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Diagnostic delay in patients with inflammatory bowel disease in Austria

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Summary

Background

Delayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD patients.

Methods

In a multicenter cross-sectional study adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of IBD.

Results

A total of 1286 patients (Crohn’s disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21; females 651) with a median age of 40 years (interquartile range 31–52 years) and a median disease duration of 10 years (4–18 years) were analyzed. The median diagnostic delay was 6 months (2–23 months) in Crohn’s disease and 3 months (1–10 months) in ulcerative colitis (p < 0.001). In the multivariable regression analysis Crohn’s disease, greater age at diagnosis and a high educational level (compared to middle degree level) were independently associated with longer diagnostic delay.

Conclusion

The diagnostic delay was longer in Crohn’s disease than in ulcerative colitis patients and was associated with greater age at diagnosis and a higher educational level.

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Abbreviations

CD:

Crohn’s disease

CI:

Confidence interval

DD:

Diagnostic delay

IBD:

Inflammatory bowel disease

IBDIS:

Inflammatory bowel disease information system

IBDU:

Inflammatory bowel disease unclassified

IQR:

Interquartile range

UC:

Ulcerative colitis

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Acknowledgements

The authors wish to thank the European Federation of Crohn’s and Ulcerative Colitis Association (EFCCA) and Prof. Di Sabatino for placing additional data from their publications at their disposal, which are given in Tables 4 and 5. The manuscript was linguistically reviewed by David Westacott.

Author information

Authors and Affiliations

  1. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Gottfried Novacek M.D, Harald Vogelsang M.D. & Clemens Dejaco M.D.

  2. Department of Internal Medicine, Brothers of St. John of God Hospital, St. Veit an der Glan, Spitalgasse 26, 9300, St. Veit an der Glan, Austria

    Hans Peter Gröchenig M.D.

  3. Darmpraxis Salzburg, Bayernstraße 17, 5020, Salzburg, Austria

    Thomas Haas M.D.

  4. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria

    Heimo Wenzl M.D.

  5. Department of Internal Medicine I, Wels-Grieskirchen Hospital, Grieskirchnerstraße 42, 4600, Wels, Austria

    Pius Steiner M.D.

  6. Department of Internal Medicine I, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria

    Robert Koch M.D.

  7. Department of Internal Medicine IV, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria

    Thomas Feichtenschlager M.D.

  8. Department of Internal Medicine, Oberpullendorf Hospital, Spitalstraße 32, 7350, Oberpullendorf, Austria

    Gerald Eckhardt M.D.

  9. Department of Internal Medicine II, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria

    Andreas Mayer M.D.

  10. Department of Internal Medicine V, Wels-Grieskirchen Hospital, Wagnleithnerstraße 27, 4710, Grieskirchen, Austria

    Andreas Kirchgatterer M.D.

  11. Department of Internal Medicine, Hall in Tirol Hospital, Milserstraße 10, 6060, Hall in Tirol, Austria

    Othmar Ludwiczek M.D.

  12. Department of Internal Medicine I, Wiener Neustadt Hospital, Corvinusring 3–5, 2700, Wiener Neustadt, Austria

    Reingard Platzer M.D.

  13. Department of Internal Medicine, Franziskus Hospital, Nikolsdorfergasse 32, 1050, Vienna, Austria

    Pavol Papay M.D.

  14. Department of Internal Medicine, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria

    Johanna Gartner M.D.

  15. Department of Internal Medicine IV, Elisabethinen Hospital, Fadingerstraße 1, 4020, Linz, Austria

    Harry Fuchssteiner M.D.

  16. Department of Internal Medicine, Brothers of St. John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria

    Wolfgang Miehsler M.D.

  17. Department of Internal Medicine, Feldkirch Hospital, Carinagasse 47, 6800, Feldkirch, Austria

    Paul-Gerhard Peters M.D.

  18. Department of Internal Medicine II, Brothers of St. John of God Hospital, Marschallgasse 12, 8020, Graz, Austria

    Gerhard Reicht M.D.

  19. Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria

    Thomas Waldhör PhD

Authors
  1. Gottfried Novacek M.D
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  2. Hans Peter Gröchenig M.D.
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  3. Thomas Haas M.D.
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  4. Heimo Wenzl M.D.
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  5. Pius Steiner M.D.
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  6. Robert Koch M.D.
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  7. Thomas Feichtenschlager M.D.
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  8. Gerald Eckhardt M.D.
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  9. Andreas Mayer M.D.
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  10. Andreas Kirchgatterer M.D.
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  11. Othmar Ludwiczek M.D.
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  12. Reingard Platzer M.D.
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  13. Pavol Papay M.D.
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  14. Johanna Gartner M.D.
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  15. Harry Fuchssteiner M.D.
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  16. Wolfgang Miehsler M.D.
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  17. Paul-Gerhard Peters M.D.
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  18. Gerhard Reicht M.D.
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  19. Harald Vogelsang M.D.
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  20. Clemens Dejaco M.D.
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  21. Thomas Waldhör PhD
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Consortia

Austrian IBD Study Group (ATISG)

Corresponding author

Correspondence to Gottfried Novacek M.D.

Ethics declarations

Conflict of interest

G. Novacek, H.P. Gröchenig, T. Haas, H. Wenzl, P. Steiner, R. Koch, T. Feichtenschlager, G. Eckhardt, A. Mayer, A. Kirchgatterer, O. Ludwiczek, R. Platzer, P. Papay, J. Gartner, H. Fuchssteiner, W. Miehsler, P.-G. Peters, G. Reicht, H. Vogelsang, C. Dejaco, and T. Waldhör declare that they have no competing interests.

Ethical standards

Ethics approval and consent to participate: The study was approved by all responsible local ethics committees (Ethics Committee of the Medical University of Vienna: EC No. 1450/2014; 1‑JUL-2014) and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The patients were informed about the study both verbally and in writing. A written informed consent was not applicable since the questionnaire was anonymous.

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Conference presentation

This work was presented in part as a poster at the ECCO Congress, February 2017, at the annual meeting of the Austrian Society of Gastroenterology and Hepatology, June 2017, and at the United European Gastroenterology Week, October/November 2017.

Authors’ contribution

GN, HPG, WM, CD, and TW made substantial contributions to the conception and design of the study. GN, HPG, TH, HW, PS, RK, TF, GE, AM, AK, OL, RP, PP, JG, HF, PGP, GR, and HV made substantial contributions to recruitment. GN, HPG, HW, WM, and TW made substantial contributions to acquisition, analysis, and interpretation of data. GN drafted the manuscript and all authors have reviewed and revised it. All authors approved the submission.

Caption Electronic Supplementary Material

508_2019_1451_MOESM1_ESM.docx

The Supplementary Material includes the comparison of diagnostic delay recorded in a database (Inflammatory Bowel Disease Information System; IBDIS) versus actually stated by the patients in 110 consective IBD patients at the Department of Gastroenterology and Hepatology of the Medical University of Vienna.

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Novacek, G., Gröchenig, H.P., Haas, T. et al. Diagnostic delay in patients with inflammatory bowel disease in Austria. Wien Klin Wochenschr 131, 104–112 (2019). https://doi.org/10.1007/s00508-019-1451-3

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