Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery

Table 1 Baseline characteristics of Crohn’s disease patients n (%)

	Total(n = 165)	Delayed(n = 41)	Non-delayed(n = 124)	P value
Age, yr (± SD)	28.2 ( ± 1.1)	29.2 ( ± 12.7)	27.9 ( ± 14.2)	0.269
Age ≥ 40	27 (16.4)	5 (12.2)	22 (17.7)	0.405
Male,	126 (76.4)	33 (80.5)	93 (75.0)	0.473
Family history,	6 (3.6)	0 (0)	6 (4.8)	0.249
Symptom to diagnosis1, d	185 (45.0-642.5)	1108 (810-2331)	79.5 (32.0-253.5)	0.000
Symptom to visit1, d	57.0 (14.0-255.8)	739 (98.8-996)	33.5 (10.8-109.8)	0.000
Visit to diagnosis1, d	20.0 (4.0-139.0)	150 (5.8-1188)	14.0 (4.0-85.0)	0.002
Smoking,	41 (24.8)	12 (29.3)	29 (23.4)	0.450
Chief complain				0.241
Diarrhea	29 (17.6)	4 (9.8)	25 (20.2)
GI bleeding	20 (12.1)	4 (9.8)	16 (12.9)
Perianal discomfort	25 (15.2)	10 (24.4)	15 (12.1)
Abdominal pain	85 (51.5)	22 (53.7)	63 (50.8)
Others	6 (3.6)	1 (2.4)	5 (4.0)
Location,				0.688
L1	39 (23.6)	12 (29.3)	27 (21.8)
L2	18 (10.9)	3 (7.3)	15 (12.1)
L3	85 (51.5)	20 (48.8)	65 (52.4)
L4	23 (13.9)	6 (14.6)	17 (13.7)
Behavior,				0.021
B1	116 (70.3)	23 (56.1)	93 (75.0)
B2	32 (19.4)	14 (34.1)	18 (14.5)
B3	17 (10.3)	4 (9.8)	13 (10.5)
Perianal disease	31 (18.8)	5 (12.2)	26 (21.0)	0.213
CRP at diagnosis, (± SD)	4.17 (± 7.76)	3.73 (± 4.35)	4.33 (± 8.68)	0.677

¹The duration was expressed as median (interquartile range); CRP: C-reactive protein.

Table 2 Baseline characteristics of ulcerative colitis patients n (%)

	Total(n = 130)	Delayed(n = 32)	Non-delayed(n = 98)	P value
Age at diagnosis (± SD)	38.9 ± 15.5	36.9 ± 13.2	39.6 ± 16.1	0.395
Male,	71 (54.6)	17 (53.1)	54 (55.1)	0.845
Family history	7 (5.4)	2 (6.3)	5 (5.1)	0.803
Symptom to diagnosis1, d	73.0 (35.0-186.5)	635 (360.5-1219)	50.5 (31.0-90.0)	0.000
Symptom to visit1, d	57.5	409.5	37.0	0.000
	(27.0-147.8)	(197.3-1183)	(15.8-70.0)
Visit to diagnosis1, d	7.00 (3.0-17.0)	10.0 (3.0-28.5)	6.00 (3.0-16.3)	0.215
Smoking	26 (20.2)	6 (18.8)	20 (20.6)	0.819
Chief complaints				0.55
Hematochezia	87 (66.9)	20 (62.5)	67 (68.4)
Diarrhea	31 (23.8)	10 (31.3)	21 (21.4)
Abdominal pain	9 (6.9)	2 (6.3)	7 (7.1)
Others	3 (2.3)	0 (0)	3 (3.1)
Location				0.594
Proctitis	52 (40.3)	12 (38.7)	40 (40.8)
Left sided	37 (28.7)	11 (35.5)	26 (26.5)
Pancolitis	40 (31.0)	8 (25.8)	32 (32.7)
Mayo score at diagnosis	5.60 ± 1.98	5.38 ± 1.95	5.67 ± 1.99	0.460
Severity2				0.748
Remission (0-2)	2 (1.5)	1 (3.1)	1 (1.0)
Mild (3-5)	53 (40.8)	14 (43.8)	39 (39.8)
Moderate (6-10)	74 (56.9)	17 (53.1)	57 (58.2)
Severe (11-12)	1 (0.8)	0 (0)	1 (1.0)
CRP at diagnosis, (± SD)	1.82 ± 3.88	1.85 ± 3.96	1.82 ± 3.88	0.970

¹The duration was expressed as median (interquartile range);

²The severity was classified according to the Mayo score.

