Department of Internal Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, South Korea.
World J Gastroenterol. 2019 Feb 28;25(8):989-1001. doi: 10.3748/wjg.v25.i8.989.
Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.
To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.
Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest follow-up] at each diagnostic interval.
The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916).
A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.
溃疡性结肠炎（UC）是一种罕见的炎症性肠病（IBD）。然而，其在韩国的发病率最近有所上升。此外，UC 的诊断经常被延误，并且在韩国患者中，诊断延迟与 UC 预后之间的关系尚未得到广泛研究。
确定影响 UC 预后的有意义的诊断延迟，并评估与韩国患者诊断延迟相关的危险因素。
回顾性分析了韩国六所大学医院门诊就诊的 718 例 UC 患者的病历；排除了 167 例首诊症状日期未知的病例。我们通过比较每个诊断间隔的预后因素[抗肿瘤坏死因子（TNF）-α 使用、因急性发作入院史、因发作频繁入院、与 UC 相关的手术以及最新随访时的临床缓解状态]，来评估 3、6、12、18 和 24 个月的诊断延迟对 UC 预后的关系。
平均诊断间隔为 223.3±483.2 d（中位数为 69 d；75%分位数为 195 d）。在预后因素中，抗 TNF-α 的使用在诊断延迟 24 个月后显著增加。24 个月诊断延迟的临床危险因素包括诊断时年龄<60 岁[比值比（OR）=14.778，95%置信区间（CI）：1.731-126.121]、吸烟史（OR=2.688，95%CI：1.239-5.747，0.012）和误诊为痔疮（OR=11.066，95%CI：3.596-34.053）。抗 TNF-α 的使用与诊断时广泛性 UC（OR=3.768，95%CI：1.860-7.632）和 24 个月诊断延迟（OR=2.599，95%CI：1.006-4.916）相关。
24 个月的诊断延迟与抗 TNF-α 的使用增加有关。诊断时年龄<60 岁、吸烟史和误诊为痔疮是诊断延迟的危险因素。
