Table 7.
Summary of adult and paediatric studies investigating diagnostic delay in IBD.
| Author [year] Country | Study design | N IBD type | Time to diagnosis [months, median [IQR] unless otherwise specified] | Predictors of diagnostic delay | Diagnostic delay identified as a risk factor for disease complications? | ||
|---|---|---|---|---|---|---|---|
| Crohn’s disease [CD] | Ulcerative colitis [UC] | Overall | |||||
| Adult | |||||||
| Schoepfer [2019]8 Switzerland | National cohort study, prospective 2006 onward, retrospective prior to 2005 | 1163 CD | 6 [1–24] | Yes, diagnostic delay associated with a higher rate of stenosis, perianal fistulae, internal fistulae, any fistulae, surgical resection, fistula surgery at presentation; diagnostic delay associated with stenosis internal fistulae and any complication over time after diagnosis | |||
| Novacek [2019]28 Austria | Cross-sectional, multicentre | 830 CD 435 UC 21 IBD-U | 6 [2–23] | 3 [1–10] | CD [vs UC], older age, higher level education | ||
| Kang [2019]22 South Korea | Retrospective chart review, multicentre | 551 UC | 2.3 [?-6.4] | Age <60 y, smoking, misdiagnosis of haemorrhoids | Yes—diagnostic delay >24 months associated with anti-tumour necrosis factor-alpha use | ||
| Szanto [2018]21 Hungary | Prospective registry-based, single centre | 428 CD 483 UC | 25 | 55 | CD [vs UC] | Yes—diagnostic delay >1 y associated with surgery and biologic use [in CD and UC] | |
| Banerjee [2018]5 India | Retrospective analysis of prospective registry, single centre | 720 CD | 18 [28–30] | Yes—diagnostic delay >12 and >18 months associated with stenosis and surgery | |||
| Nguyen [2017]7 USA | Retrospective chart review, single centre | 110 CD 67 UC | 9.5 [4–26] | 3.1 [1–10] | CD [vs UC] Exclusive ileal location [in CD] Haematochezia associated with faster diagnosis [in CD] | Yes—diagnostic delay >26 months associated with increased overall complications and intestinal strictures in CD | |
| Lee [2017]17 South Korea | Retrospective chart review, single centre | 165 CD 130 UC | 6.2 | 2.4 | Perianal discomfort [in CD] | Yes—diagnostic delay associated with intestinal surgery in CD and UC | |
| Cantoro [2017]15 Italy | Prospective registry-based, multicentre | 1537 CD 1855 UC | 7.1 [1–26] | 2.0 [0–7] | 3.0 [0–13] | CD [vs UC], age >40 y | Yes—diagnostic delay >24 months associated with complicated disease at CD diagnosis |
| Zaharie [2016]9 Romania | National registry-based, multicentre | 478 CD 682 UC 36 IBD-U | 5 | 1 | CD [vs UC] Ileal location, active smoking, symptom onset during summer [in CD] Age <40 y [in UC] | Yes—diagnostic delay associated with bowel stenosis and IBD-related surgery | |
| Nahon [2016]6 France | Prospective database, multicentre | 497 CD | 5 [2–13] | Yes—diagnostic delay >13 months associated with shorter time to first major surgery | |||
| Pellino [2015]19 Italy | Cross-sectional, single centre | 361 CD | 11 [1–163] | Yes—diagnostic delay >18 months associated with poorer quality of life, risk of surgery and penetrating disease at presentation | |||
| Moon [2015]18 South Korea | Retrospective registry-based, multicentre | 1047 CD | Mean 16 [±33.1] | Age >40 y, upper gastrointestinal tract disease | Yes—diagnostic delay >18 months associated with penetrating disease at presentation | ||
| Li [2015]13 China | Retrospective chart review, single centre | 343 CD | 10 [2–34] | Age >40 y, education level, no family history of CD | Yes—diagnostic delay associated with surgery | ||
