Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2024; 30(29): 3465-3478
Published online Aug 7, 2024. doi: 10.3748/wjg.v30.i29.3465
Diagnostic delay in inflammatory bowel diseases in a German population
Elisabeth Blüthner, Annalena Dehe, Carsten Büning, Britta Siegmund, Matthias Prager, Jochen Maul, Alexander Krannich, Jan Preiß, Bertram Wiedenmann, Florian Rieder, Raneem Khedraki, Frank Tacke, Andreas Sturm, Anja Schirbel
Elisabeth Blüthner, Annalena Dehe, Carsten Büning, Britta Siegmund, Matthias Prager, Jochen Maul, Alexander Krannich, Jan Preiß, Bertram Wiedenmann, Florian Rieder, Raneem Khedraki, Frank Tacke, Andreas Sturm, Anja Schirbel, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin 10117, Germany
Annalena Dehe, Department of Gastroenterology, Vivantes Klinikum im Friedrichshain, Berlin 10249, Germany
Carsten Büning, Department of Internal Medicine, Krankenhaus Waldfriede, Berlin 14163, Germany
Britta Siegmund, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin 12203, Germany
Matthias Prager, Praxis für Gastroenterologie Berlin Zehlendorf, Berlin 14195, Germany
Jochen Maul, Gastroenterologie am Bayrischen Platz, Berlin 10825, Germany
Alexander Krannich, Clinical Trial Office, Charité-Universitätsmedizin Berlin, Berlin 10117, Germany
Jan Preiß, Department of Gastroenterology, Diabetology and Hepatology, Vivantes Klinikum Neukölln, Berlin 10117, Germany
Florian Rieder, Raneem Khedraki, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Andreas Sturm, Department of Internal Medicine, DRK Kliniken Berlin Westend, Berlin 14050, Germany
Anja Schirbel, Gastroenterologie im Havelland, Straße der Einheit, Falkensee 14612, Germany
Author contributions: Blüthner E analyzed and interpreted data, drafted and submitted the manuscript; Dehe A designed and performed research; Büning C performed research; Siegmund B interpreted the data; Prager M performed research; Maul J performed research; Krannich A analyzed data; Preiß J performed research; Wiedenmann B interpreted the data; Rieder F and Khedraki R reviewed and edited the manuscript, Tacke F interpreted the data; Sturm A performed research; Schirbel A designed and performed research as well as interpreted the data; all authors have revised and approved the final manuscript.
Institutional review board statement: The study was approved by the local ethics committee (EA2/170/11) and was conducted in accordance with the ethical standards of the Declaration of Helsinki of 1964 and its latest revision of 2013.
Informed consent statement: Study participants were interviewed once after written informed consent was obtained.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this paper.
Data sharing statement: Data available on request from the authors.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anja Schirbel, MD, Doctor, Research Scientist, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany. anja.schirbel@charite.de
Received: February 10, 2024
Revised: April 28, 2024
Accepted: June 18, 2024
Published online: August 7, 2024
Processing time: 169 Days and 16.3 Hours
Abstract
BACKGROUND

Early diagnosis is key to prevent bowel damage in inflammatory bowel disease (IBD). Risk factor analyses linked with delayed diagnosis in European IBD patients are scarce and no data in German IBD patients exists.

AIM

To identify risk factors leading to prolonged diagnostic time in a German IBD cohort.

METHODS

Between 2012 and 2022, 430 IBD patients from four Berlin hospitals were enrolled in a prospective study and asked to complete a 16-item questionnaire to determine features of the path leading to IBD diagnosis. Total diagnostic time was defined as the time from symptom onset to consulting a physician (patient waiting time) and from first consultation to IBD diagnosis (physician diagnostic time). Univariate and multivariate analyses were performed to identify risk factors for each time period.

RESULTS

The total diagnostic time was significantly longer in Crohn’s disease (CD) compared to ulcerative colitis (UC) patients (12.0 vs 4.0 mo; P < 0.001), mainly due to increased physician diagnostic time (5.5 vs 1.0 mo; P < 0.001). In a multivariate analysis, the predominant symptoms diarrhea (P = 0.012) and skin lesions (P = 0.028) as well as performed gastroscopy (P = 0.042) were associated with longer physician diagnostic time in CD patients. In UC, fever was correlated (P = 0.020) with shorter physician diagnostic time, while fatigue (P = 0.011) and positive family history (P = 0.046) were correlated with longer physician diagnostic time.

CONCLUSION

We demonstrated that CD patients compared to UC are at risk of long diagnostic delay. Future efforts should focus on shortening the diagnostic delay for a better outcome in these patients.

Keywords: Diagnostic time; Diagnostic delay; Crohn’s disease; Ulcerative colitis; Germany

Core tip: Early diagnosis is key to reducing complications and improving response to medical therapy. This prospective questionnaire-based study aimed to identify risk factors impairing diagnostic time. We demonstrated that diagnostic delay was significantly longer in Crohn’s disease than in ulcerative colitis and was mainly physician dependent. The multivariate analysis showed that disease-specific symptoms and rapidly available diagnostic tools resulted in reduction of physician diagnostic time.