Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2019; 25(8): 989-1001
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.989
Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use
Ho Suk Kang, Ja Seol Koo, Kang Moon Lee, Dae Bum Kim, Ji Min Lee, Yoon Jae Kim, Hyuk Yoon, Hyun Joo Jang
Ho Suk Kang, Department of Internal Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
Ja Seol Koo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, South Korea
Kang Moon Lee, Dae Bum Kim, Ji Min Lee, Department of Internal Medicine, The Catholic University of Korea, St. Vincent’s Hospital, Suwon 16247, South Korea
Yoon Jae Kim, Department of Gastroenterology, Gachon Graduate School of Medicine Gil Medical Center, Incheon 21565, South Korea
Hyuk Yoon, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Hyun Joo Jang, Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, South Korea
Author contributions: Koo JS designed the study; Koo JS, Kang HS, Kim DB, Lee JM, Kim YJ, Yoon H and Jang HJ performed the data collection; Kang HS analyzed the data and wrote the manuscript; Kim DB, Lee JM, Kim YJ, Yoon H and Jang HJ revised the manuscript for important intellectual content; Lee KM supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: This study was conducted with the approval of the ethics committee of Hallym University Sacred Heart Hospital in Anyang, South Korea, IRB No. 2016-I607.
Informed consent statement: The need for informed consent was waived.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ja Seol Koo, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Jeokgeum-ro 123, Danwon-gu, Ansan-si, Gyeonggi-do 15355, South Korea.
Telephone: +82-31-4124853 Fax: +82-31-4125582
Received: December 11, 2018
Peer-review started: December 11, 2018
First decision: January 23, 2019
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 16, 2019
Published online: February 28, 2019

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; 75th 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, P = 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.

Keywords: Ulcerative colitis, Diagnostic delay, Anti-tumor necrosis factor alpha, Smoking

Core tip: We aimed to identify the diagnostic delay that affects the prognosis in Korean patients with ulcerative colitis. We found that the group with a ≥ 24-mo diagnostic delay had used anti-tumor necrosis factor alpha drugs more frequently than the group with a < 24-mo delay. We also found that additional risk factors for a 24-mo delay in diagnosis were age < 60 years, smoking history, and a misdiagnosis of hemorrhoids by a physician.