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©The Author(s) 2024.
World J Gastroenterol. Aug 7, 2024; 30(29): 3465-3478
Published online Aug 7, 2024. doi: 10.3748/wjg.v30.i29.3465
Published online Aug 7, 2024. doi: 10.3748/wjg.v30.i29.3465
Table 1 Patient characteristics, n (%)
Parameter | CD (n = 223) | UC (n = 207) | P value |
Sex, M/F | 95/128 | 101/106 | 0.198 |
Age at enrolment (yr) | 40 (30-50) | 41 (32-52) | 0.509 |
Age at diagnosis (yr) | 26 (20-35) | 28 (21-39) | 0.565 |
Residence at diagnosis | 0.554 | ||
Village | 12 (5.4) | 14 (6.8) | 0.537 |
Small-town | 18 (8.1) | 18 (8.7) | 0.801 |
Medium-sized town | 24 (10.8) | 14 (6.8) | 0.149 |
Large city | 165 (74.0) | 152 (73.9) | 0.977 |
Abroad | 1 (0.4) | 5 (2.4) | 0.081 |
Patient waiting time (mo) | 2.0 (0.5-6.0) | 1.0 (0.5-4.0) | 0.051 |
Physician time to diagnosis (mo) | 5.5 (0.75-23.5) | 1.0 (0-5.0) | < 0.001 |
Total diagnostic time (mo) | 12.0 (6.0-24.0) | 4.0 (1.5-12.0) | < 0.001 |
Predominant symptom | |||
Diarrhea | 97 (43.5) | 101 (48.8) | 0.239 |
Constipation | 1 (0.4) | 1 (0.5) | 0.954 |
Abdominal pain | 74 (33.2) | 16 (7.7) | < 0.001 |
Heartburn | 1 (0.4) | 0 (0) | 0.336 |
Bloating | 0 (0) | 3 (1.4) | 0.070 |
Blood in stool | 11 (4.9) | 70 (33.8) | < 0.001 |
Nausea/vomiting | 9 (4.0) | 0 (0) | 0.004 |
Skin | 1 (0.4) | 1 (0.5) | 0.954 |
Joint pain | 4 (1.8) | 0 (0) | 0.054 |
Fistula | 5 (2.2) | 0 (0) | 0.031 |
Weight loss | 1 (0.4) | 0 (0) | 0.336 |
Fever | 1 (0.4) | 1 (0.5) | 0.954 |
Fatigue | 5 (2.2) | 5 (2.4) | 0.897 |
Other symptoms | 8 (3.6) | 3 (1.4) | 0.164 |
Location | |||
Upper GI | 19 (8.5) | 2 (1.0) | < 0.001 |
Small bowel | 73 (32.7) | 16 (7.7) | < 0.001 |
Terminal ileum | 153 (68.6) | 21 (10.1) | < 0.001 |
Colon | 101 (45.3) | 154 (74.4) | < 0.001 |
Rectum | 49 (22.0) | 111 (53.6) | < 0.001 |
Severity | |||
Very mild | 7 (3.1) | 9 (4.3) | 0.519 |
Mild | 11 (4.9) | 23 (11.1) | 0.019 |
Moderate | 38 (17.0) | 55 (26.6) | 0.018 |
Strong | 88 (39.5) | 69 (33.3) | 0.187 |
Very strong | 75 (33.6) | 49 (23.7) | 0.023 |
Physician | |||
Gastroenterologist | 85 (38.1) | 97 (46.9) | 0.066 |
Hospital | 104 (46.6) | 73 (35.3) | 0.017 |
General practitioner | 18 (8.1) | 19 (9.2) | 0.682 |
Expert in IBD | 9 (4.0) | 9 (4.3) | 0.871 |
Another consultant | 4 (1.8) | 8 (3.9) | 0.187 |
Others | 2 (0.9) | 2 (0.9) | 0.172 |
Diagnostic tests | |||
Colonoscopy | 175 (78.5) | 199 (96.1) | < 0.001 |
Gastroscopy | 5 (2.2) | 1 (0.5) | 0.111 |
Sonography | 4 (1.8) | 1 (0.5) | 0.193 |
Computed tomography | 7 (3.1) | 1 (0.5) | 0.037 |
Magnetic resonance imaging | 5 (2.2) | 1 (0.5) | 0.028 |
Diagnosis change | 23 (10.3) | 35 (16.9) | 0.070 |
Positive family history | 35 (15.7) | 35 (16.9) | 0.808 |
Parents | 13 (37.1) | 10 (28.6) | 0.445 |
Siblings | 12 (5.4) | 8 (22.9) | 0.290 |
Aunt/uncle | 2 (0.9) | 8 (22.9) | 0.040 |