Table 3 Factors associated with a long diagnostic delay in Crohn’s disease

Variable	n	OR (95%CI)	P value
Age	-	1.00 (0.96-1.03)	0.787
Male	126	0.72 (0.23-2.26)	0.575
Smoking	41	2.26 (0.85-5.98)	0.101
Chief complaint
Diarrhea	29	Ref.	-
GI bleeding	20	1.94 (0.37-10.1)	0.432
Perianal discomfort	25	10.23 (1.93-54.37)	0.006
Abdominal pain	85	2.20 (0.64-7.62)	0.213
Others	6	1.13 (0.09-14.38)	0.925
Location
L1	39	Ref.	-
L2	18	0.71 (0.14-3.67)	0.684
L3	85	0.77 (0.28-2.11)	0.613
L4	23	0.66 (0.18-2.43)	0.533
Behavior
B1	116	Ref.
B2	32	2.33 (0.90-6.04)	0.081
B3	17	0.49 (0.12-1.97)	0.312
Perianal disease	31	0.28 (0.07-1.17)	0.080
CRP at diagnosis	-	0.98 (0.91-1.05)	0.572

GI: Gastrointestinal; OR: Odds ratio; CRP: C-reactive protein; CI: Confidence interval.

Table 4 Factors associated with a long diagnostic delay in ulcerative colitis

Variable	n	OR (95%CI)	P value
Age	-	0.99 (0.96-1.02)	0.484
Male	71	0.78 (0.30-2.04)	0.607
Smoking	26	1.26 (0.33-4.87)	0.733
IBD family history	7	1.40 (0.24-8.07)	0.709
Chief complaint
Hematochezia	87	Ref.	-
Diarrhea	31	1.34 (0.49-3.65)	0.566
Abdominal pain	9	1.03 (0.18-5.92)	0.975
Others	3	Not assessed	-
Location
Proctitis	39	Ref.	-
Left sided	18	1.45 (0.48-4.39)	0.513
Left sided	85	0.90 (0.28-2.92)	0.860
Severity1
Mild	53	Ref.
Moderate to severe	75	0.78 (0.29-2.13)	0.634

¹The severity was classified according to the Mayo score. IBD: Inflammatory bowel disease; OR: Odds ratio; CI: Confidence interval.

Table 5 Risk factors associated with Crohn’s disease related surgery

	Intestinal surgery			Any surgery
Variables	OR	95%CI	P value	OR	95%CI	P value
Age	0.99	0.96-1.03	0.743	1.00	0.97-1.03	0.973
Male	0.41	0.14-1.22	0.108	0.94	0.36-2.45	0.902
Smoking	1.90	0.74-4.87	0.182	1.10	0.51-2.38	0.812
Location
L1	1 (Ref.)	-	-	1 (Ref.)	-	-
L2	1.19	0.32-4.50	0.793	1.74	0.57-5.31	0.332
L3	0.53	0.17-1.71	0.291	0.82	0.32-2.09	0.676
L4	1.07	0.29-3.97	0.924	0.91	0.28-2.94	0.878
Behavior
B1	1 (Ref.)	-	-	1 (Ref.)	-	-
B2	4.44	1.67-11.8	0.003	2.93	1.30-6.60	0.009
B3	3.79	1.14-12.6	0.030	3.67	1.40-9.60	0.008
Perianal disease	0.97	0.20-4.81	0.968	1.84	0.69-4.87	0.222
CRP at diagnosis	1.02	0.96-1.08	0.520	1.01	0.96-1.06	0.792
Delayed diagnosis	2.54	1.06-6.09	0.036	1.76	0.87-3.57	0.119

CD: Crohn’s disease; CRP: C-reactive protein; CI: Confidence interval; OR: Odds ratio.

Table 6 Risk factors associated with ulcerative colitis related surgery

	Intestinal surgery
Variables	OR	95%CI	P value
Age	1.00	0.93-1.07	0.986
Male	1.18	0.17-8.37	0.868
Smoking	0.82	0.05-13.8	0.890
IBD family history	5.39	0.44-66.5	0.189
Location
Proctitis	1 (Ref.)	-	-
Left sided	0.85	0.10-7.24	0.878
Pancolitis	1.05	0.12-9.46	0.969
Severity1
Mild	1 (Ref.)	-	-
Moderate to severe	2.67	0.24-30.2	0.427
Delayed diagnosis	6.81	1.12-41.4	0.037

¹The severity was classified according to the Mayo score. UC: Ulcerative colitis; IBD: Inflammatory bowel disease; CI: Confidence interval; OR: Odds ratio.