Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn's Disease Patients: Results from the CONNECT Study

• Published in: PloS one 2015-12, Vol.10 (12), p.e0144390-e0144390
• Main Authors: Moon, Chang Mo, Jung, Sung-Ae, Kim, Seong-Eun, Song, Hyun Joo, Jung, Yunho, Ye, Byong Duk, Cheon, Jae Hee, Kim, You Sun, Kim, Young-Ho, Kim, Joo Sung, Han, Dong Soo
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; Adolescent; Adult; Aged; Aged, 80 and over; Care and treatment; Child; Clinical outcomes; Complications; Complications and side effects; Confidence intervals; Crohn Disease - diagnosis; Crohn Disease - pathology; Crohn's disease; Crohns disease; Delay; Diagnosis; Diagnostic systems; Disease control; Endoscopy; Female; Fistula; Helicobacter pylori; Hospitals; Humans; Immunologic factors; Inflammation; Inflammatory bowel disease; Influence; Internal medicine; Intestine; Irritable bowel syndrome; Male; Medical diagnosis; Medical records; Medicine; Middle Aged; Multivariate analysis; Patients; Perforation; Republic of Korea; Risk factors; Stenosis; Studies; Surgery; Systematic review; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0144390

Diagnostic delay frequently occurs in Crohn's disease (CD) patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn's Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years) (p = 0.014), concomitant upper gastrointestinal (UGI) disease (p = 0.012) and penetrating disease behavior at diagnosis (p = 0.001) were positively associated with long diagnostic delay (≥18 months). During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07-1.93; p = 0.017), internal fistulas (HR, 1.62; 95% CI, 1.12-2.33; p = 0.011), and perianal fistulas (HR, 1.38; 95% CI, 1.06-1.80; p = 0.016). However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.