Issue 12

Clinical Question

How do diagnostic delays impact disease behaviour and outcomes for Crohn’s disease (CD)?

Editor’s Bottom Line

Delayed diagnosis of IBD is common in adults and leads to worse health outcomes, but may be less of a problem in children.

Reference

Schoepfer A, Santos J, Fournier N, et al. Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn’s Disease. J Crohn’s Colitis. Epub ahead of print April 19, 2019; https://doi.org/10.1093/ecco-jcc/jjz065

Synopsis

This Swiss team previously reported that IBD diagnosis in adults can be delayed by over two years, and found these delays place individuals at risk of more severe disease and greater need for surgery, particularly in CD patients. In the current study, they assessed the impact of diagnostic delays in paediatric CD patients.

They analyzed data from 387 patients who were 18 years of age or younger and were diagnosed with CD after 2006. The patients were included in the Swiss IBD Cohort Study, a national prospective registry. Rates of bowel stenosis, fistulae, surgeries, and any complications at diagnosis were compared with 1,163 patients with adult-onset CD, some of whom were diagnosed before 2006. Paediatric patients were followed for a median of eight years after diagnosis, while adults were followed for a median of 11 years.

Data showed median diagnostic delays of three months in the younger cohort (interquartile range [IQR]: 1–9 months] and six months (IQR: 1–24 months) in adults. There were significantly higher rates of stenosis and internal fistulas in the paediatric cohort with shorter diagnostic delays, compared to those with longer delays (P£0.003 for both). They speculated the more aggressive disease led to more rapid diagnostic evaluation.

Rates of fistulae, surgeries, or any complication did not differ according to diagnostic delay in younger patients. However, longer diagnostic delays in adult-onset patients were associated with significantly increased rates of bowel stenosis, internal fistula and any complication.

The authors noted that diagnostic delays differ by country and recent Canadian data found a median 6.8-month delay in the diagnosis of CD in paediatric patients (IQR: 2.9–12.5 months) (Arch Dis Child. 2018;103:319–26).

Details

Study Design: Prospective cohort
Funding: The Swiss National Science Foundation.
Allocation: Not applicable
Setting: National registry
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.