Longer Time to Crohnʼs Disease Diagnosis Is Associated with Complicated Disease: 632

Introduction: European studies suggest that there is a considerable delay in diagnosing inflammatory bowel disease [IBD] (Crohn's disease [CD] and ulcerative colitis [UC]) after symptom onset - an important issue as early and effective therapy can alter disease course. This aspect has not been studied in the U.S. The aim of this study is to examine the time to IBD diagnosis and its clinical impact in a U.S. patient cohort. Methods: A retrospective cohort study of 177 adult IBD patients (110 with CD and 67 with UC) followed at Carilion Clinic, Virginia - a tertiary referral center - from 2008 to 2015 was conducted. Patient characteristics, disease phenotype, complications, disease-related hospitalizations, and time interval to diagnosis were collected. Disease complications included perianal disease, intestinal stricture, surgery, fistula, abscess, and perforation. The median time from symptom onset to diagnosis for CD and UC patients was compared using the Wilcoxon Rank Sum test. Factors associated with time to diagnosis were analyzed by the Cochran-Mantel-Haenszel or Kruskal-Wallis tests. Results: The median time from symptom onset to diagnosis was significantly longer for CD compared to UC (9.5 vs. 3.1 months, p < 0.001). While 75% of patients with UC were diagnosed within 10 months of symptom onset, the equivalent interval for CD patients was 26 months. Examining specific time intervals, the time from symptom onset to initial physician visit was similar for both groups but the time from initial physician visit to evaluation by a gastroenterologist and definitive diagnosis was significantly longer in CD compared to UC (Table 1). In CD, only ileal involvement was significantly associated with longer diagnostic time. By contrast, CD patients presenting with hematochezia were diagnosed earlier (p < 0.05) (Table 2). CD patients with longer diagnostic time had an increased number of ED visits prior to diagnosis and overall complications, including perianal disease, intestinal stricture, and surgery at the time of diagnosis (p < 0.05) (Table 3). Conclusion: CD patients experienced longer time to diagnosis compared to UC patients - the major delay occurring during the time from initial physician visit to specialist evaluation. Importantly, median time to diagnosis was >9 months for CD. CD patients with longer diagnostic time presented more often with complicated disease at the time of diagnosis. A time efficient approach to diagnose CD is urgently needed.Figure 1Figure 2Figure 3