correlated with the occurrence of bowel stenosis (odds ratio (OR) 1.76, P=0.011 for delay of ≥25 months) and intestinal surgery (OR 1.76, P=0.014 for delay of 10-24 months and OR 2.03, P=0.003 for delay of ≥25 months). Disease duration was positively associated and non-ileal disease location was negatively associated with bowel stenosis (OR 1.07, P<0.001, and OR 0.41, P=0.005, respectively) and intestinal surgery (OR 1.14, P<0.001, and OR 0.23, P<0.001, respectively).
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.
诊断延迟（从出现首发症状到诊断的时间）对克罗恩病（CD）的临床病程的影响尚不清楚。我们研究了诊断延迟的长短是否会影响疾病结局。
分析了瑞士 IBD 队列研究的数据。患者来自大学中心（68%）、区域医院（14%）和私人诊所（18%）。分析了肠狭窄、内瘘、肛周瘘和与 CD 相关的手术（肠和肛周）的发生频率。
共纳入 905 例 CD 患者（53.4%为女性，诊断时的中位年龄为 26（20-36）岁），根据诊断延迟的四分位数（分别为 0-3、4-9、10-24 和≥25 个月）将患者分为四组。中位诊断延迟时间为 9（3-24）个月。四组之间免疫调节剂和/或抗肿瘤坏死因子药物的使用频率无差异。诊断延迟的时间与肠狭窄（OR 1.76，P=0.011，延迟≥25 个月）和肠内手术（OR 1.76，P=0.014，延迟 10-24 个月和 OR 2.03，P=0.003，延迟≥25 个月）的发生呈正相关。疾病持续时间与非回肠疾病部位与肠狭窄（OR 1.07，P<0.001，和 OR 0.41，P=0.005）和肠内手术（OR 1.14，P<0.001，和 OR 0.23，P<0.001）呈负相关。
诊断延迟的时间与肠狭窄和与 CD 相关的肠内手术风险增加相关。应努力缩短诊断延迟时间。
