Diagnostic delay in inflammatory bowel diseases in a German population

doi:10.3748/wjg.v30.i29.3465

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World Journal of Gastroenterology

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Observational Study

World J Gastroenterol. Aug 7, 2024; 30(29): 3465-3478
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

CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; GI: Gastrointestinal tract.

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

The bold binary parameter denotes to what the hazard ratio is referring to. Items with P-value < 0.1 in univariate analysis were entered into the multivariate model. CD: Crohn’s disease; EIM: Extraintestinal manifestation; GI: Gastrointestinal tract; UC: Ulcerative colitis.

Table 3 Multivariate analysis for Crohn’s disease

Parameter	Patient waiting time
	HR	95%CI	P value
Abdominal pain¹	1.428	1.062-1.919	0.018
Fistula¹	2.841	1.125-7.175	0.027
Positive family history	1.734	1.196-2.514	0.004

¹Predominant symptom.

CI: Confidence interval; HR: Hazard ratio.

Table 4 Multivariate analysis of physician diagnostic time in Crohn´s disease

Parameter	Physician diagnostic time
	HR	95%CI	P value
Diarrhea¹	1.438	1.085-1.906	0.012
Skin lesions¹	9.746	1.273-74.609	0.028
Gastroscopy	2.570	1.037-6.371	0.042

¹Predominant symptom.

CI: Confidence interval; HR: Hazard ratio.

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

¹Predominant symptom.

CI: Confidence interval; HR: Hazard ratio.

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

CI: Confidence interval; HR: Hazard ratio.

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