Grandparents | 4 (1.8) | 9 (25.7) | 0.124 |
Knowledge of IBD | 49 (22.0) | 39 (18.8) | 0.437 |
Affected person | 27 (55.1) | 20 (51.3) | 0.721 |
Media | 10 (20.4) | 7 (17.9) | 0.772 |
Internet | 8 (16.3) | 6 (15.4) | 0.904 |
Profession | 6 (12.2) | 9 (23.1) | 0.179 |
Medication | |||
Mesalazine | 149 (66.8) | 180 (87.0) | < 0.001 |
Budesonide | 68 (30.5) | 24 (11.6) | < 0.001 |
Cortisone | 54 (24.2) | 115 (55.6) | < 0.001 |
Azathioprine | 2 (0.9) | 29 (14.0) | 0.007 |
Methotrexate | 7 (3.1) | 1 (0.5) | 0.607 |
Infliximab | 7 (3.1) | 5 (2.4) | 0.649 |
Adalimumab | 17 (7.6) | 1 (0.5) | 0.042 |
Local treatment | 13 (5.8) | 64 (30.9) | < 0.001 |
Table 2 Univariate analysis
Parameter | Patient waiting time | Physician diagnostic time | |||
HR | P value | HR | P value | ||
Sex, female vs male | CD | 1.235 | 0.089 | 0.852 | 0.222 |
UC | 0.954 | 0.714 | 0.897 | 0.407 | |
Age, ≤ 40 vs > 40 yr | CD | 1.071 | 0.654 | 1.176 | 0.329 |
UC | 1.407 | 0.031 | 1.109 | 0.508 | |
Year of diagnosis, ≤ 2000 vs > 2000 | CD | 1.081 | 0.520 | 0.975 | 0.846 |
UC | 0.947 | 0.666 | 0.976 | 0.856 | |
Predominant symptom | |||||
Diarrhea, yes vs no | CD | 0.826 | 0.116 | 1.484 | 0.003 |
UC | 1.141 | 0.305 | 1.065 | 0.640 | |
Constipation, yes vs no | CD | 2.045 | 0.440 | 1.835 | 0.517 |
UC | 1.011 | 0.991 | 0.882 | 0.893 | |
Abdominal pain, yes vs no | CD | 1.307 | 0.038 | 0.834 | 0.191 |
UC | 1.096 | 0.701 | 0.708 | 0.167 | |
Heartburn, yes vs no | CD | 0.975 | 0.979 | 0.826 | 0.844 |
Bloating, yes vs no | UC | 0.218 | 0.010 | 0.789 | 0.664 |
Blood in stool, yes vs no | CD | 0.609 | 0.069 | 1.272 | 0.419 |
UC | 1.014 | 0.916 | 0.999 | 0.993 | |
Nausea/vomiting, yes vs no | CD | 1.216 | 0.520 | 0.675 | 0.233 |
Skin, yes vs no | CD | 1.164 | 0.872 | 5.178 | 0.044 |
UC | 0.295 | 0.138 | 3.637 | 0.108 | |
Joint pain, yes vs no | CD | 0.844 | 0.703 | 0.323 | 0.039 |
Fistula, yes vs no | CD | 2.450 | 0.032 | 0.656 | 0.334 |
Weight loss, yes vs no | CD | 0.387 | 0.236 | 5.178 | 0.044 |
Fever, yes vs no | CD | 0.387 | 0.236 | 0.620 | 0.619 |
UC | 6.191 | 0.026 | 1.207 | 0.838 | |
Fatigue, yes vs no | CD | 1.482 | 0.335 | 1.452 | 0.390 |
UC | 1.652 | 0.225 | 1.937 | 0.101 | |
Symptoms | |||||
Diarrhea, yes vs no | CD | 0.590 | < 0.001 | 0.947 | 0.732 |
UC | 1.331 | 0.068 | 1.028 | 0.867 | |
Constipation, yes vs no | CD | 1.103 | 0.644 | 0.747 | 0.209 |
UC | 1.031 | 0.921 | 0.808 | 0.513 | |
Abdominal pain, yes vs no | CD | 0.988 | 0.934 | 0.963 | 0.812 |
UC | 1.018 | 0.889 | 0.952 | 0.708 | |
Heartburn, yes vs no | CD | 0.988 | 0.947 | 0.735 | 0.110 |
UC | 0.697 | 0.140 | 1.014 | 0.955 | |
Bloating, yes vs no | CD | 0.827 | 0.150 | 0.842 | 0.235 |
UC | 0.814 | 0.132 | 0.960 | 0.770 | |
Blood in stool, yes vs no | CD | 0.932 | 0.572 | 0.889 | 0.393 |
UC | 0.970 | 0.856 | 0.913 | 0.586 | |