| Schoepfer [2013]20 Switzerland | National cohort study, prospective 2006 onward, retrospective prior to 2005 | 905 CD | 9 [3–24] | Female, ileal location, age ≥40 y at diagnosis | Yes –diagnostic delay associated with bowel stenosis and intestinal surgery | ||
| Goel [2013]16 India | Retrospective chart review, single centre | 223 CD | 24 [range 6–240] | Yes—diagnostic delay associated with complicated disease behaviour over time | |||
| Vavricka [2012]29 Switzerland | National cohort study, prospective 2006 onward, retrospective prior to 2005 | 932 CD 625 UC 34 IBD-U | 9 [3–24] | 4 [1–12] | Age <40 y, ileal location [in CD] NSAID use, male [in UC] | ||
| Paediatric | |||||||
| Schoepfer [2019]8 Switzerland | National cohort study, prospective 2006 onward, retrospective prior to 2005 | 387 CD | 3 [1–9] | No—diagnostic delay associated with a lower risk of stricture, internal fistulae. and surgery at diagnosis; no significant association between diagnostic delay and disease complications over time following diagnosis | |||
| Krishna [2019] USA23 | Retrospective chart review, single centre | 106 UC | 7.1 [3.2–21.5] wk [colectomy] 11.9 [5.9–25.7] wk [no colectomy] | No—time to diagnosis shorter in patients who underwent colectomy | |||
| El Mouzan [2019]12 Saudi Arabia | Retrospective chart review [2003–2012], prospective [2011–2018], multicentre | 240 CD 183 UC | 8 [4–24] | 5 [2.1–8.8] | CD Ileal location [in CD] <10 years at diagnosis [in UC] | ||
| Ricciuto [2018]14 Canada | Prospective cohort study, single centre | 65 CD 46 UC/IBD-U | 6.8 [2.9–12.5] | 2.4 [1.3–5.3] | 4.5 [2.1–8.8] | CD, small bowel disease Diarrhoea, blood per rectum, weight loss associated with faster diagnosis in unadjusted analysis | Yes—lower height for age z-score |
| Schoepfer [2017]32 Switzerland | National cohort study, prospective 2006 onward, retrospective prior to 2005 | 100 CD 75 UC | 4 [2–8] | 2 [1–7] | None identified | ||
| Buderus [2015]33 Germany & Austria | Registry-based, prospective and retrospective, multicentre | 616 CD 278 UC 64 IBD-U | 6.0 [9.6] <10 y 6.0 [8.4] ≥10 y | 3.6 [9.6] <10 y 3.6 [4.8] ≥10 y | |||
| Arcos-Machancoses [2014]31 Spain | Retrospective chart review, single centre | 31 CD 19 UC 3 IBD-U | 2.8 [1.1–5.5] | CD [vs UC], young age [trend only for both] | |||
| Timmer [2011]27 Germany & Austria | Registry-based, prospective and retrospective, multicentre | 1456 CD 817 UC 163 IBD-U | 4 [2–8] | CD [vs UC], young age [<6 y] Centre effect Ileal location [in CD] | Yes—growth failure | ||
| Sawczenko [2003]25 UK | Survey, multicentre | 431 CD 211 UC 86 IBD-U | 6 [3.6–12] | 4.8 [2.4–8.4] | 5 [range <1 mo-9 y] | CD [vs UC], young age Oral, perianal, jejunal [in CD] Rectal bleeding associated with faster diagnosis | Yes—short stature |
| Kugathasan [2003]30 USA | Prospective registry [voluntary reporting] | 129 CD 60 UC 10 IBD-U | Mean 4.5 | Mean 3 | CD [vs UC] | ||
| Spray [2001]26 UK | Retrospective chart review, single centre | 64 CD 41 UC 7 IBD-U | 10.8 [range 0.9–84] | 4.6 [0.5–36] | Symptoms other than diarrhoea | Yes—growth impairment | |
| Heineken [1999]24 USA | Retrospective chart review, single centre | 58 CD 24 UC 9 IBD-U | Mean 7.1 | Mean 6.7 | Small bowel [in CD] | Yes—growth failure | |
IBDU, inflammatory bowel disease unclassified; CD, Crohn’s disease; UC, ulcerative colitis; IQR, interquartile range; y, year; mo, month; wk, week.