Vavricka Stephan R, Vadasz Nina, Stotz Matthias, Lehmann Romina, Studerus Diana, Greuter Thomas, Frei Pascal, Zeitz Jonas, Scharl Michael, Misselwitz Benjamin, Pohl Daniel, Fried Michael, Tutuian Radu, Fasano Alessio, Schoepfer Alain M, Rogler Gerhard, Biedermann Luc
Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland.
IG Zöliakie, Basel, Switzerland.
Dig Liver Dis. 2016 Oct;48(10):1148-54. doi: 10.1016/j.dld.2016.06.016. Epub 2016 Jun 23.
There is insufficient data on diagnostic delay and associated factors in celiac disease (CeD) as well as on its potential impact on the course of disease.
Specifically taking its two components - patients' and doctors' delay - into account, we performed a large systematic patient survey study among unselected CeD patients in Switzerland.
We found a mean/median total diagnostic delay of 87/24 months (IQR 5-96), with a range from 0 up to 780 months and roughly equal fractions of patients' and doctors' delay. Both mean/median total (93.1/24 vs. 60.2/12, p<0.001) and doctors' (41.8/3 vs. 23.9/2, p<0.001) diagnostic delay were significantly higher in female vs. male patients, whereas patients' delay was similar, regardless of preceding irritable bowel syndrome diagnosis. Patients with a diagnostic delay shorter than 2 years were significantly less often in need of steroids and/or immunosuppressants, substitution for any nutritional deficiency but more often free of symptoms 6 and 12 months after diagnosis.
There is a substantial diagnostic delay in CeD, which is associated with a worse clinical outcome and significantly longer in female patients. This increased diagnostic delay in women is due to doctors' but not patients' delay and cannot be explained by antecedent IBS prior to establishing the CeD diagnosis.
关于乳糜泻（CeD）的诊断延迟及相关因素，以及其对疾病进程的潜在影响，目前数据不足。
特别考虑到其两个组成部分——患者延迟和医生延迟，我们在瑞士未经过挑选的CeD患者中开展了一项大型系统性患者调查研究。
我们发现总诊断延迟的均值/中位数为87/24个月（四分位间距5 - 96），范围从0至780个月，患者延迟和医生延迟的比例大致相等。女性患者的总诊断延迟均值/中位数（93.1/24 vs. 60.2/12，p<0.001）和医生延迟（41.8/3 vs. 23.9/2，p<0.001）均显著高于男性患者，而无论之前是否诊断为肠易激综合征，患者延迟相似。诊断延迟短于2年的患者，需要使用类固醇和/或免疫抑制剂、补充任何营养缺乏的情况显著较少，但在诊断后6个月和12个月无症状的情况更常见。
CeD存在显著的诊断延迟，这与较差的临床结局相关，且在女性患者中显著更长。女性患者诊断延迟增加是由于医生延迟而非患者延迟，且无法用CeD诊断前的既往肠易激综合征来解释。