Nausea/vomiting, yes vs no | CD | 1.264 | 0.075 | 1.082 | 0.574 |
UC | 1.210 | 0.334 | 0.966 | 0.864 | |
Skin, yes vs no | CD | 0.801 | 0.261 | 0.628 | 0.036 |
UC | 0.663 | 0.157 | 0.947 | 0.859 | |
Joint pain, yes vs no | CD | 0.882 | 0.403 | 0.733 | 0.066 |
UC | 0.780 | 0.309 | 0.836 | 0.478 | |
Fistula, yes vs no | CD | 1.280 | 0.231 | 0.937 | 0.770 |
UC | 0.694 | 0.421 | 0.766 | 0.574 | |
Weight loss, yes vs no | CD | 1.019 | 0.875 | 0.900 | 0.416 |
UC | 1.400 | 0.016 | 0.893 | 0.429 | |
Fever, yes vs no | CD | 1.196 | 0.239 | 1.142 | 0.420 |
UC | 1.381 | 0.150 | 1.654 | 0.026 | |
Fatigue, yes vs no | CD | 1.094 | 0.457 | 0.959 | 0.746 |
UC | 0.961 | 0.757 | 0.767 | 0.045 | |
EIM, yes vs no | CD | 0.902 | 0.450 | 0.784 | 0.104 |
UC | 0.745 | 0.129 | 0.913 | 0.651 | |
Location | |||||
Upper GI, yes vs no | CD | 1.198 | 0.400 | 1.256 | 0.323 |
UC | 0.813 | 0.748 | 0.668 | 0.545 | |
Small bowel, yes vs no | CD | 0.910 | 0.461 | 0.929 | 0.594 |
UC | 1.007 | 0.976 | 0.818 | 0.411 | |
Terminal ileum, yes vs no | CD | 0.964 | 0.778 | 1.183 | 0.237 |
UC | 0.849 | 0.432 | 1.087 | 0.700 | |
Colon, yes vs no | CD | 1.135 | 0.292 | 0.927 | 0.565 |
UC | 1.014 | 0.924 | 1.012 | 0.934 | |
Rectum, yes vs no | CD | 1.075 | 0.616 | 1.043 | 0.791 |
UC | 0.864 | 0.251 | 0.907 | 0.457 | |
Disease severity, strong vs mild | CD | 1.359 | 0.023 | 1.240 | 0.154 |
UC | 1.098 | 0.469 | 1.247 | 0.096 | |
Diagnosis made in hospital, yes vs no | CD | 0.915 | 0.464 | 0.992 | 0.952 |
UC | 1.314 | 0.039 | 1.013 | 0.923 | |
Diagnosis made by gastroscopy, yes vs no | CD | 1.059 | 0.891 | 2.857 | 0.011 |
UC | 1.520 | 0.644 | 0.804 | 0.815 | |
Family history, positive vs negative | CD | 1.587 | 0.005 | 1.073 | 0.697 |
UC | 0.767 | 0.120 | 0.708 | 0.053 | |
Medication, strong vs mild | CD | 1.067 | 0.647 | 0.965 | 0.816 |
UC | 0.967 | 0.794 | 0.991 | 0.944 |
Table 3 Multivariate analysis for Crohn’s disease
Table 4 Multivariate analysis of physician diagnostic time in Crohn´s disease
Table 5 Multivariate analysis for ulcerative colitis
Parameter | Patient waiting time | ||
HR | 95%CI | P value | |
Bloating1 | 0.207 | 0.050-0.848 | 0.029 |
Diarrhea | 1.463 | 1.030-2.079 | 0.034 |
Table 6 Multivariate analysis of physician diagnostic time in ulcerative colitis
Parameter | Physician diagnostic time | ||
HR | 95%CI | P value | |
Fatigue | 0.685 | 0.512-0.917 | 0.011 |
Fever | 1.813 | 1.096-2.999 | 0.020 |
Positive family history | 0.681 | 0.466-0.994 | 0.046 |
- Citation: Blüthner E, Dehe A, Büning C, Siegmund B, Prager M, Maul J, Krannich A, Preiß J, Wiedenmann B, Rieder F, Khedraki R, Tacke F, Sturm A, Schirbel A. Diagnostic delay in inflammatory bowel diseases in a German population. World J Gastroenterol 2024; 30(29): 3465-3478
- URL: https://www.wjgnet.com/1007-9327/full/v30/i29/3465.htm
- DOI: https://dx.doi.org/10.3748/wjg.v30.i29.3465